Presacral teratoma is extremely rare in adults. A 35-year-old lady was diagnosed with presacral teratoma on MRI abdomen and pelvis. The tumour was enucleated laparoscopically, this being the first such case to be reported in India and fifth case in world literature. Though traditionally, anterior approach of the presacral tumours meant laparotomy, but recently, laparoscopy has been reported as a safe and effective option for these tumours with the advantages of a magnified view in the narrow pelvis, easier development of natural planes by pneumoperitoneum, faster recovery and less complications if expertise is available.Keywords Presacral teratoma in adult . MRI . Laparoscopic removal . Advantage Sacrococcygeal teratoma in adults occurs at a rate between 1 in 40,000 and 63,000 with a female preponderance of 3:1 [1]. According to Altman Classification, they are of four types: type I tumours are predominantly external; type II are predominantly external but have a small but intrapelvic component; type III are predominantly intrapelvic, with a small external mass; and type IV tumours are entirely internal, otherwise known as retrorectal or presacral teratoma. Type IV tumours are excised by posterior (perineal), anterior (abdominal) or combined approach. Laparoscopic management of such cases is a new addition in surgical armamentarium. Very few cases have been reported to be successful in this endeavour. Case ReportA 35-year-old lady presented with dull aching pain in the lower abdomen. On per rectal examination, lower part of a tense cystic mass was palpated which was nontender and had restricted mobility; rectal mucosa was not involved. There was no evidence of neurologic involvement. Transvaginal sonography followed by MRI abdomen and pelvis showed "well defined lesion of about 6.7X4.4X4.7cm size, in presacral space extending inferiorly posterior to the anal canal. It appeared hypointense on T1 weighted imaging with multiple calcific foci and hyperintense in T2 weighted images. There was no evidence of post contrast enhancement of the lesion, involvement of adjacent structures or intraspinal extension (Fig. 1)." Serum tumour markers, including human chorionic gonadotropin, alpha-fetoprotein, carcinoembryonic antigen, lactate dehydrogenase and CA 125 were in normal range. The patient was taken up for laparoscopic excision based on clinical and radiological findings. In brief, the patient was placed in the modified lithotomy position. Access was gained with a 10-mm supraumbilical port followed by two 5-mm ports in the left and right lower quadrant 2 cm medial and above the anterior superior iliac spine and another 5-mm port 1 cm lateral to midline at the same level. The abdomen was insufflated to a pressure of 12 mmHg with CO2. Uterus was anteverted and deviated to the right with a vaginal manipulator and the rectum was deviated to the right side with a rectal probe. The mesorectal dissection from the sacral promontory was continued up to the level of the levator ani muscles keeping medial to the left uret...

Objective To present a case of right-sided unilateral tubal and ovarian absence, along with laparoscopic images. Patient A 23-year-old patient presented with primary infertility of 4 years’ duration. Right adnexal structures were not visualized on transvaginal ultrasound and laparoscopy. Intervention Diagnostic laparoscopy and hysteroscopy. Main outcome measure Complete absence of the right fallopian tube together with ovary was detected during laparoscopy. Subsequent urinary tract evaluation with intravenous pyelography was planned. Result Ipsilateral absence of the fallopian tube and ovary without any other system anomalies were detected. Conclusion Torsion or congenital defect might be the possible etiologic factors. However, vascular accident stands in the forefront of suggested etiologies. Laparoscopy is a feasible option as a diagnostic tool for these kinds of cases. How to cite this article Sukhadiya M, Grover SV. Unexplained Unilateral Absence of Fallopian Tube and Ovary: A Rare Occurrence. J South Asian Feder Menopause Soc 2014;2(1): 46-47.

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