Cases Of Prolapse Research Articles

Perineal Rectosigmoidectomy with defunctioning colostomy for Gangrenous Rectal Prolapse; A Case Report

A rare complication of rectal prolapse is incarceration or even strangulation. This type of complication needs emergency intervention either by medical reduction or surgical procedures. In this report, a rare case of rectal prolapse with deep mucosal ulceration down to the muscle with an unremarkable past medical history, and no predisposing pathology presented. The patient underwent laparotomy and perineal proctosigmoidectomy (Altemeier operation) but without primary anastomosis. The distal stump was closed and reduced with a temporary defunctioning colostomy. The postoperative course was uneventful. The colostomy was joined to a distal stump by a stapler after 6 months with an excellent outcome. This procedure gives a value of multi-procedures in the unusual presentation of rectal prolapse.

Cord prolapse and the neonatal outcome

Aims and Objectives: The primary objective of this study was to determine the obstetric risk factors and the management protocol of cord prolapse in our unit through analysis of cases diagnosed over a period of 30 months. The secondary objective was to assess the neonatal outcomes that may be associated with cord prolapse.
 Materials and Methods: A retrospective analysis for a period of 30 months was done during which there were 24 cases of cord prolapse (0.19% incidence) excluding cord presentations. The obstetric variables, parameters which determine the perinatal outcome were analysed. Statistical analyses were performed with the SPSS, Chi-Square test was used to test the statistical significance.
 Results and Conclusion: The mean maternal age was 31.8±5.5 years. In 50% of the cases, labor was induced. The incidence of abnormal fetal presentation was 8%, and in two patients (8%) onset of labor was preterm. The mean diagnosis to delivery interval (DDI) was 15 minutes and 30 seconds; except for one vaginal delivery, all women underwent crash cesarean section delivery. There were no perinatal mortalities noted. It throws light onto whether DDI could be a critical determinant in deciding the neonatal outcome. Maneuvers to relieve pressure on the umbilical cord was followed but poorly documented (25%) as was the communication with the women and their partners. Various neonatal parameters such as the five-minute Apgar score, Cord pH, hypoxia ischemic encephalopathy (HIE), intubation during resuscitation and length of stay were assessed during the study which showed satisfactory neonatal outcomes.

Case of Mitral Valve Prolapse – Associated Sudden Cardiac Death in Pregnancy

BACKGROUND Mitral valve prolapse (MVP) is a frequent echocardiographic finding that can be accompanied by symptoms ranging from a benign course to occasionally catastrophic complications, such as heart failure, and rarely, sudden cardiac death. Female sex, younger age, physiological or psychological stress, electrical instability, and changes in the structure of the mitral apparatus all seem to be risk factors for fatal ventricular arrhythmias in patients with MVP. We report a case of MVP-related cardiac arrest in a pregnant woman, which is rarely reported. CASE REPORT A 34-year-old woman who had collapsed at home from cardiac arrest was transported to the hospital. She had no history of cardiac diseases and was 8 weeks pregnant. Premature ventricular complexes and sinus tachycardia were observed on the 12-lead electrocardiogram as she arrived at the Emergency Department. The second cardiac arrest she experienced while in the hospital was observed to be from torsades de pointes. Further investigations revealed severe mitral valve regurgitation due to posterior leaflet prolapse and regional hypokinesis of the inferior wall and interventricular septum. CONCLUSIONS Ventricular arrhythmia is a frequent finding of mitral valve regurgitation. However, it rarely results in serious consequences. Malignant arrhythmic mitral valve regurgitation can result in sudden cardiac death; therefore, physicians need to be aware of patients with MVP who exhibit characteristics of a potential high-risk profile in order to avoid tragic outcomes.

Case Report on Kawasaki Disease with Rectal Prolapse

Background: Mucocutaneous lymph node syndrome and infantile polyarthritis nodes are other names for Kawasaki illness, which is characterized by inflammation of the walls of various blood vessels in the body. It is particularly common among children and adolescents. Case presentation: A 6-year-old male child was brought by his parent to the pediatric unit after suffering from high-grade intermittent fevers of up to 102°F for three days, mild dehydration, tachycardia, rhinorrhea, cough, oropharyngeal changes, and oral thrush. He has a history of the previous hospitalization for a mild case of rectal prolapse which was pushed into place manually. On physical examination, he was agitated, febrile, and had a body temperature of 102°F. He also had mild swelling in the lymph node, no pallor but some dehydration, tachycardia (130 bpm), a respiratory rate of 35 breaths per minute, redness of the tongue, redness of the sole, a skin rash, and edematous lips. Later he was treated with antiplatelets, antibiotics, and intravenous fluids. Conclusion: Kawasaki disease (KD), an unusual kind of systemic inflammation, is most frequently found in children below the age of five. Due to the maternal antibodies' protective qualities, Kawasaki disease is rarely diagnosed in infants under the age of four months. There are ten to twenty occurrences per 100,000 children under five. The most well-known cause of acquired cardiovascular disease in newborns and young children is Kawasaki disease. If recognized and treated promptly, kids feel better in a few days and have a low risk of developing long-term heart issues.

A Case of Umbilical Cord Prolapse With Intact Membranes Managed Successfully With Conservative Measures

Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord prolapses beyond the internal os with intact membranes, there is an opportunity to intervene and reduce the risk of fetal morbidity and mortality. A healthy 30-year-old, gravida 1 para 0 was incidentally found to have a short cervical length at 25 weeks five days on routine anatomy ultrasound evaluation. On evaluation via ultrasound by the maternal-fetal medicine service, the umbilical cord was noted to be prolapsing through the cervix with membranes intact. The cord prolapse with intact membranes resolved after placing the patient in the Trendelenburg position and nifedipine was administered for tocolysis given the uterus was noted to be contracting. For the remainder of the pregnancy, the patient underwent close follow-up and serial ultrasound scans with confirmation of the fetal head as the presenting part. The patient ultimately delivered vaginally at term. Cord prolapse with intact membranes, when identified via ultrasound, can be managed conservatively via Trendelenburg positioning and tocolysis to avoid premature cesarean delivery.

Anorectal prolapse in an infant mimicking gluteal mass

Rectal prolapse is rare in children but usually occurs before four years of age. There are a few conditions that predispose to rectal prolapse as well as numerous conditions that mimic the condition. We present a case of rectal prolapse that presented as a gluteal mass and diagnosis was confirmed by radiology imaging and was successfully managed surgically. • Rectal prolapse in children is uncommon but usually presents before four years of age. • The cause is idiopathic in most cases and resolves spontaneously but sometimes surgery correction is needed. • Common causes are chronic constipation and cystic fibrosis. • There are various conditions that mimic anorectal prolapse hence easily misdiagnosed.

Surgery for Lumbar disc prolapse in pregnancy: Case series

Low back pain during pregnancy due to weight gain, biomechanical changes, increase level of relaxin hormone produced by the corpus luteum during pregnancy, are the probable etiologies. Lumbar disc herniation causing radicular pain during pregnancy is a rare clinical entity. Surgical management during pregnancy poses high risk to the developing fetus and the mother. Key issues to be considered are the diagnostic tests, Indications for surgery, timing of surgery in respect of gestation, anesthesia and drugs, operative positioning, and continuation of pregnancy after surgery.Herein, author present three cases of lumbar disc prolapse causing low back pain with radiculopathy in pregnancy.

Cryoablation of Papillary Muscles at Surgery for Malignant Ventricular Arrhythmias Due to Mitral Valve Prolapse.

Mitral valve prolapse (MVP) is relatively common condition and while generally benign a small subset of patient suffers from malignant ventricular arrhythmias (MVA) and sudden cardiac death (SCD). We report three cases of mitral valve prolapse, mitral regurgitation and malignant ventricular arrhythmias refractory to medical therapy, who had surgical cryoablation at the time of surgery on the mitral valve. During a follow-up period ranging from 3 to 11 years all three patients have remained free of ventricular arrhythmias and cryoablation lesions targeting the base of the papillary muscles have not caused any detrimental effect on the valve function. Surgical cryoablation of papillary muscles as described in this article should be considered in MVP who suffer from MVA, aborted SCD or frequent ventricular ectopics likely to cause LV dysfunction.

Mitral Annulus Disjunction and Arrhythmic Mitral Valve Prolapse: Emerging Role of Cardiac Magnetic Resonance Imaging in the Workup.

Mitral valve prolapse is a commonly described entity with a highly variable and benign course. However, it is associated with ventricular arrhythmias and sudden cardiac death in a small subset of patients. Recent studies have yielded insight into myocardial mechanics and the causation of ventricular arrhythmias in these groups of patients. Mitral annular disjunction (MAD) characterized by detachment of mitral annulus from left ventricular myocardium is associated with morphological and functional remodeling of the left ventricular myocardium. Resultant fibrosis acts as a substrate of ventricular arrhythmia and sudden cardiac death. We present two such cases of arrhythmic mitral valve prolapse associated with MAD. Cardiac magnetic resonance imaging provides excellent morphological information and also helps in the assessment of fibrosis.

Non-Descent Vaginal Hysterectomy (Ndvh): A Promising Surgical Technique in Benign Uterine Disorders

Background: Hysterectomy, one of the most common gynaecological surgeries performed around the world, has many techniques including abdominal, vaginal, laparoscopic and robotic. The Vaginal technique which was introduced and performed eras back has been less successful due to lack of experience and eagerness among gynaecologists because of a misconception that the abdominal route is safer and is easier. Aims and Objectives: Evaluation of most efficient and suitable route of hysterectomy.comparison between intraoperative and postoperative complications in non descent vaginal hysterectomy and abdominal hysterectomy. Materials and Methods: This retrospective study was conducted during the period from October 2020 to December 2021, it studied 60 women who underwent hysterectomy for benign uterine disorder at Khemchand Jain Hospital, Sagar, out of which 30 women underwent non descent vaginal hysterectomy and 30 women underwent total abdominal hysterectomy. Result: Baseline characteristics were similar between the two groups with no intraoperative complications in either. Regarding operation duration, intraoperative blood loss, post-operative pain, post-operative blood transfusion, mobilization in post-operative periods, post-operative wounds infection, febrile morbidity, duration of hospitality stay, P-value was significant in vaginal hysterectomy when compared to abdominal hysterectomy. Regarding post-operative systematic infection, P-value was not significant. None of the cases in the vaginal group were converted to abdominal route and none of the cases in the whole study group underwent relaparotomy. Conclusion: The study concludes that patients requiring hysterectomy for benign non prolapse cases may be given the option of vaginal hysterectomy because it has quicker recovery, shorter hospitalization, lesser operative and post-operative morbidity compared to abdominal route.

Follow-Up of Robotic Mitral Valve Repair: A Single Tertiary Institution Experience in China.

Surgical treatment of mitral valve diseases has become minimally invasive. This study analyzed the follow-up results of patients after mitral valve repairs (MVRep) using the da Vinci robot. The clinical data of patients who underwent minimally invasive MVRep using the da Vinci robot between January 2016 and June 2021 and completed follow-ups were prospectively collected. All operations were performed by the same surgeon and assistants. The data of a total of 120 patients were available for analysis, including 78 males (65%) and 42 females aged 49.9 ± 12.1 years (range, 19–73 years). Among them, there were 30 cases (25%) of mitral valve prolapse, 87 cases (72.5%) of mitral regurgitation, and 40 cases of combined tricuspid regurgitation. Edwards Physio II annuloplasty rings were implanted intraoperatively, followed by continuous sutures. The intraoperative cardiopulmonary bypass time was 152.32 ± 45.77 min, and the aortic occlusion time was 95.13 ± 5.64 min. After surgery, patients were followed up regularly with echocardiography with a follow-up period of 3–57 months postoperatively. One patient died in the early stage, and five patients required sternotomy due to postoperative bleeding. Follow-up transesophageal echocardiography showed that the end-systolic diameter, end-diastolic diameter, and ejection fraction of the left ventricular all improved after surgery. Among Chinese patients, MVRep using the da Vinci robot is a safe and effective surgical approach.

Cog Threads for Transvaginal Prolapse Repair: Ex-Vivo Studies of a Novel Concept

The diagnosis and treatment of pelvic organ prolapse (POP) remain a relevant and scientifically challenging topic. The number of cases of genital prolapse increases each year, one in ten women need at least one surgical procedure and one in four women in midlife have asymptomatic prolapse. Using mesh implants to correct POP presents unsatisfactory clinical outcomes, requiring hospital readmission and further surgery. We hypothesize using an alternative surgical intervention technique, applying injectable biodegradable cog threads, currently used for face lifting procedures, to reinforce and correct vaginal wall defects. The threads used in this investigation are commercially available 360° 4D barb threads (PCL-19G-100), made of polycaprolactone (PCL), supplied in sterile packs (Yastrid, Shanghai, China). Eleven sows’ vaginal walls were used to analyze the immediate reinforcement effect of the threads. Uniaxial tensile testing and scanning electron microscopy (SEM) was performed for the initial characterization of the threads. Threads were inserted into the vaginal wall (control n = 5, cog n = 5) and were characterized by ball burst testing; a pull-out test was performed (n = 6). With SEM images, dimensions, such as thread diameter (≈630 µm), cut angle (≈135°), cut depth (≈200 µm) and cog distance (≈1600 µm) were measured. The mechanical behavior during uniaxial tensile testing was nonlinear. Threads could sustain 17–18 N at 18–22% of deformation. During the ball burst test, vaginal tissue reinforced with threads could support 68 N more load than normal tissue (p < 0.05), indicating its strengthening effect. Comfort and stress zones were significantly stiffer in the tissues reinforced with threads (p < 0.05; p < 0.05). Both groups showed identical deformation (elongation); no significant differences in the comfort zone length were observed, showing that threads do not affect tissue compliance. The pull-out test showed that the threads could sustain 3.827 ± 0.1891 N force when the first cog slip occurs, at 11.93 ± 0.8291 mm. This preliminary research on using PCL cog threads for POP treatment showed promising results in increased vaginal wall resistance to pressure load and, at the same time, not affecting its compliance. Nevertheless, to obtain long term host response in vivo, further investigation will be carried out.

A case of Transvaginal NOTES (vNOTES) hysterectomy. Multidisciplinary minimal invasive approach for all aspects

Umbilical single-port surgeries developed with advanced technological equipment like flexıble optics and reticulated graspers. Single-port surgeries decreased skin incision and multiple port-site pain concerns. Case: In this study, a 74-years-old, postmenopausal female had P2G2 descensus uteri, subtotal uterine prolapse. Complaints were about vaginal mass disturbing life quality associated with bladder incontinence. vNOTES Hysterectomy performed. Case: vNOTES Hysterectomy was performed and spinal anaesthesia was used as a regional anaesthesia (RA) for the procedure. vNOTES allow for safe surgery for ovarian and adnexal structures and visual exploration in the abdominal cavity. Conclusion: vNOTES Hysterectomy allows safe surgery, especially for elderyl and uterine prolapse cases.

Fetal heart rate evolution patterns in cerebral palsy associated with umbilical cord complications: a nationwide study

BackgroundThe aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord complications.MethodsThis case–control study included children born: with a birth weight ≥2000 g, at gestational age ≥33 weeks, with disability due to CP, and between 2009 and 2014. Obstetric characteristics and FHR patterns were compared among patients with CP associated with (126 cases) and without (594 controls) umbilical cord complications.ResultsThere were 32 umbilical cord prolapse cases and 94 cases with coexistent antenatal umbilical cord complications. Compared with the control group, the persistent non-reassuring pattern was more frequent in cases with coexistent antenatal umbilical cord complications (p = 0.012). A reassuring FHR pattern was observed on admission, but resulted in prolonged deceleration, especially during the first stage of labor, and was significantly identified in 69% of cases with umbilical cord prolapse and 35% of cases with antenatal cord complications, compared to 17% of control cases (p < 0.001).ConclusionHypercoiled cord and abnormal placental umbilical cord insertion, may be associated with CP due to acute hypoxic-ischemic injury as well as sub-acute or chronic adverse events during pregnancy, while umbilical cord prolapse may be characterized by acute hypoxic-ischemic injury during delivery.

Acute gastric prolapse through gastrostomy site: A surgical emergency

Gastric prolapse through a gastrostomy site is a rare but potentially fatal complication in gastrostomy-tube (G-tube) dependent pediatric patients. We describe a case of strangulated gastric prolapse through a gastrostomy site in a 5-month-old patient with chronic respiratory failure, poor nutritional status, and multiple preceding G-tube complications. The patient required immediate surgical evaluation and underwent operative reduction and gastrostomy access revision within hours of presentation. There are documented cases of gastric prolapse in pediatric and adult patients, but there is no standardized management strategy. In this paper, we aim to increase vigilance of gastric prolapse in high-risk pediatric patients and to demonstrate a management plan that focuses on rapid surgical assessment and intervention to prevent significant morbidity and mortality.

Prolapse and amputation of phallus in a greater rhea (Rhea americana) kept in captivity: Case report

Rheas are the largest birds in South America. Belonging to the order of Struthioniformes, they are bred in captivity for their beauty and also for the quality and use of their meat, leather, feathers and eggs. The objective of this report was to describe a case of prolapse and amputation of the phallus after clinical and surgical care of a greater rhea (Rhea americana), to contribute to the literature on the occurrence of this condition in ratites. The animal was raised and is kept in captivity at Federal University of Piauí (UFPI), in Teresina, Piaui state, Brazil. The animal relapsed after two attempts to reduce the phallus prolapse, requiring amputation, since the animal’s organ presented areas of necrosis. After the intervention, the animal was returned to the previous enclosure, regrouping with the flock without complications and maintained a normal pre-surgery behavior. To the author’s knowledge, this is the first case of phallus and cloaca prolapse reported in Rhea americana.

Acute prolapse of giant submucosal fibroid polyp mimicking uterine inversion- A rare case report

Acute prolapse of giant submucous fibroid polyp is very rare. We share our experience of management of this case with polypectomy.Leiomyomas are the most common benign tumors of the uterus. Some submucousal myomas become pedunculated in the uterine cavity, dilate the cervix and protrude into the vagina. Also the myomas may become necrotic, infected and gangrenous due to inadequate blood circulation through a long pedicle or if the pedicle of leiomyoma twists.We report a case of acute prolapse of giant fibroid polyp which mimic’s uterine inversion.Giant fibroid polyp is a rare condition, it should be kept in mind as a differential diagnosis to mass per vaginum.Acute prolapse of giant submucosal fibroid polyp without any associated complications can be managed by polypectomy avoiding unnecessary hysterectomy.

Spontaneous clinical and radiological resolution of a large extruded disc in the lumbar spine

Low back ache arising due to a herniated lumbar disk with radicular pain to the lower limbs is a commonly occurring problem evaluated by spine surgeons. Conservative treatment has usually been proposed for an acute disk prolapse in cases without significant motor or sensory deficit. Spontaneous radiological regression of an extruded herniated disk with complete symptomatic recovery has occasionally been reported. A case of conservatively treated large extruded lumbar disk is described who showed complete radiological resolution, along with regression of the clinical symptoms.

Ayurvedic Approach to Female Pelvic Organ Prolapse w.s.r. to Prasramsini Yonivyapad: A Case Study

Background: One of the 20 Yonivyapad described by Acharya Sushruta as a condition in which any irritation to the Yoni causes it to prolapse is Prasamsini Yonivyapad. This syndrome is linked to both primary and secondary uterine prolapse. When dealing with the problem of genital prolapse, surgical procedures cannot always be used or, in some situations, avoided. In such circumstances, conservative approaches may be recommended. Ayurvedic Acharyas have recommended numerous therapeutic approaches that have been used since ancient times and have proven beneficial outcomes in many cases of prolapse. Main observations: In present case study, a young female aged 38 years consulted the Ayurvedic OPD of M.M.M. Govt. Ayurved College&amp; Hospital, Udaipur with complaints of something coming out of vagina, lower abdominal pain, white discharge per vagina and burning micturition suggestive of second degree uterine prolapse confirmed by bimanual examination. It can be correlated to prasramsini yonivypada in Ayurveda. So, we planned an ayurvedic treatment regime with the goal of improving the symptoms of patient. Result- The patient was treated with local Application of Majuphal churn and Shubhra bhasm with some oral medications. Only traditional Ayurvedic medicines were used during the treatment. Patient’s condition was assessed through improvement in symptoms. Therefore, this study was conducted to evaluate one of the treatment regimens of pelvic organ prolapse. Conclusions: The study concluded that ayurvedic medication was significantly effective in treating Prasramsini yonivypada (female pelvic organ prolapse)

Management of Two Cases of Spina Bifida and Neonatal Genital Prolapse at the University Hospital of Parakou and Review of the Literature

Spina bifida, or spinal dysraphism, is a malformative pathology related to an anomaly in the development of the nervous system, occurring during embryogenesis. The neural tube does not close properly around the 28th day of life and affects the development of the spinal column and spinal cord. Spina bifida is characterised by damage to the nervous system and will generate handicaps and damage of varying degrees: neurological motor, sensory, cognitive, genito-phincter (bladder and anorectal) deficits with consequences for the quality of life of these people. The literature describes the association between spinal dysraphism and genital prolapse. However, genital prolapse is an exceptional and rare entity in newborns. We report the observations of two newborns: the first case of a newborn born at term, at 7 days of age, who presented a prolapse of the uterine cervix in association with myelomeningocele, without any neuromuscular repercussions, and the second case of a newborn at 10 days of age, presenting with a lumbosacral spina bifida and a uterine prolapse. They benefited from conservative medical treatment characterised by manual reduction of the prolapse in both cases with a favourable evolution. In the case of spina bifida, a cure of myelomeningocele was performed surgically with simple postoperative course.