Review of Postoperative Perineal Hernia and Available Reconstruction Techniques

Postoperative Perineal hernia (PerH) is a recognised rare complication of radical pelvic oncologic procedures for rectal cancer, with a reported prevalence of 0.6-7%. PerH is a swelling in the perineum caused by herniation of abdominal or pelvic viscera through a defect in the pelvic floor. The cause of postoperative PerH is not known, however, wide extent of dissection, wound infection, neoadjuvant radiotherapy, length of small bowel and wider female pelvis, have been identified as risk factors for development of postoperative PerH. Cause of PerH is not known. Universal case definition of PerH does not exist, except it is a bulge in the perineum. Patients who are fit for surgery, have no recurrency, and are bothered or have severe symptoms (perineal swelling, perineal skin necrosis, urinary problems and/or intestinal obstruction) are offered surgical treatment. The aim of surgical repair is to exclude recurrency, closure of the pelvic defect with reconstruction of a new pelvic floor and repair of hernia.

Endoscopic removal of an incidentally discovered intrauterine contraceptive device eroding into the rectum

Intrauterine contraceptive device (IUCD) is a common birth control method. It is safe but can be associated with serious complications including migration into the peritoneal cavity and penetration into other intra-abdominal and pelvic viscera; most commonly the rectosigmoid colon. Different retrieval methods including endoscopy, laparoscopy or open abdominal surgery have been described. We report the case of 38-year-old woman who became pregnant shortly after insertion of the IUCD 6 years prior to presentation. She delivered vaginally and ‘expulsion’ of the device was assumed. Some 4 years later, she had another IUCD inserted and remained asymptomatic till she recently presented with iron-deficiency anaemia. As part of the investigation, diagnostic colonoscopy was performed. Surprisingly, the old IUCD was found penetrating into the midrectum. Uneventful endoscopic removal was performed and she remained well at 3-month follow-up. Migrating IUCD remains asymptomatic and may be discovered accidentally during routine investigation for some other symptoms.

Study on Variations in the Origin and Branching Pattern of Internal Iliac Artery in Cadavers

The variations in blood vessels are common and have long received the attention of anatomists and surgeons. The true pelvic cavity usually refers to that part of pelvis, which has its bony walls, the sacrum and lower part of hip bone. This small area is well covered by bones and has important structures namely the pelvic viscera, pelvic floor muscles, vessels and nerves supplying it. The aim of the study was to know the branching pattern of internal iliac artery based on the Adachis classification, along with length and thickness of artery. The internal iliac artery was traced from its origin, course, branching pattern, length and thickness of the trunk of internal iliac artery was measured by using digital vernier calliper from its point of origin to bifurcation into anterior and posterior division. The length of right & left internal iliac artery ranged from 2.4 cm to 5.4 cm with average length of 3.943cm ± 0.859cm, whereas the length of left internal iliac artery ranged from 2.7cm to 4.7cm with average length of 3.610cm ± 0.626cm. Bilateral ligation of internal iliac artery is helpful in controlling postpartum haemorrhage. Applying ligatures on an anomalous blood vessel may lead to alarming haemorrhage. The most ideal point of ligation of internal iliac artery would be distal to its posterior division, since proximal ligation has been associated with buttock claudication and necrosis. Knowledge regarding the internal iliac artery and its branches is helpful in applying ligatures safely during pelvic surgeries.

Emergency and Trauma of the Pelvic Ring

Pelvic ring fractures are a common consequence of high-energy blunt trauma with a high rate of morbidity and mortality due to associated injuries, especially to the head, pelvic viscera, and vascular structures. The Young and Burgess classification system is the most widely utilized for categorizing pelvic ring injuries and assessing stability. The initial identification of these injuries often comes from an anteroposterior radiograph; however, computed tomography examination with three-dimensional volume-rendered reconstructions represents the reference standard and has essentially eliminated the requirement for inlet and outlet views. The appropriate treatment depends on a good knowledge of the anatomy and biomechanics of the pelvis. This review article underlines the importance of the integrity of ligaments to pelvic stability and describes the patterns of pelvic ring injuries and their associated mechanisms of injury.

Two unusual cases of external rotator muscle pathology producing hip pain

Two unusual cases of inflammation of the external rotator muscles of the hip are presented. In each case, the patient presented with acute hip pain. The diagnoses of acute calcific periarthritis involving the gluteus medius muscle, and pyomyositis of the obturator internus muscle secondary to a perianal fistula, were made with the aid of diagnostic imaging and histology. The importance of reviewing the pelvic viscera is highlighted.