A rare case report of ovarian torsion with sigmoid volvulus

Ovarian torsion results from twisting of the ovary about the suspensory ligament, which contains the ovarian artery and vein, lymphatic’s, and nerves. Volvulus is a torsion of a segment of the alimentary tract, that often leads to intestinal obstruction. Ovarian torsion leading to sigmoid volvulus is the rarest complication which authors found in this case. Hence the case was presented. A 28-year-old women presented with acute pain in abdomen since 14 hours, followed by 2 episodes of vomiting, abdominal distension since 10 hours. Plain X-ray Abdomen erect was done which showed ‘Coffee bean’ sign with multiple air fluid levels suggestive of sigmoid volvulus. On laparotomy, after opening the peritoneum, large right ovarian cyst around 12×11×10 cm with solid and haemorrhagic content with long pedicle around 8 cm with 3 turns of torsion was noted. Abutting the ovarian mass, sigmoid colon was seen twisted around its mesentery including the twisted ovarian pedicle. Hence, the twisted component included the twisted ovarian pedicle and twisted sigmoid mesentery. Stepwise detorsion of ovarian pedicle followed by oophorectomy was done. For sigmoid volvulus, resection of vascular compromised sigmoid colon and descending colon stoma was done. Reanastomosis was done later after 3 months post operatively.

An interesting case report of ruptured pyogenic liver abscess with 40 weeks gestation in labour

Pyogenic liver abscess during pregnancy is an extremely rare condition. Although rare, in situations of sepsis or septic shock in pregnancy, as well as the common sources of infection, a possibility of a liver abscess should be considered. We present a case report of 32-year-old primigravida 37.3 weeks by date, 37 weeks by scan with breech presentation with premature rupture of membranes and pain in abdomen since 12 hours with breathlessness, fever and diarrhoea since 2 days came in emergency to study hospital. General condition of the patient on arrival was pulse-140 beats per minute, blood pressure was 90/60 mmHg, respiratory rate was 40/min, on per abdominal examination, breech presentation with fetal heart rate of 150 beats per minute on doppler was noted. Per vaginal examination revealed cervical os 5 cm dilated, 40% effacement, breech presentation, absent membranes. With urgent report of complete hemogram and acid blood gas analysis, metabolic acidosis was noted which was corrected and patient was taken for emergency lower segment caesarean section. Intra-operative, 250 ml greenish pus flakes fluid was noted inside the abdominal cavity. Fluid was drained and sent for culture sensitivity with maximum aseptic precautions, uterus was opened, baby was delivered followed by uterus closure. Ruptured liver abscess 6×4×2 cm in 2nd and 3rd segment of liver was noted, abdominal wash with antibiotics and NS was given, drain was kept. Appropriate antibiotics were started and was discharged on day 14 after suture removal.