Difficult airway management is a dilemma for any anaesthesiologist. In the following case we encountered an acutely enlarging thyroid mass that was compromising the airway. Due to the huge neck mass which caused airway compression leading to breathlessness and difficulty in breathing in supine position. This 70 years old male was being investigated for a swelling in the anterior neck region and had sudden increase in the size of swelling. He became breathless and could not breathe in supine posture. Biopsy revealed the swelling to be follicular carcinoma of the thyroid with bilateral lung metastasis. His breathing difficulty compelled us to contemplate emergency tracheostomy because of decreased in saturation and severe respiratory distress.

We present an unusual case of iatrogenic small bowel perforation in a woman with endometrial cancer. A 57-year-old postmenopausal woman with past history of total colostomy with loop ileostomy for ulcerative colitis, was referred to our department for evaluation and further management of suspected endometrial cancer following dilatation and curettage (D&C) elsewhere. The histopathology showed intestinal element which was attributed to metaplasia; however, no malignancy was identified in the biopsy specimen. Imaging carried out elsewhere after D&C showed thickened endometrium with suspicious small bowel infiltration. The patient was completely asymptomatic with no signs of bowel injury or peritonitis. After a complete evaluation, a class 1 extrafascial hysterectomy and bilateral salpingo-oophorectomy with segmental ileal resection and anastomosis and frozen section were performed. Intraoperatively, small bowel loop was found adherent to the posterior uterine wall extending up to the cervix with no obvious sign of any uterine or bowel perforation. The final histopathology revealed endometrioid adenocarcinoma grade 1, stage IA, with tumor located at the fundus along with cervical isthmic perforation on the posterolateral wall with full thickness ileum perforation. Uterine perforation at D&C is a known complication, but a silent bowel injury presenting with intestinal tissue in endometrial biopsy is very unusual. A high degree of suspicion is required to detect such complications at D&C especially in postmenopausal women with past history of abdominal surgery.