Story One – all on the same day!

Well it was few days ago, I was asked to assist in an interesting case, a lady with a abnormal tract connecting her uterus to her previous surgical scar over the lower abdomen. This is what we call as utero-cutaneous fistula. Now how did that come about? Well, a year ago she presented herself to the emergency department in severe abdominal pain. She was taken immediately to surgery and was found to have more than a litre of pus within the abdomen. Her uterus had ruptured – from what we call pyometra (pus within the uterus). This is rare in humans. She developed the fistula thereafter. As the gynae, investigated her despite the intraoperative findings, she was diagnosed to have uterine didelphy. This is a congenital anomaly where there are a pair of uterus, a pair of cervix and also a pair of vagina! Hmmm..!

I showed her Xrays a few days ago and Dr Vijay answered the quiz correctly.
We took her into surgery again hoping to revise her fistula and we managed to do so. I always enjoyed working with the Gynae chaps. A few hours later, I was back in to the operating theatre for Case 2

She was discharged home well 3 days later.

##Anomalies of fusion of the paramesonephric duct are completed by the 18th week of fetal life. The overall incidence is 0.1-3%. UTERINE anomalies are found in 9% women with infertility and/or repeated spontaneous abortions. 25% of women with UTERINE abnormalities have fertility problems. Associated urinary tract anomalies occur in 20-50% of the cases. There is also a possible increased familial occurrence of limb reduction.##