The purpose of this review is to provide evidence-based guidance for surgical decisions during abdominal hysterectomy performed for benign indications. Using combinations of terms "abdominal," "hysterectomy," and "randomized clinical trials (RCT)," we performed Ovid, PubMed, and Cochrane searches for publications between 1988 and 2008. After reviewing over 3,000 abstracts, 19 RCT were identified. There are no grade A recommendations. The only grade B suggestion is use of a bipolar vessel sealing device (LigaSure) for vascular pedicles rather than sutures. Routine closure of peritoneum should be avoided. Evidence behind 71 % (15/21) of surgical steps is insufficient (grade I). Despite its common performance, there are no grade A recommendations that can be made for the technical aspects of abdominal hysterectomy. Since almost 70 % of the surgical steps during abdominal hysterectomy lack randomized clinical trials, adequately designed studies are needed to decrease perioperative morbidity.

Abstract:Aggressive angiomyxoma is an uncommon mesenchymal tumor of pelvic area and is usually found to have local invasiveness. It is more commonly found in females and mostly involves pelvis, vulva, vagina, perineum, and urinary bladder. Due to its rare nature there is lack of single clearly beneficial and affective treatment option for this tumor. In the following case report, we discuss the case of a 41 year old female who was seen for an annual gynecological exam and was found to have a vulvar mass upon examination.

We report a case of an extremely rare presentation of a sigmoid carcinoma, which presented as an appendicular abscess along with pseudomembranous colitis involving the small bowel. Colo-rectal carcinoma has presented as abdominal wall abscess in the past, but to the best of our knowledge, an incident of colo-rectal carcinoma presenting as an appendicular abscess and later developing pseudomembranous colitis involving the small bowel has never been reported. Such patients’ condition is potentially curable if detected early through careful history taking, examination, investigations and regular screening programs.