A Rare Case of Isolated torsion of Haematosalphinx Presenting as Acute Abdomen During Pregnancy

Isolated fallopian tubal torsion is a rare non obstetric cause for pain abdomen during pregnancy.We report a case of a 34 year old second gravida who presented with history of amennorrhoe of 7 months, colicky pain in the left iliac fossa , with 2 episodes of vomiting. A Trans vaginal scan revealed a left ovarian cyst. An emergency laparotomy was performed for suspected torsion or haemorrhage into an ovarian cyst. Surprisingly ovaries were normal and a congested and necrotic left tubal torsion with a tubal collection (haematosalphinx) was identified and a salpingectomy was then performed. The differential diagnosis is discussed and the literature is reviewed as it is a very rare clinical entity

Successful Pregnancy Outcome In Maternal Crigler Najjar Syndrome Type II.

Estimated incidence of Crigler-Najjar syndrome(CNS) is 1 case per 1,000,000 births(1 million). The overall prevalence of CN syndrome is unknown, with only several hundred people reported to have this disease. It is interestingly very rare to encounter a pregnant adult women with congenital jaundice. Pregnancy in CN type II patients is a diagnostic and a therapeutic challenge because of the high risk of bilirubin encephalopathy with serious neurological damage as life-threatening complications for the fetus. To date 8 pregnancy outcome have been reported from 5 women and we report the6 woman with a successful 9 th pregnancy outcome. We have discussed detail history, presentation and management during pregnancy and care of the new born

Reproductive Wastage in Recurrent Partial Hydatidiform Mole: A Clinical Dilemma.

Recurrent partial Hydatidiform mole is an extremely rare clinical entity which represent a part of the gestational trophoblatic neoplasia spectrum. Since the first case was reported by Honore. LM in 1987 about eight cases of , recurrent partial moles have been reported in the English medical literature. Present two cases are the 9th and 10th case with recurrent partial moles to be described. We have discussed the aetiology, environmental factors, dietary habits , clinicopathologic features, the clinical dielemmas faced by us while counselling, follow up and pregnancy outcome in women presenting with two and three recurrent partial moles respectively. We have also reviewed the literature

A Rare Case of Reversible Encephalopathy Syndrome Accompanying Late Postpartum Eclampsia or Hypertensive Encephalopathy-A Clinical Dilemma

Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinic-radiologic diagnosis. Clinically it is characterized by non specific symptoms such as headache, confusion, visual disturbances and seizures. The radiological findings in PRES are thought to be due to vasogenic oedema, predominantly in the posterior cerebral hemispheres, and are reversible with appropriate management. We report a case of reversible encephalopathy diagnosed by MRI scan occurring in atypical areas like the caudate and lentiform nuclei of the brain following an uneventful lower segment caesarean section in a normotensive patient, who was successfully treated with antihypertensives, anticonvulsants and supportive treatment. The differential diagnosis of convulsions in the post-partum period is discussed

Borderline Ovarian Malignancies : A Single Institute Retrospective Study.

Background: Borderline ovarian tumors are histologically characterized as epithelial tumors with a stratified growth pattern but without destructive stromal invasion. Little is known about the histological subtypes and outcome, role of fertility sparing surgery and role of postoperative therapy in advanced stage in Indian scenario. While there is ample data in the world literature about this disease, prognosis in Indian patients is largely unknown due to dearth of studies in our setting. Objective: To study the demographic profile, clinical features, imaging, treatment and outcome of borderline ovarian tumors. Methods: This is a retrospective study of eighty seven patients with pathologically proven diagnosis of borderline ovarian tumor, diagnosed and treated from January 2006 to October 2011 at our institution. Most patients underwent surgical staging which incuded total abdominal hysterectomy and bilateral salphingo-oophorectomy, infracolic omentectomy, bilateral pelvic and para aortic lymphadenectomy. Young patients who had not completed their family underwent fertility sparing surgery. Patients with invasive metastatic implants received adjuvant chemotherapy. The outcome of these patients was correlated with stage, type of peritoneal implant, type of surgical procedure and with histological subtype. Results: At a median follow-up of 48 months, 100 percent survival was noted. One patient with stage III disease had recurrence. Conclusions: Borderline ovarian tumors occur at a younger age compared to invasive tumors. In patients with early stage disease who wish to preserve fertility, hysterectomy and contralateral oophorectomy are not necessary. Serous tumors occur at a younger age. They can be associated with invasive peritoneal implants and raised CA125 values. Majority of the serous tumors are bilateral and smaller in size compared to mucinous and endometroid tumors. Raised CA125 values did not correlate with the stage of disease. These patients have an excellent prognosis even in Indian scenario where majority of patients present with big ovarian masses

Successful Pregnancy Outcome In Maternal Crigler Najjar Syndrome Type II

Estimated incidence of Crigler-Najjar syndrome(CNS) is 1 case per 1,000,000 births(1 million). The overall prevalence of CN syndrome is unknown, with only several hundred people reported to have this disease. It is interestingly very rare to encounter a pregnant adult women with congenital jaundice. Pregnancy in CN type II patients is a diagnostic and a therapeutic challenge because of the high risk of bilirubin encephalopathy with serious neurological damage as life-threatening complications for the fetus. To date 8 pregnancy outcome have been reported from 5 women and we report the6 woman with a successful 9 th pregnancy outcome. We have discussed detail history, presentation and management during pregnancy and care of the new born

A Rare Case of Isolated torsion of Haematosalphinx Presenting as Acute Abdomen During Pregnancy

Isolated fallopian tubal torsion is a rare non obstetric cause for pain abdomen during pregnancy.We report a case of a 34 year old second gravida who presented with history of amennorrhoe of 7 months, colicky pain in the left iliac fossa , with 2 episodes of vomiting. A Trans vaginal scan revealed a left ovarian cyst. An emergency laparotomy was performed for suspected torsion or haemorrhage into an ovarian cyst. Surprisingly ovaries were normal and a congested and necrotic left tubal torsion with a tubal collection (haematosalphinx) was identified and a salpingectomy was then performed. The differential diagnosis is discussed and the literature is reviewed as it is a very rare clinical entity

A Rare Case of Reversible Encephalopathy Syndrome Accompanying Late Postpartum Eclampsia or Hypertensive Encephalopathy-A Clinical Dilemma

Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinic-radiologic diagnosis. Clinically it is characterized by non specific symptoms such as headache, confusion, visual disturbances and seizures. The radiological findings in PRES are thought to be due to vasogenic oedema, predominantly in the posterior cerebral hemispheres, and are reversible with appropriate management. We report a case of reversible encephalopathy diagnosed by MRI scan occurring in atypical areas like the caudate and lentiform nuclei of the brain following an uneventful lower segment caesarean section in a normotensive patient, who was successfully treated with antihypertensives, anticonvulsants and supportive treatment. The differential diagnosis of convulsions in the post-partum period is discussed

A Rare Case of Metastatic Intra-abdominal Melanoma Following Exenteration of Right Eye for Primary Choroidal Melanoma

The most common primary intraocular malignant tumour is choroidal melanoma. Reported incidence of intraocular melanoma is less than 1 per 100,000. Liver is the most frequent site of metastasis, and involvement of the other sites generally occurs in association with liver metastasis. The present case had an unusual presentation of, rapidly refilling massive ascites and right pleural effusion, following exenteration of the right eye 4 years earlier for primary choroid melanoma. To the best of our knowledge this is the first case of intra abdominal melanotic rapidly refilling ascites following primary choroidal melanoma masquerading as an ovarian tumour. We have discussed the atypical presentation, difficulties in arriving at a diagnosis preoperatively, intraoperative dilemmas and the post operative management