Spontaneous Transvaginal Intestinal Evisceration Two Years after Vaginal Hysterectomy, a Case Report.

Vaginal evisceration is an exceedingly rare and poorly documented complication following vaginal hysterectomy. Prompt detection and surgical intervention are critical to prevent severe complications such as bowel ischemia, perforation, and secondary sepsis. We present the case of an 84-year-old woman with a history of vaginal hysterectomy two years prior, who presented with acute abdominal pain and a significant portion of her small bowel protruding through a defect in the vaginal vault. The patient was urgently transferred to the operating room, where the loops of the small bowel were manually reduced through the vaginal defect. As the bowel appeared viable, no resection was required. The etiology of this condition is unclear and likely multifactorial. Various surgical approaches, including laparoscopic, abdominal, transvaginal, and combined techniques, have been described, all offering comparable outcomes. Therefore, the choice of surgical procedure should be tailored to the patient's clinical presentation.

Clinical outcomes and complications of a new high-density polyethylene-based spherical integrated porous orbital implant.

PURPOSE: To describe our experience over 6 years using a new high-density polyethylene-based spherical integrated porous orbital implants (Oculfit). METHODS: This is an observational retrospective case series study analyzing all cases requiring Oculfit implants between February 2015 and September 2021. Clinical information regarding the population included, the characteristics of the implant, and the outcomes and complications during the follow-up were noted. The success of the implant was defined according to anatomical and functional parameters. RESULTS: The study analyzed 90 cases of anophthalmic patients. The main causes for enucleation or evisceration were ocular decompensations (36.7%) and neoplasms (27.8% uveal melanoma and 7.8% retinoblastoma). Anatomical success was identified in 63 (70.0%) cases, functional success in 79 (87.8%) and complete success (anatomical + functional) in 61 (67.7%) cases. Factors associated with the functional success were age and exposure of the primary orbital implant. Complications appeared in 11 (12.2%) cases, which were completely resolved without sequelae in 4 (4.4%). Orbital explant was required in 5 (5.6%) cases. CONCLUSION: In our experience, Oculfit can be considered a useful alternative among the currently available options for orbital implants and has a good efficacy/safety profile.

Novel point-of-care biomarkers of the dry anophthalmic socket syndrome: tear film osmolarity and matrix metalloproteinase 9 immunoassay.

PURPOSE: To compare tear film osmolarity (TFO) values and matrix metalloproteinase 9 (MMP-9) levels between anophthalmic sockets and healthy fellow eyes and to assess the use of the MMP-9 and TFO as objective biomarkers for the dry anophthalmic socket syndrome (DASS). METHODS: In this prospective single-center study, the anophthalmic sockets and healthy fellow eyes of 98 unilateral anophthalmic patients were assessed using the ocular surface disease index (OSDI) questionnaire, InflammaDry® MMP-9 point-of-care immunoassay, TFO with TearLab™ Osmolarity System, and clinical conjunctival inflammation. MMP-9 concentration and conjunctival inflammation were graded semi-quantitatively. Differences between anophthalmic sockets and the healthy fellow eyes for OSDI scores, MMP-9, TFO values, clinical conjunctival inflammation, and eyelid abnormalities as well as the correlation between these factors and demographic data were evaluated. RESULTS: Patients had significantly higher OSDI, MMP-9, and TFO values, as well as higher conjunctival inflammation on the anophthalmic side, compared to the healthy side (p ≤ 0.002, respectively). For anophthalmic sockets, there was a significant positive correlation between OSDI scores and TFO values (p = 0.007), between the grade of posterior blepharitis and TFO values (p = 0.026), and between the conjunctival inflammation and MMP-9 values (p < 0.001), as well as between MMP-9 levels and time since eye loss (p = 0.004). CONCLUSIONS: Measuring MMP-9 and TFO may be helpful tools as efficient, quantifiable biomarkers, disease course parameters, or predictors for treatment response in the clinical management of patients with DASS or future therapy studies. Ophthalmologists should consider the updated diagnosis criteria including TFO and the definition for DASS proposed in this study.

Transvaginal small bowel evisceration after cervical loop electrosurgical excision procedure: a case report.

Transvaginal small bowel evisceration is a life-threatening condition, which is usually seen in postmenopausal women with a history of gynecological surgery. Cervical loop electrosurgical excision procedure (LEEP) is widely used in the treatment of cervical intraepithelial neoplasia (CIN), and its surgical risk and postoperative complications are relatively low because of the simplicity of the operation. However, improper operation may result in perforation of the uterus, which can cause prolapse of the small bowel into the vagina. We here reported an extremely rare case of a young woman with transvaginal small bowel evisceration after cervical LEEP, achieving a good prognosis after the prolapsed bowel was reduced. The patient underwent cervical LEEP as a treatment for CIN III, but the LEEP resulted in a laceration of about 4.0 cm × 3.5 cm on the peritoneum of the uterovesical peritoneal reflection and a laceration of about 2.0 cm × 1.5 cm on the anterior wall of the cervical canal. Through the two lacerations, the pelvic cavity is connected to the vagina and the small intestine prolapsed into the vagina. Due to aggressive surgical intervention, the patient achieved a favorable prognosis after successfully reducing the prolapsed bowel.

Nutritional metabolism evaluation and image segmentation of the chicken muscle and internal organs for automatic evisceration.

The chicken is rich in various proteins, fatty acids, polysaccharides, trace elements, and other human essential nutrients that contribute to its high nutritional value. In this study, the expression levels of nutrition-related genes (acetyl-CoA acyltransferase, ACAA) of native chicken breeds were investigated. The level of GgalACAA1-2 transcripts expression in the liver of chicken was significantly higher than that of muscle and heart. Moreover, three protein extracts were isolated from the muscle, heart, and liver tissues from the chicken, and their nutritional function was evaluated in the present study. These protein extracts had excellent DPPH and hydroxyl radical scavenging capacities and exhibited significant superoxide anion scavenging ability. Moreover, the protein extracts of muscle tissue showed an important mouse splenocyte proliferation activity and could be used as an immunomodulator of natural origin. In addition, this report presented an automatic visual inspection of chicken viscera using the active contour algorithms and the image processing method for eviscerating by the parallel robot. The recognition and positioning rate of chicken viscera obtained by the proposed method could reach 96.45%. These methods provided basic data for automated poultry slaughter and segmentation, avoiding unnecessary health risks by a pathogenic microorganism, such as avian influenza, Newcastle disease virus, and coronavirus. Moreover, the internal organs of the chicken could be fully harvested by the image segmentation of automatic evisceration, which also facilitated the processing value of these internal organs as by-products of poultry.

Perineal bowel evisceration after extralevator abdominoperineal excision and vertical rectus abdominis myocutaneous flap closure.

INTRODUCTION: Perineal bowel evisceration is a rare complication after extralevator abdominoperineal excision (ELAPE). This surgical technique is used to resect low rectal and anal cancer, with a lower likelihood of positive surgical margins, but resulting in a larger perineal defect. A vertical rectus abdominis myocutaneous (VRAM) flap allows filling of the empty pelvic space and closure of the defect in the pelvic floor. CASE PRESENTATION: A 77-year-old woman, with a hysterectomy in her medical history, underwent an ELAPE followed by reconstruction of the perineal defect with a VRAM flap after neoadjuvant radiotherapy for a moderately differentiated invasive adenocarcinoma of the distal rectum. The postoperative course was complicated with a herniation of the perineal wound and evisceration of a bowel loop. CONCLUSION: Closure of the perineal defect after ELAPE remains a challenge, especially in cases where several risk factors for delayed wound healing, flap failure and perineal herniation are present.

Outcome of eviscerations and enucleations at a Swedish tertiary referral centre between 2008 and 2019: improved surgical management leading to reduced complication rate.

PURPOSE: The aim of this study was to investigate the results of all eviscerations and enucleations performed at the Department of Ophthalmology, Sahlgrenska University Hospital, during 2008-2019 and to compare them with previously collected data from 1999 to 2007. METHODS: This was a retrospective investigation using the medical records for all patients having had an evisceration or an enucleation at the Department of Ophthalmology, Sahlgrenska University Hospital, during the two defined periods of time. Main outcome measure was postoperative complications. RESULTS: During 1999-2007, 181 surgeries were performed, 100 with implants, and 28/100 exposed implants and 9/100 removed implants were recorded during follow-up. During 2008-2019, 250 operations were performed with 158 implants, and there were 3/158 exposed implants and 2/158 extruded implants. Two ruptures of the surgical wound without implant exposure were noted, and one implant was exchanged. The reduction of exposed implants between the two periods was statistically significant (p < .001, Chi-square test). In enucleations, the use of one kind of porous polyethylene implant in the recent study period replaced a multitude of implants in the earlier study period. In eviscerations, the major change between the two study periods was the introduction of the split sclera technique and smaller implant size. CONCLUSION: The change in surgical technique between the two periods led to a significant reduction in implant-related complications.

Novel use of an autologous scleral button graft to close the anterior defect in evisceration surgery.

PURPOSE: To present an alternative evisceration technique with long-term follow-up data. This technique involves the insertion of an acrylic implant into a modified scleral shell which is closed using an autologous scleral graft. METHODS: This was a retrospective analysis of eviscerations performed in a district-general hospital in the UK. All patients underwent conventional ocular evisceration after total keratectomy. A full thickness scleral graft is harvested from the posterior sclera, using an internal approach, with an 8 mm dermatological punch. An 18-20 mm acrylic implant is placed into the shell, and the scleral graft is used to close the anterior defect. Demographic characteristics, implant size and type, and cosmetic results from pictures of all patients were recorded. All patients were invited for a review to measure motility, eyelid height, patient recorded satisfaction and complications. RESULTS: Of the five patients identified, one had since died. The remaining four attended a review in person. The mean time between surgery and review was 48 months. The mean implant size was 19 mm. There were no cases of implant extrusion or infection. All four had a <1 mm asymmetry in measured eyelid height and ≥5 mm horizontal gaze motility. All patients self-reported "good" cosmesis. An independent assessment identified "mild asymmetry" in two cases and "moderate" in the other two. CONCLUSION: Evisceration with this novel autologous scleral graft technique restores volume in the anterior orbit with good cosmetic results, and with no cases of implant exposure reported in this small case series. This technique should be compared prospectively to established techniques.

Risk factors for enucleation or evisceration in endophthalmitis.

PURPOSE: To identify clinical risk factors for enucleation or evisceration in patients with endophthalmitis at an academic institution. METHODS: A retrospective review of patients diagnosed with endophthalmitis at Wilmer Eye Institute from 2010 to 2019 was conducted. Clinical characteristics, including demographics, cause for endophthalmitis, microbial culture results, salvaging procedures and surgical intervention were recorded. In patients who underwent enucleation or evisceration, type of surgery and placement of a primary implant were recorded. Chi-squared, Student's t-tests and multivariate analysis were used to identify clinical factors that predicted enucleation or evisceration. RESULTS: Two hundred and fifty three patients treated for endophthalmitis over the study period were identified, of which 25 (9.88%) underwent enucleation or evisceration. Risk factors for enucleation or evisceration included poor presenting visual acuity (OR 7.86, CI: 2.26, 27.3), high presenting intraocular pressure (OR 1.07, CI: 1.03, 1.12), presence of relative afferent pupillary defect (OR 3.69, CI: 1.20, 11.37) and positive vitreous culture for methicillin-resistant staphylococcus aureus (MRSA) (OR 18.3, CI: 1.54, 219.2) on multivariate analysis. Patients undergoing enucleation or evisceration were also more likely to have trauma, corneal ulcer or combined causes for endophthalmitis and underwent fewer salvaging surgical and procedural interventions. There were no significant differences in characteristics of those receiving enucleation versus evisceration in our cohort. CONCLUSION: Patients with endophthalmitis who underwent enucleation or evisceration had more severe disease on presentation compared to those treated with eye sparing therapy. Presenting clinical characteristics may have a role in triage and management decisions for patients presenting with severe endophthalmitis.

Lagophthalmos-induced corneal perforation in a patient with congenital erythropoietic porphyria.

Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disorder in which the activity of uroporphyrinogen III synthase (UROS) is decreased. This results in the accumulation of photoreactive porphyrinogens, primarily in the skin and bone marrow. We describe a case of a patient with CEP who initially presented with scarring and shortening of the anterior and posterior lid lamella, which led to the development of lagophthalmos. Vascularized hyperkeratotic plaques in both corneas were also present. Despite treatment with topical ocular surface lubricants, corneal perforation with iris and uvea prolapse developed and evisceration of the right eye under local anesthesia was performed. The presented case suggests that despite topical therapy, ocular complications may exacerbate requiring surgical intervention, especially in the presence of lagophthalmos.

Single or double? A comparison of evisceration techniques.

PURPOSE: We compared the rates of implant exposure and extrusion after evisceration with single and double scleral closure techniques. METHODS: This retrospective cohort study included all patients who underwent evisceration with an implant insertion over the past 18 years at Tung Wah Eastern Hospital and Pamela Youde Nethersole Eastern Hospital. Clinical documents and operation records were reviewed. RESULTS: A total of 81 ethnic Chinese patients (44 male) who underwent evisceration with primary implant insertion were reviewed. 39 (48%) patients underwent the double scleral closure technique with an implant placed posterior to the posterior sclera, and 42 (52%) patients underwent the single scleral closure technique with an implant inserted in the intra-scleral cavity. The follow-up interval was 70 months. The surgical indications were endophthalmitis (35%), painful blind eye (23%), traumatic disfigured globe (22%) and phthisis bulbi (20%). Silicone was the most used implant material (69%). The patients who underwent double scleral closure had a larger size of the implant (19.7 vs 17.9 mm, p < 0.05). Both implant exposure (26% vs 3%, p < 0.05) and implant extrusion (26% vs 0%, p < 0.05) were more common in patients who underwent single scleral. CONCLUSIONS: Double scleral closure technique allows a larger implant, and it is associated with a lower rate of implant exposure and extrusion. The double scleral closure technique is a superior technique of choice in these patients with primary implant placement.

Laparoscopic management of vaginal evisceration of the small bowel.

Vaginal vault dehiscence leading to bowel evisceration is a rare but potentially lethal surgical emergency. Various aetiologies have been reported in the literature, but the condition is most commonly seen after hysterectomy in post-menopausal women. Prompt reduction of the bowel is necessary to prevent ischaemic complications. Although most cases in the past have been managed by exploratory laparotomy, the condition may be managed laparoscopically if the prolapsed bowel is viable, giving the benefit of minimally invasive surgery to the patient. A hybrid approach of laparoscopic bowel reduction and per vaginal repair of the vault is technically simple and can be performed even by non-expert surgeons in an emergency setting.

[Immunomorphological aspects of post-traumatic subatrophy of the eyeball]. / Immunomorfologicheskie aspekty posttravmaticheskoi subatrofii glaznogo yabloka.

PURPOSE: The study attempts to characterize immunomorphological disorders at different degrees of post-traumatic subatrophy of the eyeball. MATERIAL AND METHODS: The study included 123 patients with blind and unpromising eyes, eyeball subatrophy of various degrees, who were divided into three groups (1, 2 and 3) depending on the degree of eyeball subatrophy. RESULTS: The greatest risk of autoimmune inflammation was observed in patients with degree I subatrophy. Contusion injury of the eye was proven to not exclude the course of post-traumatic autoimmune uveitis. The development of post-traumatic subatrophic process is associated with activation of systemic organ-specific immunity, shift of balance in main regulatory subpopulations. CONCLUSION: The study showed that the most severe clinical course of chronic post-traumatic uveitis is observed in patients as a result of penetrating trauma to the eyeball. The contusion nature of such ocular injury does not exclude the development of autoimmune inflammation.

Post-autotomy regeneration of respiratory tree in sea cucumber Holothuria parva.

The respiratory trees present only in the class Holothuroidea and the rest of the echinoderms lack it. Only some holothurian species have the ability to regenerate their respiratory trees after autotomy. Therefore, respiratory trees could be considered as a suitable model to assess the regeneration mechanisms in animals. In the present study, the respiratory tree regeneration after posterior evisceration were examined in Holothuria parva during 75 days. Since autotomy reduces antioxidant defense in the organisms, in the present study alterations of antioxidant enzymes were also evaluated during the experiment. H. parva is the dominant intertidal species distributed in the north of the Persian Gulf. In the present study, H. parva ejected the left respiratory tree, the digestive tract and supportive mesenteries from the anus, about 1-2 min after potassium chloride injection. The closure of the opening at the posterior ends of the body was the first reaction to the injury. Seven days after evisceration, the small bud formed on the dorsal side of the cloaca which was covered with the coelomic epithelium of cloaca. The coelomic epithelium started to proliferate to undifferentiated cells on the apex of the buds. The primary respiratory tree consisted of the luminal cuboidal epithelium and thin connective tissue surrounded by the slender coelomic epithelium. This preliminary organ was observed at the apex of the buds, 13 days after evisceration. Gradually, myoepithelial cells arranged around a longitudinal axis and formed a circular muscle. The primitive branches of primary respiratory tree started to form 18 days after evisceration. Forty days after evisceration, the luminal epithelium of the respiratory tree had the same appearance as the intact luminal epithelium. The regenerated respiratory tree was histomorphologically very similar to an intact respiratory tree 56 days postevisceration, but unlike that, it was not yet wrapped around the intestine and was completely separate from it. Despite the development of the regenerating respiratory tree, no wrapping around the intestine was observed until the end of the experiment. According to the results, the activity of the catalase (CAT) and superoxide dismutase (SOD) in the muscle homogenate was significantly higher than the control 5 days after evisceration. The CAT and SOD levels gradually decreased in eviscerated animals. The lipid peroxidation level followed a decreasing trend in the eviscerated animals during the experiment. However, its value reduced to the control level at the end of the experiment.

Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse.

BACKGROUND: Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral. CASE PRESENTATION: We report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness. CONCLUSIONS: Early detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team.

Outcomes and complications of evisceration with primary implant: an electronic medical record driven analytics of 1800 cases.

PURPOSE: To describe the surgical outcomes and implant complications in 1,800 patients undergoing evisceration with primary implant. METHODS: An Electronic Medical Record-driven analysis of 1,800 patients undergoing evisceration with primary implant between 2013 and 2019. Implant sizing was performed intra-operatively to place the largest implant without tension on the wound closure. Outcome measures included implant complications, prosthesis measurements, and incidence of a good aesthetic outcome. Good outcome was defined as <2 mm enophthalmos and grade 1 or less superior sulcus deformity with a custom ocular prosthesis. RESULTS: Eighteen hundred eyes of 1800 patients were included. The mean age at surgery was 36 ± 21 years (median 32 years). Implants used were poly(methyl methacrylate) (PMMA) in 1737 (97%) and porous polyethylene in 63 (3%) patients. Two-petal sclerotomy was performed in 1512 (88%) and four-petal sclerotomy in 165 (10%) patients. The mean diameter of the implant used was 19.35 ± 1.18 mm (median 20, range 10-22 mm). The implant extrusion rate was 3% (56) and implant displacement was seen in none. The mean prosthesis volume and thickness were 2.22 ± 0.67 ml (median 2, range 1-6.5 ml) and 6 ± 1 mm (median 6, range 2-9 mm). The mean difference in prosthesis projection on Hertel's exophthalmometer was 0.28 ± 1 mm (median 0, range 0-1 mm). Good outcome was observed in 93%. The mean follow-up period was 351 ± 386 days (median 194). CONCLUSION: Evisceration with empirically selected primary orbital implant placement is associated with minimal implant complications and gives a good aesthetic outcome in 93% of the patients.

Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades.

PURPOSE: To determine the trends in eye removal surgeries at a tertiary hospital in Nigeria over 26 years. METHODS: A retrospective comparative review of clinical records of all patients who had eye removal surgery at a tertiary hospital in Ile-Ife, Nigeria, between 2014 and 2019 was done. Patients' demographic and clinical data, including indication for eye removal and type of surgery were analysed and compared with two earlier studies at the same hospital between 1994 and 2013. RESULTS: There was an average of 14.3 surgeries per year between 2014 and 2019. Patients' ages ranged from 2 to 102 years, M:F was 1.5:1, the commonest indication for eye removal was infection (n=30, 34.9%), and the most common surgery was evisceration (n=70, 81.4%). Studies from 1994 to 2003 and 2005 to 2013, reported an average of 9.2 and 10 surgeries per year; ages ranging from 4 days to 88 years and 3 months to 88 years; with a M:F of 2.1:1 and 3.4:1 respectively. In both studies, the commonest indication for eye removal was trauma (43.4% and 43.8% respectively) and the most common surgery was enucleation (57.6% and 55% respectively). Trend data showed a progressive increase in eye infections (12% vs 15% vs 34.9%) and eviscerations (19.6% vs 31.2% vs 81.4%) over time. CONCLUSION: There was a change in trend towards an increase in eviscerations and infective indications for eye removal at the hospital over three decades. Prompt and optimal treatment of orbito-ocular infections is recommended to reduce the incidence of eye removal surgeries.

BUT: Déterminer les tendances des chirurgies d'ablation de l'oeil dans un hôpital tertiaire du Nigeria sur une période de 26 ans. MÉTHODES: Un examen comparatif rétrospectif des dossiers cliniques de tous les patients ayant subi une chirurgie d'ablation de l'œil dans un hôpital tertiaire d'Ile-Ife, au Nigeria, entre 2014 et 2019, a été effectué. Les données démographiques et cliniques des patients, y compris l'indication de l'ablation de l'œil et le type de chirurgie, ont été analysées et comparées à deux études antérieures menées dans le même hôpital entre 1994 et 2013. RÉSULTATS: Il y avait une moyenne de 14,3 chirurgies par an entre 2014 et 2019. L'âge des patients allait de 2 à 102 ans, le rapport M:F était de 1,5:1, l'indication la plus courante pour l'ablation de l'œil était l'infection (n=30, 34,9%), et la chirurgie la plus fréquente était l'éviscération (n=70, 81,4%). Les études menées de 1994 à 2003 et de 2005 à 2013 ont fait état d'une moyenne de 9,2 et 10 interventions chirurgicales par an, d'âges allant de 4 jours à 88 ans et de 3 mois à 88 ans, et d'un rapport M:F de 2,1:1 et 3,4:1 respectivement. Dans les deux études, l'indication la plus courante pour l'ablation de l'œil était le traumatisme (43,4 % et 43,8 % respectivement) et la chirurgie la plus courante était l'énucléation (57,6 % et 55 % respectivement). Les données sur les tendances ont montré une augmentation progressive des infections oculaires (12 % vs 15 % vs 34,9 %) et des éviscérations (19,6 % vs 31,2 % vs 81,4 %) au fil du temps. CONCLUSION: On constate un changement de tendance vers une augmentation des éviscérations et des indications infectieuses pour l'ablation des yeux à l'hôpital sur trois décennies. Un traitement rapide et optimal des infections orbitooculaires est recommandé pour réduire l'incidence des chirurgies d'ablation des yeux. Mots clés: Anesthésie, énucléation, éviscération, exentération, implant orbitaire, tendances.

[Perioperative augmented reality technology in surgical treatment of locally advanced recurrent rectal cancer]. / Perioperatsionnoe primenenie tekhnologii dopolnennoi real'nosti v khirurgicheskom lechenii bol'nogo mestnorasprostranennym lokoregionarnym retsidivom raka pryamoi kishki.

Rectal cancer occupies the leading position among cancers, and incidence of locally advanced recurrences is still high despite comprehensive treatment. Combined resections are usually associated with high perioperative risks. These procedures are technically complex interventions requiring further improvement. Virtual reality technology in surgical treatment of locally advanced rectal cancer recurrence has not been widely discussed. The authors present multidisciplinary construction of the matched topographic-anatomical virtual model and virtual planning of the combined surgical intervention. Intraoperative use of augmented reality allowed specifying topographic and anatomical features of surgical area, level of vascular ligation, localization of tumor fixation points and resection borders. These data ensured safety and quality of resection. Further research of augmented reality technology and improvement of its technical aspects will improve the results of surgical treatment of patients with locally advanced pelvic tumors and recurrences.

Transvaginal strangulated bowel evisceration through uterine perforation due to unsafe abortion: a case report and literature review.

BACKGROUND: Induced abortion, whether therapeutic or elective, is a surgical procedure frequently practiced worldwide. It is a significant cause of maternal morbidity and mortality. When the procedure is performed in precarious conditions, by unqualified personnel, it leads to serious consequences, including uterine perforation and its associated lesions. Its management remains a medico-surgical emergency. CASE PRESENTATION: We present two cases of unsafe abortions performed by cervical dilatation and intrauterine curettage which resulted in uterine perforation and intestinal evisceration through the vagina leading to acute intestinal obstruction. Both patients underwent intensive resuscitation followed by an emergency laparotomy. The first case was a 26-year-old woman living in rural Cameroon. Following a procedure of termination of her pregnancy, the patient noted the presence of bowel at the vaginal introitus associated with signs of intestinal obstruction. She was transferred to a specialized center was after 4 days later of the onset of the evisceration. Considering the gangrened eviscerated terminal ileum, a right hemicolectomy with anastomosis was performed, as well as a suture of the uterine perforation. The second patient was an 18-year-old African living as a refugee in Cameroon. She was referred for abdominal pain in the context of intestinal obstruction with a viable jejunal loop extruding through the vagina. A simple jejunal resection was performed with end-to-end anastomosis and suture of the uterine perforation. In both cases, the postoperative course was uneventful. CONCLUSIONS: Uterine perforation is a serious complication of intrauterine gynecological procedures and instrumental abortion in particular. It can lead to evisceration of the intra-abdominal viscera through the uterine perforation. It is therefore a real surgical emergency with multiple and fatal consequences.

Lateral frontal galeal-cutaneous flap for reconstruction after orbital exenteration for advanced periorbital skin cancer.

BACKGROUND: Orbital exenteration (OE) is one of the most disfiguring procedures leading to significant deformity. Defect reconstruction is challenging, especially in elderly patients. Herein, experiences with orbital exenteration and primary reconstruction with lateral frontal galeal-cutaneous flap based on superficial temporal artery were reviewed. METHODS: Data on patients treated for nonmelanoma skin cancer invading the orbit during a 10-year period were analyzed. The patient demographics, tumor features, reconstructive techniques used, complications, and survival were recorded with a median follow-up of 27.5 months. RESULTS: Included in the study were 26 patients in whom OE was performed, comprising 14 males and 12 females, with a mean age of 75.29 years (range: 61-87). The majority of the patients were treated for basal cell carcinoma with medial cantus as the primary site. All of the defects were closed using a lateral frontal galeal-cutaneous flap based on the superficial temporal artery, and in 2 patients, a temporalis muscle pedicle flap was used as an additional flap for reconstruction of the orbital roof in order to separate the brain from the empty orbit, and it was then covered with the same galeal-cutaneous flap. In 19 patients, the frontal area was closed primarily, and in 7 patients, skin graft was used for the secondary defect. There was no flap loss. Tumor-related death was registered in 3 patients (inoperable recurrent tumors) (11.5%), 7 died from complications that were unrelated to the tumors (2 were operated for recurrent orbital tumors), and 16 survived. DISCUSSION: The preferred method for reconstruction after OE at our university affiliated center is lateral frontal galeal-cutaneous flap based on the superficial temporal artery. Flap harvesting is simple, safe, and obtains enough tissue to cover the defects, even after extended exenteration. The complication rate is low. The simultaneous use of this flap with pedicle temporalis muscle flap is suggested only for reconstruction of the scull base after anterior cranial fossa resection.