Umbilical Endometriosis, a Rare Clinical Entity: Case Report and Management in Port-Harcourt, Nigeria, Africa |Chapter 3 | Medicine and Medical Research: New Perspectives Vol. 3

 

Endometriosis is the presence of endometrial tissue outside the lining of the uterine cavity. It is a benign gynaecological disorder affecting about 5% of reproductive-age women. The aetiology is uncertain, but certain theories are postulated, like retrograde menstrual regurgitation of viable endometrial glands and tissue along the fallopian tubes and subsequent implantation on the pelvic peritoneal surfaces. These cells respond to hormones in a cyclical manner. Surgical procedures that breach the endometrium can inoculate other parts of the pelvis with endometrial tissue, there is also haematological spread. Cyclical bleeding from these deposits leads to inflammation, fibrosis, and adhesions. Umbilical endometriosis is the presence of an endometrial gland and stroma in the umbilicus. It is a rare site of occurrence. It is usually preceded by a history of pelvic surgery, as was found in this patient. The management usually involves a multidisciplinary team comprising the gynaecologist, the plastic surgeon, the colorectal surgeon, Fertility and Pain management teams. This was the case of a 33-year-old nullipara, who had abdominal myomectomy 5 years prior to presentation. She noticed bleeding and pain from her umbilicus one year ago. Bleeding was cyclical, associated with her menses, and was bright red in colour. The umbilicus eventually produced a tender-feeling, hyperpigmented exophytic mass. There was a laparotomy, intraperitoneal adhesiolysis, and total removal of the umbilical tumour. She experienced no pain during her first menstruation following surgery, and the repaired umbilical location was free of haemorrhage. She will be sent to the fertility team when she is prepared to begin a family.

 

The significance of this study is that every clinician, especially gynaecologists should have a high index of suspicion of endometriosis when a young woman presents with bleeding from unusual sites.

 

Author(s) Details

Iwo-Amah R. S.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Jumbo A. I.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Altraide B. O. A.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Okah K.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Lebara L. B.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Amachree P. T.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

Briggs N. N.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

Wadi I.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Ndii L. D.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Weje F. C.
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v3/1278

A Surgical Removal of Morbidly Adherent Placenta Due to Multiple Uterine Fibroids | Chapter 11 | Medicine and Medical Research: New Perspectives Vol. 12

The present study reports on surgical removal of the morbidly adherent placenta due to multiple uterine fibroids. Retained placenta is a common complication accounting for 3% of all deliveries, and especially in mid-trimester miscarriage. However, when it is further complicated by the presence of multiple fibroids negating removal through the vagina route, it becomes a problematic finding necessitating laparotomy for both myomectomy and removal of the placenta. Risk factors for retained placenta include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions, history of a prior retained placenta, and congenital uterine anomalies. A 36-year-old G3P0+2 who had a miscarriage at 19 weeks 5 days gestation had a retained placenta with failed attempts at both medical and manual removal due to multiple uterine fibroids. She eventually had a hysterotomy and myomectomy with satisfactory results. The intraoperative challenges were the removal of numerous uterine fibroid seedlings of various sizes including large ones in a gravid uterus leading to an estimated blood loss of 4,500 ml and necessitating the transfusion of a total of eight units of blood. This operation has proven to be life-saving because there was no way else to have delivered the placenta, and in doing the surgery, the uterine fibroids were managed, despite the risky circumstances. This case highlights one of the several complications of fibroids coexisting with pregnancy and its management.

 

Author (s) Details

Michael Tyodoo Maanongun
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

 

Jude Obotu Ben-Ameh
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

 

Joseph Chiahemba Agulebe
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

 

Michael Ushakuma Anenga
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v12/2631

Successful Management of a Rare Case of Abdominal Gunshot Injury: Insights and Outcomes| Medical Science: Recent Advances and Applications Vol. 2

A study was taken up with the objective of reporting the pattern and incidence of fatal firearm injuries in Delhi and comparing it with the pattern seen in other countries. One hundred and seven firearm fatalities autopsied during the last 6 years were studied. A 55-year-old male patient came to the casualty of a medical college and hospital with an alleged history of assault with firearm injury on his back. The present study was conducted at Medical College and Hospital in Central India. The patient was conscious with GCS 15/15, his pulse rate was 133 beats per minute, blood pressure was 100/60 mmHg, SpO2 was 95% and pallor was present. On local examination, there was a single entry wound at the lower back on the left side of size 1 cm X 1 cm with no exit wound. Generalized abdominal tenderness and guarding were present. The patient was immediately resuscitated. Blood grouping and cross-match were sent immediately. The abdominal radiograph did not show any gas under the diaphragm but a foreign body (a bullet) was seen. Ultrasonography and computerized tomography scan of the abdomen were suggestive of hemoperitonium and a foreign body bullet in the abdomen. Exploratory laparotomy showed moderate hemoperitonium of about 1000 ml which was sucked out completely. Evidence of retroperitoneal rent of size approximately 1 cm X 1 cm was seen with oozing through it which was closed in layers. A bullet was seen in the anterior abdominal wall but the skin was intact. Five jejunal perforations distal to 20 cm from the duodenojejunal flexure were seen and the bullet was removed from the anterior abdominal wall. Resection of the jejunal segment with jejuno-jejunal anastomosis was done. Jejunal mesenteric rents were closed. The abdominal wall is closed in layers. Post-operative recovery was uneventful. The patient was kept nil by mouth for 7 days, jejunal feeding started on the 7th postoperative day. The patient was discharged on the 10th postoperative day. The case report revealed that the amount of work or damage inflicted on tissues depends on the amount of kinetic energy possessed by the bullet when it strikes the body and the amount possessed when, and if, it exits the body. The chest (39%) and head (29.6%) were the two most common entry sites for the bullets, a pattern somewhat similar to that of other countries. Moreover, in gunshot wounds (GSW), the possibility of intra-abdominal injuries is high, and the necessity of surgical treatment is the rule. To perform this type of treatment, the hospital must be prepared, equipped with human and material resources and have a well-defined protocol and the necessary infrastructure. The study concluded that early diagnosis and treatment in the golden hours can save the lives of the patients. A mass education on the dangers of these guns and the harm they can cause as well as legal regulations for their restricted use seem to be necessary.

 

Author (s) Details

Ashok S. Gajbhiye
Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.

 

Mrunal Nikhade
Karmveer M.S. Kannamwar, Government Medical College, Chandrapur, Maharashtra, India.

 

M. N. Deshmukh
Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.

 

Parag Jaipuriya
Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.

 

Kishor Jehughale
Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.

 

P. Mehata
Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.

 

Abhinav Kumar
Department of General Surgery, Indira Gandhi Government Medical College and Hospital,

 

Ankur Kumar
Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v2/3066

Incidentally Discovered Malrotation in a Case of Gastric Perforation | Chapter 3 | New Visions in Medicine and Medical Science Vol. 8

Aim: The study is a case report of a 36-year-old male with blunt trauma to the abdomen following a road traffic accident, with an intraoperative finding of gastric perforation alongside an incidentally detected malrotation.

Introduction: The term "intestinal malrotation" refers to abnormalities affecting intestinal fixation and intestinal nonrotation or partial rotation around the superior mesenteric artery. Only 0.2 to 0.5% of people exhibit symptoms, with the remainder exhibiting none at all.

Case Presentation: A 36-year-old man arrived at the hospital two days ago with traumatic abdominal damage. Examination results showed that the patient had a blood pressure of 90/60 mmHg, a pulse of 130 bpm, a respiratory rate of 32 breaths per minute, and a saturation of 78% in room air. X-ray chest showed gas under diaphragm. An anterior gastric rupture with a transverse colon below the stomach and a jejunum with small bowel loops present on the right was discovered during an emergency laparotomy. Gastrojejunostomy was done. The patient's postoperative stay went smoothly, and on POD 10, he was discharged, able to resume his regular oral diet and pass stool.

Conclusion: Intestinal malrotation is a rare developmental anomaly of the embryonic gut. In babies, bilious vomiting is the most prevalent presentation; in older children and adults, chronic and sporadic abdominal pain is evident. Surgery is debatable in asymptomatic patients. However, adults with delayed malrotation presentation manifest with varied symptoms. Hence, to prevent further difficulties, a high index of suspicion together with pertinent investigations (CT and USG) is required.

Author(s) Details:

Abhishek Soham Satpathy,
Department of Surgery, S.C.B. Medical College and Hospital, Cuttack, 753007, India.

Please see the link here: https://doi.org/10.9734/bpi/nvmms/v8/8288E

A Case Report on Full Term Broad Ligament Pregnancy | Chapter 11 | Highlights on Medicine and Medical Science Vol. 17

 A broad ligament pregnancy is a very uncommon ectopic pregnancy with a high maternal and perinatal mortality rate. It's much less likely that such pregnancies will be carried to term. Ultrasonography can aid in diagnosis, however it is normally done during a laparotomy. G2P1 came to see us with stomach pain at 39 weeks of pregnancy, which was an unscheduled visit. On ultrasound, a live foetus was discovered with severe intrauterine growth restriction (estimated foetal weight of 1.98 kg), transverse lying, severe oligohydramnios, and full placenta praevia. The patient was taken to the operating room for a caesarean section. The foetus was removed alive and the broad ligament, placenta, left fallopian tube, and ovary were excised after an intraoperative diagnosis of left broad ligament pregnancy. The post-operative time went without a hitch. To avoid a negative foetal or maternal outcome, a high index of suspicion and rapid therapeutic intervention are required.

Author (S) Details

Vidhi J. Shah
Department of Obstetrics and Gynecology, Saraswati Hospital, Badsam Bypass Road, Rajasthan, India.

View Book :- https://stm.bookpi.org/HMMS-V17/article/view/2614