11/171. Protruding urethral leiomyoma obscuring vaginal introitus: case report. leiomyoma is quite rare in the female urethra. We report an additional case to 29 reported in the literature. A multiparous woman presented with a complaint of a gradually enlarging mass causing dyspareunia for the last seven months. The mass was originating from the upper part of the distal urethra with a relatively thin stalk covered by squamous epithelia, and immunohistopathological examination confirmed it as leiomyoma. ( info) |
12/171. The relationship of the in-situ advancing vaginal wall sling to vaginal epithelial inclusion cyst. Epithelial inclusion cyst is an under recognized complication of the in-situ advancing vaginal wall sling. A 63-year-old woman with stage I pelvic organ prolapse and mixed incontinence underwent in-situ sling placement in November 1997. In February 1998 she presented with a painful recurrent inflammatory anterior vaginal wall mass. The mass was cystic and drained spontaneously four times over the period of conservative management. The patient underwent resection of a clinical and pathological vaginal epithelial inclusion cyst in September 1998. At 6-month follow-up the patient remains continent and the cyst has not reformed. The vaginal surgeon should be aware of the potential for epithelial inclusion cyst formation after in-situ sling placement, and actively search for them at postoperative examination. ( info) |
13/171. rupture of the rectosigmoid colon with evisceration of the small bowel through the anus. Spontaneous rupture of the rectosigmoid colon and herniation of the small intestine through the rupture site and eventual evisceration through the anus is a very rare event. In the literature, only 42 cases have been reported. The majority of them occurred in patients with rectal prolapse and one case was reported in association with a third-degree uterine prolapse. We experienced an 81-year-old female patient with rectal prolapse and second-degree uterine prolapse complicated by spontaneous perforation of the rectosigmoid colon and anal evisceration of the small intestine. Segmental resection of the nonviable small intestine, primary repair of the ruptured rectosigmoid colon, and sigmoid loop colostomy were performed, and the patient recovered well. In our patient, both rectal and uterine prolapses cooperatively damaged the anterior wall of the rectosigmoid colon and resulted in perforation. So, rectal and uterine prolapses should be treated before the complication develops. In this patient, uterine prolapse should be treated because of the recurrence of this rare episode. ( info) |
14/171. Incisional hernia in a 5 mm laparoscopic port site incision. Herniation of omentum or bowel through laparoscopic incision sites is uncommon. Herniations through 5 mm ports sites are very rare, with less than a handful described in the literature. Undoubtedly however, with the increasing interest. ( info) |
| Congenital bladder exstrophy affects 1 in 125,000 to 250,000 females. Consisting of absence of the anterior abdominal wall with exposure of the ureteral orifices, failure of pubic symphysis fusion, and deficient anterior pelvic diaphragm musculature, bladder exstrophy is frequently associated with genital prolapse. pregnancy may be complicated by recurrent urinary tract infections, preterm labor, mild procidentia, and malpresentation. Due to the rarity of the condition, there is a corresponding scarcity of obstetric literature regarding management during pregnancy. We report the case of a young woman with surgically repaired bladder exstrophy who developed genital prolapse. The uterus was suspended using a sacral colpopexy utilizing a Gore-Tex graft. Subsequently, the patient became pregnant and delivered a healthy male infant at 35 weeks' gestation via cesarean section (without recurrence of the genital prolapse postpartum). Sacral colpopexy to correct genital prolapse associated with bladder exstrophy may preserve fertility in young patients. ( info) |
16/171. Vaginal subtotal hysterectomy and sacrospinous colpopexy: an option in the management of uterine prolapse. Interest in vaginal hysterectomy is rising. Controversy remains regarding the value of conservation of the cervix at hysterectomy. Subtotal vaginal hysterectomy is a simple procedure that carries a low risk of morbidity. In combination with sacrospinous fixation it can be an option in the management of patients with marked uterine prolapse who desire retention of the cervix. The technique is described, and a case is reported. ( info) |
17/171. Sprengels deformity: anaesthesia management. A 28 years old lady presented with Sprengels deformity and hemivertebrae for Fothergills surgery. Clinically there were no anomalies of the nervous, renal or the cardiovascular systems. She had a short neck and score on modified Mallapati test was grade 2. She was successfully anaesthetised using injection propofol as a total intravenous anaesthetic agent after adequate premedication with injection midazolam and injection pentazocine. Patient had an uneventful intraoperative and postoperative course. ( info) |
18/171. urinary retention resulting from incarceration of a retroverted, gravid uterus. urinary retention resulting from urethral obstruction by a retroverted, gravid uterus is an uncommon disorder that is reported only once in the emergency medicine literature. Yet these patients may present in extreme distress and precipitate considerable confusion regarding the cause of and solution to this problem. No study evaluating outcome, risk of complications, or therapy exists. We present two cases that clarify diagnostic and therapeutic controversies and provide a better understanding of what is known about the pathophysiology and treatment alternatives. ( info) |
19/171. Complete vaginal prolapse: an unusual presentation of anovestibular fistula. An adolescent girl with an anovestibular fistula presenting as a complete vaginal prolapse and large-bowel obstruction is reported. The prolapse was reduced manually after repeated bowel washouts and a divided high sigmoid colostomy. The patient is awaiting posterior sagittal anorectoplasty. Possible etiopathologic factors of the prolapse are discussed. A vaginal prolapse in a patient with an anorectal malformation has not been reported previously in the English literature. ( info) |
20/171. Simultaneous upper and lower urinary tract obstruction associated with severe genital prolapse: diagnosis and evaluation with magnetic resonance imaging. Genital prolapse causing both urethral and ureteral obstruction is an infrequent occurrence, especially in the absence of uterine prolapse. We report on a patient with massive genital prolapse causing both urethral and ureteral obstruction in whom magnetic resonance imaging demonstrated the level of obstructive uropathy and, after surgical repair of the prolapse, confirmed restoration of the normal pelvic and upper urinary tract anatomy. ( info) |