Scar Endometriosis - A Rare Entity: Case Series

Endometriosis is a condition where there are functional endometrial glands and stroma in sites other than uterine mucosa. It is a unique condition which is benign but has a tendency of invasion and extension locally. Scar endometriosis is a rare entity where there is presence and proliferation of endometrial gland and stroma in the scar of the previous surgery. It is estimated to be only 0.03 to 0.15% of all cases of endometriosis. Because of its deceptive nature and lack of specific diagnostic tools, scar endometriosis is often difficult to diagnose. It is also a challenge for the clinicians as this condition is difficult to treat because it is nonresponsive to hormonal treatment and excision is often the only effective treatment. Here we present two cases of scar endometriosis that we have encountered in BIRDEM general hospital, Dhaka, Bangladesh in last five years.

Comparison of Hysterosalpingography and Laparoscopy as Diagnostic Tool for Tubal Infertility in Bangladesh

Background: Tubal evaluation is an integral part of the evaluation of female infertility. Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes, which has been used as a first-line test for tubal assessment since 1920s. Laparoscopy is considered to be the gold standard for the diagnosis and management of tubo-peritoneal pathology. The objective of this study is to evaluate and compare the diagnostic value of both HSG and laparoscopy for assessment of tubal occlusion.

Methods: This is a prospective cross-sectional study. Laparoscopic chromopertubation was conducted on 125 consecutive infertile women who attended the “Infertility Management Center” from October 2018 to September 2019. All patients had HSG performed in the radiology department of different hospitals. Laparoscopic findings were used as a reference standard to analyze the findings of HSG for tubal occlusion. Data were analyzed by SPSS software (version 16).

Results: Normal HSG findings were seen in 53 patients (42.4%). Unilateral tubal occlusion was present in 38 (30.7%), and bilateral occlusion in 34 (27.2%) patients. Laparoscopy showed normal findings in 85 (68.0%) patients. Unilateral tubal occlusion was demonstrated in laparoscopy in 27 (21.6%) and bilateral tubal occlusion in 13 (10.4%) patients. HSG findings for diagnosis of tubal occlusion was true positive in 30 (24%) cases, false positive in 42 (33.6%) cases, false negative in 10 (8%) cases, and true negative in 43 (34.4%) cases in comparison to laparoscopy findings. Sensitivity of HSG was found to be 75.0%, specificity 50.6%, and accuracy 58.4%. Positive predictive value and negative predictive value were 41.7% and 81.1%, respectively.

Conclusion: HSG is widely used for tubal assessment in Bangladesh as it is a relatively inexpensive, low-risk office procedure. But it has a low specificity and positive predictive value with a relatively high negative predictive value. Laparoscopy, on the other hand, is preferable when there is high suspicion of tubal pathology.

Surgical Management of Desmoid Tumor of the Female Pelvis: A Case Report

A 25 years married women having one child delivered vaginaly presented in the department of Obs & Gynae, Bangabandhu Sheikh Mujib Medical University, Bangladesh on April 2013 with pelvic pain and discomfort. No history of previous pelvic trauma was present. Patient examination showed a isolated mass in the right lower abdomen, right adnexa, extending to the pelvic wall upto lower end of ureter. Tumor markers were within normal limit. Intravenous pyelogram (IVP) showed mild right hydroureter and hydronephrosis with obstruction at the lower end of ureter. She was diagnosed as a case of adnexal mass with mild hydroureter & mild hydronephrosis and it was decided to operate on the patient. The surgical approach was transabdominal. On laparotomy a pseudocystic lesion 12×10cm in size was found over the right paracolic gutter and extending down into the pelvis involving the right parametrium. No abnormality was found in the uterus or tubes. The histological examination revealed a desmoid tumor of the pelvis. The patient's recovery was uneventful.

Post operative diagnosis of osteopetrosis

Osteopetrosis is a rare hereditary disease that was first described by a German Albert Schonberg in 1904. At least five types of osteopetrosis have been described. Among them osteopetrosis congenita (autosomal recessive) and osteopetrosis tarda (autosomal dominant) are most common. Here we are reporting a case of osteopetrosis tarda, who is a female of fifty years of age presented with fracture femur. Preoperatively there was no suspicion of osteopetrosis. She was only suspected while introducing an IM Nail during her fracture reduction. Diagnosis of osteopetrosis was confirmed post operatively by histopathology of medullary cavity of her femur.