Adnexal torsion due to hyperstimulation is one of the well-recognized serious complications of assisted reproductive techniques like in vitro fertilization (IVF). We report a case of a 35-year-old primigravida who presented to the emergency department with complaints of acute severe left iliac fossa pain and nausea. Further history revealed that the patient had previously undergone one cycle of ovulation induction and was diagnosed with ovarian hyperstimulation syndrome (OHSS). After prompt management, she reportedly underwent a cycle of IVF successfully. Her gestational age was five weeks and one day on presentation. A transabdominal ultrasound revealed bilateral enlarged ovaries with adequate blood supply and a single intrauterine gestational sac with a yolk sac.The patient was admitted as a case of recurrent OHSS for conservative management. Despite the initial improvement of symptoms with parenteral analgesia, an emergency laparoscopic surgery was done later due to worsening symptoms. Intraoperative findings were consistent with the suspected diagnosis of adnexal torsion which was managed accordingly. Postoperatively, the patient recovered without complications and was discharged two days later with a plan for outpatient follow-up.

Manganese (Mn)-induced cerebral toxicity is a rare neurological condition that can present as a stroke mimic in high-risk populations.We present a case of a 40-year-old male with no known comorbidities who was brought to the emergency department with complaints of nonprogressive slurred speech and left facial weakness for eight days. Further history revealed that he had been working as a welder in a steel factory for the past seven years without using proper personal protective equipment (PPE). On physical examination, an upper motor neuron (UMN) type weakness on the left side of his face and spastic dysarthria could be appreciated. Following a brain computed tomography (CT) scan that showed ill-defined hypodensities in the basal ganglia without any signs of a hemorrhage, he was admitted to the stroke unit for conservative management and further investigations. A magnetic resonance imaging (MRI) scan of the brain done later showed features of manganese deposition and absorption in the globus pallidus and corticospinal tracts, indicating a diagnosis of manganese-induced cerebral toxicity. His serum manganese levels obtained during admission were normal. He was managed conservatively with intravenous rehydration and was discharged after symptomatic improvement. He was counseled and educated regarding the importance of wearing protective equipment while at work to reduce further exposure to the metal. During his follow-up visit, his symptoms had considerably improved with proper adherence to workplace safety measures.

Uterine fibroids are a common, benign gynecological smooth muscle neoplasm highly prevalent in women of reproductive age which can lead to multiple complications including small bowel obstruction.We report a case of a 31-year-old female, primigravida at 13 weeks gestation, a known case of uterine subserosal fibroids who presented to the emergency with complaints of dark red vaginal bleeding and cramping abdominal pain. On examination, her abdomen was 38 weeks in size. An abdominal ultrasound showed intrauterine retained products of conception measuring 5x5 cm. She was admitted as a case of incomplete miscarriage and underwent an evacuation of retained products of conception (ERPOC) immediately.A post-procedure computed tomography (CT) scan done showed the presence of multiple large uterine fibroids. The patient continued to worsen clinically with complaints of abdominal pain and diarrhea. Further laboratory tests revealed a continuous rise in inflammatory markers with positive stool clostridium toxins. She was hence shifted to the intensive care unit (ICU) as a case of sepsis. In the following days, she developed signs and symptoms of small bowel obstruction, and the diagnosis was supported by abdominal Xrays. Despite starting her on conservative management for the same, she deteriorated clinically, and a repeat CT abdomen showed new signs of small bowel obstruction. The gynecology team performed an exploratory laparotomy during which a myomectomy was done. The patient recovered well post-operatively and was discharged in a stable condition.In view of the presented case, small bowel obstruction should be considered as a complication of uterine fibroids in females with a history of large leiomyomas despite it being quite rare as it can cause considerable morbidity and mortality.