Background: North East is the “cancer capital” of India where there is acute lack of oncologists and oncology facilities. Objectives of the study were to evaluate the trends of gynecological malignancies and to evaluate the need for oncology facility in Sikkim.Methods: This is a retrospective desk review conducted in department of obstetrics and gynecology at Sikkim Manipal institute of medical sciences, India, for a period of three years after the start of oncology surgeries. Women operated for any gynecological malignancy were taken into the study while women referred outside for alternative treatment were excluded from the study.Results: A total 29 women with gynecological malignancies were operated during the 3-year period. Of the total, 17 (58%) were women operated for carcinoma ovary, 6 (21%) for cancer cervix and 6 (21%) for carcinoma uterus. Epithelial ovarian cancer was the most common ovarian cancer. 105 women with large complex ovarian masses were operated during the three-year period, however, only 17 women were diagnosed with cancer of which 8 women had stage I disease while 9 women had advanced disease (stage III-IV). 12 women underwent primary debulking surgery while 5 women underwent interval debulking surgery. Average age for cervical cancer was 48 years, average age for ovarian cancer was 46 years while 52 years was the average age for cancer uterus. Conclusions: High number of gynecological malignancies operated in the only center offering minimum oncological surgical facility points towards the need for a specialized center providing all the needs for treating oncology cases in Sikkim

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Pelvic inflammatory disease (PID) during late pregnancy is rare. Authors report a case of severe PID manifesting as subacute intestinal obstruction at early third trimester of pregnancy. A 26 years woman at 28 weeks of gestation was admitted in OBG department of Central Referral Hospital (CRH), Sikkim for evaluation of pain in left hypochondrium with tachycardia and mild rise in temperature. Her WBC was 26,900/cmm while urine and blood cultures were sterile. USG showed single live gestation of 27weeks 3days with a heterogeneous mass suggestive of degenerative fibroid. She had recurrent episodes of subacute intestinal obstructions. Her condition deteriorated, hence, elective caesarean with exploratory laparotomy was done. Single live baby was delivered after which abdominal exploration revealed purulent ascites with multiple pockets of pus. Omental cake along with the bowel was adhered to the fundus of uterus. There was no area of perforation in the gut. Bilateral adnexa were adherent to the pre-sacral region which was densely adhered to underlying great vessels. Post operatively antibiotic to cover the anaerobic bacteria were given to which she responded. Baby died after 4 days of birth due to sepsis. One week after discharge she was readmitted with left sided pleural effusion which responded to antibiotics. PID should be considered a cause of abdominal pain and rise in temperature in pregnancy, as early diagnosis can be managed conservatively with antibiotics thus decreasing maternal and perinatal morbidity and mortality.

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