Small Bowel Internal Herniation through Acquired Defect of Vesicouterine Pouch- A Late Complication following Oophorectomy

Hollow viscus herniation through a defect between vesicouterine pouch following previous pelvis surgery is exceedingly rare. There was only 1 similar case reported in the English literature. In this current report, we describe a 84-year-old woman presented with lower abdominal pain. She had a history of previous gynecology surgery. Computed tomography of abdomen showed small bowel obstruction with transition zone at the pelvis. Laparotomy revealed small bowel loops trapped in the vesico-uterine space via a narrow defect about 1.5cm. The detailed clinical summary and operative management are described in the report.

Pilimiction, A Rare Presentation of Ovarian Teratoma: A Case Report

Background: Adnexal teratoma involving the urinary bladder is a very rare condition. Presentation is variable ranging from irritative LUTS (lower urinary tract symptoms) to pilimiction or trichiuria (passage of hair in the urine).Case presentation: We report a case of a 42-year-old woman who presented with pilimiction and lower abdominal pain. Contrast-enhanced computed tomography scan (CECT) and Cystoscopy were used for the diagnosis. Tumor markers were negative. Right side salpingo-oophorectomy and partial bladder wall excision were performed. Histopathology of the specimen showed features consistent with mature teratoma. The Patient-reported improvement of symptoms in the subsequent follow-up visits.Conclusion: Pilimiction is a pathognomonic sign of bladder teratomas. Therefore, it is wise to think of this pathology in patients who report the passage of hair through the urine (trichiuria or pilimiction), as in our case. Cystoscopy and cross-sectional imaging aided in the initial diagnosis. However, a definitive diagnosis was provided by histopathology.We performed right-side salpingo-oophorectomy and partial cystectomy. Transurethral resection is associated with a high recurrence rate and is not recommended for secondary bladder teratomas.

Mesenteric Cyst in a 5-Year-Old Child with Partial abdominal Obstruction: Case Report from Bahrain

Mesenteric cysts are rare, variably-sized intra-abdominal lesions developing during childhood. Their symptoms vary from being asymptomatic and incidentally found to non-specific, presenting as lower abdominal pain, nausea and vomiting, constipation and diarrhea. Clinically, these abdominal masses may be palpable in more than 50% of patients. The diagnosis of these lesions can be made accurately radiologically through abdominal ultrasound and CT. The treatment of choice is complete surgical resection. Hereby we report the clinical course of a 5 year old child with a mesenteric cyst who complained of acute abdominal pain, constipation and vomiting and were surgically treated after being diagnosed with a mesenteric cyst based on radiological examination.

Iniencephaly

Iniencephaly is an uncommon form of neural tube defects which is characterized by retroflexion of the head and absence of neck as a consequence of defective closure of the vertebral body and arch. Multiple identified risk factors for its causation include environmental, genetic and drugs. We report a case of 38-year-old woman with prior history of still birth and abortions who presented at 35 weeks of gestation with lower abdominal pain and high blood pressure. Mother had consanguineous marriage. Her hypothyroidism was untreated in the first and second trimester. She delivered an iniencephalic baby girl via emergency c-section with multiple malformations at 38 weeks gestation secondary to fetal cardiac deceleration. Baby survived for less than 18 hours. In this case, proper antenatal care and follow up visits were needed along with postnatal genetic and pathological evaluation including assessment of risk factors. Appropriate management is important to prevent complications and recurrence in subsequent pregnancies.

Spectrum and Presentation of Urinary Bladder Growth: a Single-Center Retrospective Study

Introduction: Urinary bladder cancers are heterogeneous diseases consisting of a divergent group of tumors. Diseases of the urinary bladder, both neoplastic and nonneoplastic contribute to notable mortality and morbidity. Histopathology remains the gold standard of diagnosis. Bladder transurethral resection of the tumor is a therapeutic procedure that ensures the material necessary for histopathological diagnosis because it allows assessment of the degree of differentiation, depth of tumor invasion, parameters useful in the elaboration of diagnosis and prognosis assessment Material and Methods: All the urinary bladder biopsies submitted in the pathology laboratory during 1 year time period were included in the study. Results: Among the 51 total cases in the study, the male to female ratio was 4.67:1 with the age group of 22-96 years. Among the study population, 30 (52.7%) presented with hematuria, 10 (19.2%) with burning micturition, frequent urination, and lower abdominal pain. In the study, 44 (86%) showed neoplastic lesions while 7(14%) remaining were non-neoplastic lesions. Infiltrative urothelial carcinoma with low and high grades was diagnosed in 23% (12/51) Conclusions: This study has revealed that neoplastic lesions are more common than non-neoplastic lesions. A great majority of neoplastic lesions are of urothelial origin. Majority of which are invasive urothelial neoplasm. All urothelial neoplasms are more common in males. Cystoscopic studies and biopsies help in the early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow-up.

Some Clinical and Inflammatory Aspects of Trichomonas vaginalis Infection among Women with Pelvic Inflammatory Diseases

Infection with Trichomonas vaginalis and its relation to some diseases have lately had much attention. The objective of this study was to assess the infection rate of T. vaginalis and its relation to pelvic inflammatory diseases, infertility, and vaginosis. The study also assessed some demographic, clinical, and immunological parameters in women infected with T. vaginalis. The study included 160 non-pregnant married women who attended some private clinics and public hospitals in Baghdad from October 2020 to February 2021. All participants had symptoms of vaginal discharge only or vaginal discharge with lower abdominal pain. The participants were divided into an infertility group (n = 61) and fertility group (n = 99). The participants were also divided into Pelvic Inflammatory Disease (PID) group (n=41) and non-PID group (n=119). All participants underwent vaginal examination. Vaginal swabs were taken from all participants for T. vaginalis, bacteria, yeast, clue cell, pH, and vaginal leukocyte examinations. Sera were also taken to measure both IL-1α and IL-8 using sandwich ELISA technique to compare them with apparently healthy control subjects who had no vaginal discharge. The study revealed that the total infection rate of T. vaginalis was 14.37%. The results showed no significant relations between T. vaginalis positive status and each of age, infertility, vaginosis, contraceptive use, and high BMI. While a significant relation (P=0.03) was noticed between T. vaginalis positive status and PID. Women with PID exhibited a higher infection rate with T. vaginalis (24.39%) versus non PID women (10.92%). High clue cells number was not significantly related to T. vaginalis positive status, only if both PID and vaginosis were considered in the statistical analysis. In addition, high leukocytes count was not related to T. vaginalis positive status. While abnormal vaginal pH was significantly (P=0.01) related to T. vaginalis positive status. Finally, the levels of both IL-1α and IL-8 were noticed to be declined in women who had T. vaginalis infection, although they were not declined significantly. This study gives an insight about some clinical aspects of T. vaginalis infection among PID women. T. vaginalis is highly predictable in women with PID. Consequently, attention and more investigation would be needed on this topic in Iraq.

Maternal serum CA-125 repeated measurement during pregnancy and how to use as a prognostic factor of first trimester pregnancy outcome

Background: The aim of this study was to estimate the prognostic efficacy of repeated measurement of maternal serum CA125 in first trimester threatened miscarriage.Methods: Prospective case control study was conducted in the outpatient clinic. 100 pregnant women were divided into 50 women with normal course of pregnancy, and the other 50 were subdivided into 25 pregnant women with lower abdominal pain without vaginal bleeding and 25 presented with minimal vaginal bleeding. Repeated measuring of serum CA125 was done for each case on the 5th, 10th weeks of gestation.Results: Findings of this study suggested the possibility of using serum CA-125 for determining the prognosis of first trimester threatened miscarriage with cut-off value of CA125 38.25 U/ml on the 5th week of gestation and 53 U/ml on the 10th week of gestation in patients presented with pain only but in patients presented with minimal vaginal bleeding the cut-off value of CA125 on the 5th week of gestation become 45.6 U/ml and 68 U/ml on the 10th week of gestation.Conclusions: CA125, on its own, can discriminate between continued and non-continued pregnancy.

A Rare Variation of Retroaortic Left Renal Vein Draining into Left Common Iliac Vein

A 24-year-old woman without underlying disease presented with right lower abdominal pain for a day. The patient’s clinical symptoms were suspected acute appendicitis and underwent multidetector computed tomography. There is diffuse enlarged appendix with diffuse wall thickening and enhancement as well as minimal surrounding fat stranding. Mild thickened peritoneum is also observed. There is no fluid collection or free air. The radiologist diagnosed acute appendicitis without complication. Incidentally, the patient was found a rare anatomical variation of the retroaortic left renal vein draining into left common iliac vein. Patient underwent appendectomy. We would like to present a characteristic imaging of the renal vein variations.

Mixed Germ Cell Tumour of Ovary WTH Chemotherapy Side Effect

Introduction: Mixed germ cell tumour is a very rare type of aggressive cancer, consisting of more than one type of germ cell components. The most common component reported was dysgerminoma, followed by endodermal sinus tumour, teratoma, choriocarcinoma and embryonal carcinoma respectively. This study focuses on the combination of dysgerminoma and endodermal sinus tumour (yolk sac tumour) along with the hearing loss as the side effect of chemotherapy. Clinical Findings: Pain in the lower abdomen (lump is visible and has occupied hypogastrium along with bilateral iliac region extending 2-3 cm above the umbilicus), backache, fever (100.6 °F). Later after the third chemo cycle, it was found that the patient has progressive mild hearing loss. Diagnostic Evaluation: HB= 9.7gm%, TLC= 10300/cumm, PLT= 5,49 lakhs/cumm, CA 125= 909 U/ML. Histopathology Report: Ascitic fluid along with thirteen containers containing right ovarian mass, right ovary with mass, right fallopian tube, bowel deposits as well as residual nodules and pelvic deposits were sent of which, the reports indicated mixed germ cell tumour of the ovary. Therapeutic Intervention: Packed red blood cells transfusion, Pre-chemo and post-chemo hydration, Pre-chemo and post-chemo drugs, BEP Chemotherapy (Bleomycin, Etoposide, Cisplatin). Conclusion: My patient aged 11 years old female was admitted to Gynaecology Ward No – 16, AVBRH on 27/12/2020 for the first cycle of chemotherapy with the complaints of lower abdominal pain, backache and fever. The patient was diagnosed as the case of mixed germ cell tumour, further had mild hearing loss as the side effect of chemotherapy The patient is on chemo and is advised for follow up care once a month.