Pyometrocolpos in an 18-Month-Old Child: A Rare Cause of Acute Abdomen.

Acute abdomen secondary to pyometrocolpos as a result of microperforate hymen in an 18-month-old child is extremely rare to witness. Such a child was admitted with a history of poor appetite, lethargy, high-grade febrile episodes, frequent urination, and multiple episodes of vomiting in seven days. There was no relief of symptoms on oral antibiotics. On careful examination, the abdomen was distended. A suprapubic bulge with mild tenderness was palpable. Genital examination revealed the absence of vaginal introitus with a bulging membrane. Ultrasound showed the presence of echogenic contents within the dilated uterine and vaginal cavities. An emergency hymenotomy drained 150 cc of malodorous purulent material. Symptoms were relieved post-surgery. This, to our knowledge, being the youngest case of microperforate hymen presenting with acute abdomen makes it worth reporting.

Post Caesarean Section Deep Pelvic Abscess: CT Guided Transgluteal Drainage.

Organ space surgical site infection (SSI), in itself, is a problematic condition for the surgeon and also adds pain and misery to the patient. If it happens along with deep pelvic collection, it further increases the risk of sepsis to the patient. Untreated abdominal or pelvic abscesses are associated with high mortality. This outcome is improved due to advances in image-guided percutaneous interventional techniques. The aim is to drain the collection with minimal morbidity to the patient. We report a case of deep surgical site infection following caesarean section in a COVID-19 positive patient managed with minimal intervention.

Assessing the Barriers to Postpartum Tubal Ligation Among Multiparous Women.

BACKGROUND: Unmet demands for postpartum tubal ligation are estimated to be greater than the actual number of tubal ligations done, especially in low-resource settings. Through this study, we therefore assessed the barriers to postpartum tubal ligation in the developing world. MATERIALS AND METHODS: It is a prospective cohort study including 3671 multiparous women from northern India. Recruited patients were given survey questionnaires during their antenatal and postpartum period which evaluated the patient-related, healthcare facility-related and social factors which were the determining factors for the unfulfillment of their desire for permanent sterilization. RESULTS: Out of the recruited population, 1576 women wished to undergo tubal ligation. Following attrition, a total of 1024 were followed up prospectively. Of them, sterilization was successfully done only in 309 (30.18%) participants. A large proportion of mothers had their demand unmet (715 mothers; 69.82%). Out of them, 505 (70.63%) women stated that tubal ligation was not done because they did not deliver by Caesarean section. Insufficient counselling regarding tubal ligation was quoted by 325 (45.45%) mothers. Majority of the participants denied tubal ligation as they were not given enough information about the procedure (589 participants; 82.38%). While 568 (79.44%) mothers had changed their mind after delivery, 257 (35.94%) thought that their health was not fit to undergo the procedure and 213 (29.79%) mothers wanted more children in the future. We found that there was strong opposition from their male partners (56.78%). CONCLUSION: Postpartum tubal ligation is of paramount importance in women with completed families, especially in developing countries. This prospective study addressed the barriers to tubal ligation, which would help combat future unintended pregnancies.

Gynaecological Laparoscopic Surgeries in the Omicron Era: Improvising the Management Skills After Lessons Learnt From the Delta Wave.

Background During the peak of the Omicron wave, elective laparoscopic surgeries were restricted; however, semi-emergency and emergency cases were managed despite the limited resources and manpower. We conducted this study to assess the types of gynaecological laparoscopic surgeries performed, the difficulties faced during the Omicron wave, and how we could implement the lessons learnt from the previous Delta wave for better management of gynaecological cases in the Omicron wave. Methodology We conducted a prospective cohort study over a period of three months involving 105 patients who underwent laparoscopic surgeries. Based on the decision regarding surgical incision time, the surgeries were sub-classified into immediate, urgent, and expedited. The surgical outcome and satisfaction rates among the patients were assessed through various parameters. Results Most of the women (81.9%) were pre-menopausal. Diabetes and chronic hypertension were the predominant medical co-morbidities. Three patients had a history of cardiac valve replacement which required switching warfarin to unfractionated heparin in the pre-operative period. Nearly three-fourthsof the study patients were doubly vaccinated against coronavirus disease 2019 (COVID-19) (77; 73.4%). A total of 14 (13.3%) patients had a history of COVID-19 infection in the past two weeks prior to the current admission. Immediate, urgent, and expedited surgeries comprised 11.4%, 22.8%, and 65.8% of total surgeries, respectively. On assessing the ease of pre-operative preparation according to the five-point Likert scale, immediate, urgent, and expedited surgeries were rated with a mean score of two, four, and five, respectively. The mean duration of surgery in the immediate and urgent groups was 37.6 and 44.2 minutes, respectively. The expedited group comprising mostly laparoscopic myomectomies and hysterectomies required an average duration of 92.6 minutes. The mean rating of patient satisfaction measured by the Likert scale was four, five, and five, respectively, in the three subgroups. Pre-operative patient preparation during the Omicron wave was faster, thereby decreasing the decision to incision interval compared to the Delta wave. Conclusions The lessons learnt from the previous Delta wave were used to modify the existing hospital policies in the Omicron wave. More number of vaccinated ground staff, less stringent intubation and extubation protocols during surgery, and lesser duration of post-operative stay helped modify our existing hospital policies for better patient care and satisfaction.

Ruptured Rudimentary Horn Pregnancy: Delayed Diagnosis.

Developmental anomalies of the genital tract result from defective fusion and absorption of various parts of Mullerian ducts in fetal life. Rudimentary horn pregnancy is a rare occurrence of one in 76,000 and one in 160,000. We present a case of a 24-year-old primigravida with ruptured rudimentary horn pregnancy initially managed in the line of an intrauterine pregnancy with severe anemia. Hemodynamic instability made us suspect ruptured rudimentary horn pregnancy and lifesaving laparotomy was performed for the same. A 1.5-liter hemoperitoneum was encountered with a right ruptured rudimentary horn. Multiple adhesions were present with necrotic tissue adherent and clumped together as tubo ovarian mass. Resection of the rudimentary horn was performed. We report this case to emphasize the need to consider rare uterine anomalies as a possibility in patients presenting with acute abdomen in early pregnancy. Obstetricians should consider these rare entities in the differential diagnosis to provide efficient management of these cases.