Vaginal evisceration is a rare condition most commonly associated with previous vaginal surgery. It usually presents with vaginal bleeding, lower abdominal pain and a protruding mass, and requires immediate assessment and surgical management to salvage the prolapsed bowel. Any delay in the treatment may result in bowel ischaemia and perforation which is associated with higher morbidity and mortality. We report a case of spontaneous vaginal evisceration during defaecation in a 56-year-old postmenopausal women 11 months post hysterectomy. This case highlights the benefits of a combined laparoscopic and transvaginal approach in the successful management of this surgical emergency.

A 72-year-old woman was brought to the hospital emergency department with a history of 8 hours of abdominal pain and vomiting. The clinical examination was unremarkable. A plain x-ray of the abdomen showed multiple air/fluid levels. She was admitted to the surgical ward with a suspected mesenteric vascular ischemia. Her condition in the next 24 hours waxed and waned, with stable vital signs. On a repeat film, her earlier x-ray findings were not seen. She had a history of hypertension and was on irregular treatment. She had had similar episodes of abdominal pain with vomiting during the 10 days prior to this presentation. They were of short duration and self-limiting.On the second day, she developed sudden hypotension and dyspnea. The abdominal pain worsened. An ECG revealed an acute ST-elevation inferior myocardial infarction (AMI). (The ECG at admission had been within normal limits.) While she was being managed for the AMI, a repeat x-ray and an abdominal ultrasound confirmed the presence of mesenteric vascular ischemia. She was stabilized with conservative management.A high-risk consent was obtained and she underwent a successful bowel resection. The surgical findings were of a gangrenous small bowel, sparing 70 to 90 cm of the jejunum after the duodenojejunal flexure, and a gangrenous colon extending up to the proximal third of the transverse colon. The pathology report of the resected bowel identified intestinal infarction due to mesenteric vascular occlusion.An echocardiogram was done postoperatively. To our surprise, it revealed a large, highly mobile mass in the left atrium. It moved freely in and out of the mitral valve orifice with each cardiac cycle. It was attached to the interatrial septum. The distal border was shaggy in appearance and showed small multiple hyperechoic areas. The clinical diagnosis of the mass was a left atrial myxoma. The clinical picture was now explainable as resulting from emboli thrown from the myxoma migrating into the mesenteric and coronary vasculature.

No abstract

This book represents the first serious consideration of Ismaili-Shia esotericism in material and architectural terms, as well as of pre-modern conceptions of religious plurality in rituals and astrology. Sufism has long been reckoned to have connections to Shi'ism, but without any concrete proof. The book shows this connection in light of current scholarly work on the subject, historical sources, and most importantly, metaphysics and archaeological evidence. The monuments of the Suhrawardi Order, which are derived from the basic lodges set up by Pir Shams in the region, constitute a unique building archetype. The book's greatest strength lies in its archaeological evidence and in showing the metaphysical commonalities between Shi'ism/Isma'ilism and the Suhrawardi Sufi Order, both of which complement each other. In addition, working on premise and supposition, certain reanalysed historical periods and events in Indian Muslim history serve as added proof for the author's argument.

No abstract