Objective: To determine the justification for hysterectomies and the frequencies of histopathological lesions and complications in hystrectomised patients. Methodology: As a part of a quality assurance process at the Mercy Teaching Hospital, hysterectomies performed between 1st January, 2010 and 1st Jan 2012 were retrospectively analyzed for presenting complaints, surgical indication, histologic findings, and postoperative complications. The hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report or if significant alternate pathology was present. Results: A total of 123 hysterectomies were performed during this period. Eleven (8.9%) patients’ results could not be traced. The other 91.1% had some pathology found. Histologic findings reconfirmed the clinical diagnoses. The hysterectomies were considered justified if p=0.000. Hysterectomy was performed abdominally in 88 (71.5%) patients, vaginally in 35 patients (28.4%). The most common indication for hysterectomy was fibroid related menorrhagia n=40(32.5%), followed by third degree uterovaginal prolapse n=30(24.4%), and dysfunctional uterine bleeding 29(23.6%) patients. Fever was the most common 7(5.7%) post operative complication followed by urinary tract infection 5(4.9%) The incidence of postoperative fever was greater following abdominal surgery, while urinary tract infection was greater following vaginal hysterectomy (P=0.370). Conclusion: Almost 91.1% of all hysterectomies in this study were justified. Clinical diagnoses were related to presenting complaints (p=0.000) and were confirmed by histopathogic findings (p=0.000). Most of the hysterectomies were carried out abdominally in part because fewer patients presented with prolapse.

Fibroepithelial stromal polyps are mesenchymal lesions occurring typically in reproductive age women with a predilection for the vulvo-vaginal region. Malignancy may mimic this polyp in morphology, rendering further investigations including detailed histopathology mandatory. Histologically its characteristic features are stellate and multinucleate stromal cells identified near the epithelial-stromal interface. This case report discusses incidental finding of largest fibroepithelial polyp presented in a 31-year-old nulliparous woman. She was initially admitted with sepsis and detailed physical examination revealed a right-sided infected pedunculated labial mass measuring 20×21 cm. After initial resuscitation for sepsis, she was further investigated for the mass. Transabdominal ultrasound was essentially normal apart from a small fibroid 3×2 cm in the anterior wall of the uterus. The vulval mass was removed under local and regional anaesthesia and was confirmed to be a giant fibroepithelial stromal polyp on histopathology. The woman recovered well and was followed up until 1 year.

Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This life-threatening condition has been historically managed in various ways as no single modality is reliable enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but requiring Surgical management later on. Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP. HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman required surgical management 10 weeks after the initial management, but the blood loss was minimal. Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be considered even with high HCG levels. Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is crucial. Medical management can be considered in most cases even with high HCG, but management has to be tailored according to the patient. Close follow up of patient after Medical treatment is important as they may require further intervention.

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