Vesicouterine fistula: A case report of successful repair

The increasing rate of cesarean deliveries especially in previous scars is a major cause of vesicouterine fistula (VUF). The incidence of VUF is on the rise because of the increasing incidence of cesarean deliveries. VUF is a pathological communication between the uterus and the bladder. VUF presents in various ways, the main symptoms are urinary incontinence with or without hematuria. There could be depression or psychological distress, which may culminate in reduction in quality of life. The precise and early diagnosis of vesicouterine fistula may be difficult; thus necessitating myriad of investigations such as retrograde cystography, cystoscopy, contrast‑enhanced CT scan, MR urogram, and transvaginal ultrasound with or without Doppler. Examination under anaesthesia (EUA) is crucial to the diagnosis of VUF and this includes methylene blue test. We report a case of VUF.Key words: Urinary bladder; urogenital fistula; uterus; vesicouterine fistula

Hysterosalpingogram findings among women with infertility in Ogun State, Nigeria

Background: Infertility is a relatively common health challenge in the society with social and psychological consequences. Hysterosalpingogram (HSG) is traditionally used to ascertain some of the causes of infertility. The use of ionizing radiation and contrast media injection with the possibility of complications, make new imaging modalities preferable, especially when in-vitro fertilization is being considered as a management option. Objective: To describe the pattern of the cervical, uterine, tubal and adnexial abnormalities causing infertility as detected by HSG in a tertiary health care institution, and demonstrate the prospects of retaining Hysterosalpingography in the investigation of female infertility. Methods: The HSG and reports of 124 patients referred to the Radiology Department of a tertiary health facility between January, 2013 and June, 2014, at a tertiary healthcare institution, were reviewed for abnormalities in the cervix, uterus, the fallopian tubes and adnexial structures. Results: Secondary infertility was the commonest indication for the procedure among in 66 of the 124 HSG reviewed. Pathologies in the cervix were found in 66 (51.6%) cases, of which the most frequent abnormality was cervical fibrosis in 59.4% (36/66) cases. Uterine abnormalities were found in 71.7% (89/124) cases, with uterine fibroid occurring in 82% (73/89) of these cases. Pathologies in the Fallopian tube occurred in 68 (54.8%) cases, with bilaterally blocked tubes occurring most frequently in 32.4% (22/68). Twenty-seven of the 68 cases (39.7%) with tubal abnormalities were aged 20-29 years. Conclusion: Secondary infertility was the commonest indication for HSG in the study, while uterine fibroid, cervical fibrosis and bilaterally blocked tubes were the most prominent findings in descending order of frequency. Therefore, caution should be exercised in managing pelvic infections, inflammations, diagnostic dilation and curettage and post-abortal and post-surgical periods in order to reduce the risk of fibrosis

Case Report: Cotrimoxazole in the Treatment of a Midbrain Toxoplasmosis in HIV Patient

This is a case of cerebral toxoplasmosis presenting at the time of diagnosis of HIV. Cerebral toxoplasmosis is one of the most common intracranial opportunistic diseases occuring in HIV, presenting with mass lesions. A 52 year-old woman who presented to Olabisi Onabanjo University Teaching Hospital (OOUTH) with features of headache, visual blurring, drooling of eyelids, vomiting and progressive difficulty walking. She was sero-positive for HIVwhen tested in the course of the illness and she is HAART-naive. Brain MRI done showed multiple ring-enhancing lesions with mass effects consistent with cerebral toxoplasmosis with the involvement of the midbrain. She was treated with cotrimoxazole, HAART and medical decompression therapy. She made significant improvement and was discharged 3 weeks after. Six month post treatment parameters showed resolution of lesions on the MRI and rise of CD4 count from 24 to 240cells/mm