Spontaneous vaginoperitoneal fistula as a rare complication of carcinoma ovary: a case report

Background Spontaneous vaginoperitoneal fistula formation in a case of carcinoma ovary is a very rare occurrence and has never been reported. Case presentation A 55-year-old postmenopausal lady presented with complaints of abdominal distention and mass coming out of the vagina for the last 10 days. On examination, she had tense ascites, uterovaginal prolapse and hard, fixed mass felt anteriorly on per-rectal examination. Biochemical investigations and radiological imaging suggested advanced stage ovarian neoplasm. She was planned for neoadjuvant chemotherapy. During the second cycle of chemotherapy, she developed spontaneous vaginoperitoneal fistula which was confirmed on exploratory laparotomy where interval debulking surgery was performed in collaboration with gastro-surgeons on a semi-emergency basis. The postoperative course was uneventful. Conclusion Spontaneous vaginoperitoneal fistula is a rare complication and should be kept in mind while managing advanced ovarian neoplasm.

Leiomyoma of the anterior vaginal wall: a rare case

Background: Leiomyoma is a benign smooth muscle mesenchymal tumor, usually of uterine origin but may rarelydevelop in the vaginal walls. Case presentation: A case of 40-year-old para 5+0 woman with anterior vaginal wall leiomyoma is reported. Thepresentation mimics that of uterovaginal prolapse and hence presents a diagnostic challenge. The unusualappearance of the protrusion, failure to reduce at any time even while lying down, and complete absence of urinarysymptoms raised the suspicion of a rare case. The diagnosis was made through examination under anesthesia,cystoscopy, and biopsy. Histological examination of the biopsy specimen confirmed vaginal wall leiomyoma. Thepatient had complete excision of the mass without any complications. Discussion and Conclusion: Vaginal wall leiomyoma is a rare benign vaginal lesion that can easily bemisdiagnosed. Diagnosis involves critical clinical evaluation, especially during pelvic examinations. Any vaginalprotrusion should be approached with a high index of suspicion, especially in patients of reproductive age.

Cervical leiomyoma: a rare case with unusual presentation

Leiomyomas or fibroids are the most common benign pelvic tumors in females that grow mono-clonally from the smooth muscle cells of the uterus. Most common tumors of the uterus are fibroids but cervical fibroid is rare during pregnancy with different management difficulties but cervical leiomyomas are less than 5% of all leiomyomas. A middle-aged female patient came to the obstetric opd with complaints of amenorrea for 2 months, per vaginal spotting and abdominal pain for 5 days. Her obstetric score is gravida 2 para 1 living 1. She has no h/o of urinary retention, urgency, constipation or mass per vagina. There is no history of bleeding during coitus. This case is of great importance not only because of its atypical presentation, but because we are dealing with rare pathology that can have consequences as serious as a total uterine inversion or a complete uterovaginal prolapse. Decision of myomectomy SOS hysterectomy may be considered intra operatively based on 1. Age, 2. Parity, 3. Severity of symptoms and 4. Experience of surgeon

Renal dysfunction due to advance pelvic organ prolapse

Uterovaginal prolapse is the downward descent of the pelvic organ, resulting in protrusion of the vagina, uterus, bladder or rectum. The association between POP and hydronephrosis has been shown by various studies, but severe hydronephrosis leads to renal dysfunction are rarely seen. We report a case of 70 years old female with massive vaginal prolapse and chronic renal impairement. She presented with urinary tract infection (UTI) and raised creatinine levels of 4.5mg/dl. After correction of UTI, she surgically managed to relieve her obstructive symptoms. After surgery her creatinine levels drop to 2.0mg/dl but chronic renal failure persisted. Advance stage prolapsed may damage renal function if left untreated. Timely diagnosis and management may prevent irreversible damage to kidneys Continuous...

Multiple urinary bladder calculi: a rare cause of irreducible uterovaginal prolapse

A case of irreducible prolapse with multiple bladder calculi in a 65-years-old multiparous, postmenopausal woman is reported. Inability to walk, constipation and urinary incontinence were her primary complaints. Routine ultrasound of the abdomen and pelvis failed to reveal multiple vesical calculi as the prolapse was lying outside the pelvis. However, targeted plain X-ray of the prolapsed mass showed multiple vesical calculi. The patient was managed with single-stage vaginal hysterectomy and laparotomy. First vaginal hysterectomy was done then prolapsed cystocele was reduced and extraperitoneal vesicolithotomy done. Currently, the patient is relieved of all symptoms. Management of an irreducible procidentia and a hard mass in the anterior compartment, as in this case, can be challenging and requires a diligent effort to confirm the diagnosis and to execute the appropriate surgical protocol to achieve optimal outcome with minimal intra- and post-operative complications.

Uterovaginal prolapse following suspected sexual abuse to a child: a case report

Background Uterovaginal prolapse occurs when damaged connective tissues allow the uterus to drop into the vagina. Rare in children, uterovaginal prolapse can occur as a result of violent sexual assault. This case is being reported because there has been no previous report of acquired pelvic organ prolapse following trauma suspected to be sexual abuse in a child in our setting. Case presentation Two-year-old female presented to our hospital with a 3-day history of abnormal protrusion from the vagina and a 2-day history of bleeding per vagina. Traumatic rupture of the hymen was observed. The urethra was not edematous or hyperemic. The reduction was done successfully under sedation and maintained using a crepe bandage. There was no recurrence after 3-month follow-up. Conclusions Uterovaginal prolapse presenting among children below 5 years is rare. If bleeding per vagina is reported in a child, the clinician should be aware of the possibility of uterovaginal prolapse.