Acute abdomen in pregnancy due to nonobstetric surgical diseases: a challenge for the surgeon

Background of study: Acute abdomen may occur during pregnancy due to several non obstetric surgical diseases. Diagnosis is often difficult because clinical features may be masked and diagnostic radiology is constrained. Management may be delayed due to hesitancy of the surgeon to operate on the pregnant mother. Objectives: To identify the cases presenting with an acute abdomen due to non obstetric surgical diseases in an antenatal population; to note the frequency, incidence, clinical features, and to evaluate the managementMaterials and methods: This was a prospective observational study in a tertiary teaching hospital. The study period extended over one year( January- December 2019). All antenatal patients attending the OPD/ER during the study period were assessed for the presence of acute abdomen due to non obstetric surgical diseases. All such patients were admitted and received initial medical management followed by emergency surgery if indicated. The patients were discharged after clinical resolution and followed up till delivery to note feto-maternal outcome. The institution ethics committee approved the study. The data was analysed by Statististical Package of Social Sciences , version 24. Results:54 patients were detected out of 9768 antenatal cases with an incidence of 0.55%. Acute cholecystitis was most frequent(46.29%) followed by acute appendicitis(29.62%). 33 cases(61.11%) were treated medically while 21 cases (38 88%) required emergency surgery.The maternal mortality rate was 1.851% (out of all cases of acute abdomen) and 4.76% among surgically treated patients. Foetal loss was 5.55%( among all cases of acute abdomen) and was 14.28% following surgery. Preterm labour occurred in 9.25% cases of acute abdomen and 14.28% of cases following surgery. Conclusion: A multidisciplinary approach, effective diagnostic modalities, and safe surgery are imperative for management of acute abdomen in pregnancy due to non obstetric surgical diseases

Primary pelvic hydatid cyst in a postmenopausal female: a surgical challenge

Primary pelvic hydatid cysts are a rare entity and are often overlooked as a differential diagnosis of a pelvic-space-occupying lesion particularly in non-endemic regions. Unpreparedness and a hasty decision on the surgical approach may end in life-threatening complications and systemic dissemination of the disease. We report the case of a 55-year-old postmenopausal woman with a history of two previous unsuccessful surgeries to remove pelvic cystic lesions due to dense adhesions between the surrounding gut wall, bladder, and the cyst wall. Clinical and imaging findings failed to diagnose the nature of the cysts, and a laparotomy was contemplated. On the third surgical attempt, the clinical suspicion was considered and by meticulous dissection the cysts were removed thoroughly without undue complications. In the postoperative follow-up period there was no sign of disease recurrence or disseminatio

Primary pelvic hydatid cyst in a postmenopausal female: a surgical challenge

Primary pelvic hydatid cysts are a rare entity and are often overlooked as a differential diagnosis of a pelvic-space-occupying lesion particularly in non-endemic regions. Unpreparedness and a hasty decision on the surgical approach may end in life-threatening complications and systemic dissemination of the disease. We report the case of a 55-year-old postmenopausal woman with a history of two previous unsuccessful surgeries to remove pelvic cystic lesions due to dense adhesions between the surrounding gut wall, bladder, and the cyst wall. Clinical and imaging findings failed to diagnose the nature of the cysts, and a laparotomy was contemplated. On the third surgical attempt, the clinical suspicion was considered and by meticulous dissection the cysts were removed thoroughly without undue complications. In the postoperative follow-up period there was no sign of disease recurrence or disseminatio

Demographic and clinico-pathological profile of carcinoma stomach in a tertiary referral centre of Eastern India

Objectives: This prospective study was done to assess the incidence, clinical presentations, histopathological subtypes of gastric adenocarcinoma in a referral institute of Eastern India. Methods: The patients admitted with diagnosis of gastric carcinoma in a tertiary referral hospital in Eastern India between January2006 to December2010 were included in this study. Data were compiled and analyzed with regards to their age, sex, socioeconomic status, their clinical presentations, site of lesion & histopathological subtypes. Results: 150 patients were included in this study of which 50 patients were of ≤50 years age. The median age group was 57 years. The male: female ratio was 2.3:1. Most of the patients were from lower socioeconomic strata (55.33%). Anemia (41.33%) and weight loss (38%) were the predominant presenting features irrespective of age, whereas gastric outlet obstruction due to antral growths was the commonest presentation in patients of ≤50 years age group. The most common histopathological type was adenocarcinoma; patients of≤50 years of age group presented with well differentiated and moderately differentiated adenocarcinoma while those in >50 years age group with poorly differentiated growth. Most (82.66%) of the patients presented with advanced growth(T3/T4). Conclusion: 1) The incidence of gastric carcinoma in patients younger than 50 years was more common than Western world. 2) Patients are presenting more with lesion in distal stomach than Western world. 3) Gastric outlet obstruction and metastatic disease are commoner than abdominal lump and upper GI bleeding. The latter being the commoner presentations in Western world. 4) Regarding the histological type, adenocarcinoma are commoner than in Western world and 5) Patients with signet cell subtype are much less than Western world

Primary Fallopian Tube Carcinoma (PFTC) - A Rare Genital Malignancy with Unusual Presentation

A 33 yrs. multiparous lady attended GOPD with insidious dull abdominal pain with sudden onset of abdominal distension. On examination, along with positive shifting dullness, an intra-abdominal firm mass was palpable in left iliac fossa which corroborates USG findings. After proper preoperative investigations, patient was admitted and planned for laparotomy.On laparatomy about 1.5 litres of ascitic fluid was drained, uterus was found bulky & inspite of normal right fallopian tube, left tube had been replaced by firm growth. After adhesiolysis, total abdominal hysterectomy with bilateral shaphingo-oophorectomy was performed and specimen sent for HP study. HP examination revealed – poorly differentiated papillary adenocrcinoma of left fallopian tube with metastasis in both ovaries and other fallopian tube. Body of uterus & cervix were not invaded. Thus the patient was diagnosed to be a case of PFTC. Patient received six courses post-operative chemotherapy at 3 weeks interval consisting of – Inj. Paclitaxel & Carboplatin. Patient is reasonably well upto seven months of follow up

Partial Invasive Molar Pregnancy –2 Case Reports

Gestational trophoblastic disease encompasses several entities like complete mole , partial mole , invasive mole , gestational trophoblastic carcinoma and trophoblastic carcinoma from implantation site . These entities are different from each other by their origins , morphology , their evolution and their treatment. Among all components partial mole is very common (90%) and triploid genetically. This is one of the important causative factors of miscarriages. Very rarely (2-4%) partial mole can develop into invasive one presenting with features of incomplete abortion , missed abortion and sometimes as obstetric emergencies like intra peritoneal hemorrhage and torrential vaginal bleeding .So proper diagnosis and timely intervention can prevent mortality and reduce morbidity of the patients. Here we report two such cases of partial invasive molar pregnancies with varied picture