Case report: Elective management of a bicornuate uterus with hematometra, incidentally found submucosal fibroids, rectus sheath hematoma, and hydronephrosis in a resource limited setting.

INTRODUCTION AND IMPORTANCE: Bicornuate uterus is a rare type of congenital mullerian anomaly, presenting as a diagnostic challenge. Metroplasty either via an open approach or laparoscopically can be performed to definitively diagnose and treat the defect. CASE PRESENTATION: A 26-year-old female, with no known comorbids and past surgical history of endometriotic cyst excision presented with acute symptoms of left lower abdominal pain, burning micturition, and relative constipation. After clinical and radiologic investigations, the diagnosis of bicornuate was suspected. An elective exploratory laparotomy was then performed due to limited resources and skilled surgical techniques. Intra-operatively it was found that she had a bicornuate uterus with a single cervix and vagina, with the left cornuate being non-communicating with fluid suggesting hematometra. Dense adhesions were reported with drainage of 150-200 ml of free fluid upon opening the rectus sheath. Postoperatively she remained vitally stable and was discharged home. CLINICAL DISCUSSION: We report a rare case of a bicornuate uterus with double horns along with submucosal fibroids, rectus sheath hematoma, and left sided hydronephrosis. Diagnosis of bicornuate uterus is associated with diagnostic uncertainty mainly due to its rarity and nonspecific presentation. CONCLUSION: Although bicornuate is rare, it may result in complications if not attended to timely. Early diagnosis and management are necessary to minimize associated morbidity and mortality that can occur as a consequence of associated unattended pressure symptoms.

Case report: Emergency management of unilateral herniation of bowel and a bilateral defect of the broad ligament in a resource limited setting.

INTRODUCTION: Broad ligament herniation is a rare type of internal hernia, presenting as a diagnostic challenge. An exploratory laparotomy can be performed to definitively diagnose and treat the defect. CASE PRESENTATION: A 36-year-old female, with no known comorbids and no significant past medical and surgical history presented with acute abdominal pain, multiple episodes of vomiting, and absolute constipation. After clinical and radiologic investigations, the diagnosis of an internal herniation of small bowel to the broad ligament was suspected. An emergent exploratory laparotomy was then performed. Intra-operatively it was found that she had a bilateral defect to the broad ligament and a unilateral broad ligament hernia (BLH). Postoperatively she remained vitally stable and was discharged home. CLINICAL DISCUSSION: We report a rare case of a unilateral broad ligament hernia with a bilateral defect. Diagnosis of BLH is associated with diagnostic uncertainty mainly due to its rarity and nonspecific presentation. CONCLUSION: Although broad ligament herniation is rare, it is a significant cause of intestinal obstruction and may result in complications if not attended to timely. Early diagnosis and management is necessary to minimize associated morbidity and mortality that can occur as a consequence of bowel ischemia and necrosis.

Home Isolated COVID-19 Patients Adhering To Recommended Guidelines: A Cross Sectional Survey In Karachi.

Objectives: To assess compliance level of coronavirus disease-2019 patients with recommended isolation guidelines. METHODS: The cross-sectional phone-based survey was conducted in Karachi, from March to October 2020 after approval from the ethics review board of Dow University of Health Sciences, Karachi, and comprised patients of either gender who had been tested positive and were advised home isolation due to mild/asymptomatic nature of their infection. Data was collected using a predesigned 42-item questionnaire in the light of the guidelines issued by the National Institutes of Health, Islamabad, Pakistan. Data was analysed using SPSS 20. RESULTS: Of the 450 patients approached, 305(68%) responded; 176(57.7%) females and 129(41.1%) males. The overall mean age was 35.16±14.15 years (range: 13-78 years). Of the total, 9(2.95%) patients did not isolate themselves at all, 51(16.7%) came into contact with other people, 75(24.6%) broke the home isolation and 69(22.6%) were sharing their rooms with other family members. Overall, 260(85.2%) participants were keeping themselves updated with the changes in the guidelines through conventional and social media. CONCLUSIONS: Coronavirus disease-2019 patients who were advised home isolation adhered to some but not all of the recommendations.