An unprecedented large mesonephric cyst posing diagnostic dilemma and surgical challenge

Mesonephric cyst is a vestigial remnant of the Wolffian duct in females. Occasionally, the mesonephric duct persists lateral to the vagina and uterus, and cystic lesions may sometimes develop into neoplastic lesions. Mesonephric cysts are very rare. Here we report an unprecedented large left broad ligament mesonephric cyst in a 27 year old lady that posed diagnostic and surgical challenges. Ultrasound findings included cystic swelling probably arising from left ovary suggestive of left ovarian cyst. Plain abdominal computed tomography scan showed large simple left paraovarian cystic mass with no solid areas. During laparotomy, we found a large left thin walled cyst with smooth external surface with vascular prominence measuring 20x13x11 cm arising within the broad ligament stretching the left Fallopian tube, close to left ovary and adherent to recto-sigmoid. Cystectomy was done with preservation of left ovary. Histopathology report was consistent with mesonephric cyst. Mesonephric duct cyst should be considered in the diagnosis of abdomino-pelvic masses in females of adolescent and early reproductive age

Incisional hernia as a late surgical complication of an infertile patient treated for abdominal tuberculosis

Abdominal tuberculosis (TB) can be of various forms including peritoneal TB, tuberculous lymphadenopathy, gastrointestinal TB and visceral TB. The potential pathway includes direct spread to the peritoneum from infected adjacent foci, including the fallopian tubes or adnexa, or psoas abscess, secondary to tuberculous spondylitis. The exact stimulus for the inflammatory reaction is not known, but some suggest that it may arise due to a subclinical primary viral peritonitis, as an immunological reaction to gynaecological infections, or due to retrograde menstruation. The diagnosis of extra pulmonary TB can be difficult as it presents with nonspecific clinical and radiological features and requires high degree of suspicion for diagnosis. The abdominal TB, which is not so commonly seen as pulmonary TB, can be a source of significant morbidity and mortality and is usually diagnosed late due to its nonspecific clinical presentation. Approximately 15%-25% of cases with abdominal TB have concomitant pulmonary TB. Hence, it is quite important in identifying these lesions with high index of suspicion especially in endemic areas. Post – operative period in such patients is not smooth. They include prolonged hospital stay, enterocutaneous fistulae requiring re-operation upon failed conservative management, mortality associated with re-exploration, late complication being incisional hernia. Here we report a case of large incisional hernia following a laparotomy performed for non-resolving sub-acute intestinal obstruction which turned out to have tubercular origin later. The present case was managed by meshplasty using component separation technique (CST)

Large Intraosseous Haemangioma of the Sacral Vertebra: The radiological imaging findings

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Comparison of Ultrasound-Guided Umbilical Venous Catheter Insertion with Blind Method: A Randomized Controlled Trial

Introduction: Ultrasonography (USG) can be used in neonates to manipulate and place the umbilical catheter in the correct position. Although chest radiograph (CXR) is the gold standard, a noninvasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician. The purpose of the study was to evaluate whether USG-guided umbilical venous catheter (UVC) insertion is superior to the conventional method for the successful insertion of UVC. Method: The neonates born between 25 and 42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit (NICU) between September 2020 and November 2022 were randomized in two weight-based strata: ≤1,200 and >1,200 g. USG-guided UVC insertion was done in the intervention group and blind UVC insertion was done in the control group. Results: Out of 112 enrolled neonates, 58 were in the USG-guided group and 54 in the blind group. There was no significant difference in the failure rate between the intervention and control groups (20% versus 29% [RR: 0.69, 95% CI: 0.36–1.33]). The sensitivity and specificity of USG in locating tip position were 97 and 46.8%, respectively. The mean procedure time in USG and blind groups was 8.9 and 8.3 min, respectively (p value 0.56). Conclusion: USG does not reduce the failure rates during the insertion of umbilical catheters. However, being a safe, noninvasive procedure, it can be considered a rescue modality to CXR in NICUs equipped with portable USG for guiding UVC insertion

Periureteral inferior vena caval venous ring presenting as urinary obstruction

The embryological development of the inferior vena cava (IVC) is complex, and thus the vena cava may undergo a large number of congenital anomalies. Periureteric venous ring is a rare developmental anomaly of IVC where the right ureter passes through a slit-like opening in a partially duplicated infrarenal IVC, resulting in dilatation of upper urinary tract. Split-bolus multidetector computed tomography technique is useful in detecting such vascular anomaly causing ureteric obstruction as it can clearly show the vascular and ureteric phase in a single acquisition

Transmesenteric Internal Abdominal Hernia : Multi-detector row computed tomography findings

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Ectopic Posterior Pituitary and Its Associations with Extrapituitary Intracranial Anomalies

Posterior pituitary ectopia is a very rare entity in the development of the pituitary gland. Several factors and multiple genes are associated with this entity causing both pituitary and extrapituitary abnormalities. Pituitary abnormalities can be various endocrine problems and extrapituitary abnormalities can be optic nerves and cerebellar hypoplasia, heterotopia, and abnormal vessels. This pictorial review represents the imaging manifestations of extrapituitary intracranial anomalies that can be associated with posterior pituitary ectopia