IntroductionA supernumerary ovary was found attached to the mesentery of the descending colon. The patient had a very long history of pelvic pain and numerous operations. Thirty-four cases found in the literature are listed.

Guillain-Barré syndrome (GBS) is rare in pregnancy with an incidence estimated to be between 1.2 and 1.9 cases per 100,000 people annually, and it is generally accepted that it carries a high maternal risk. Delayed diagnosis is common because the initial non-specific symptoms may mimic changes in pregnancy. GBS should be considered in any pregnant patient complaining of muscle weakness, general malaise, tingling of the fingers and respiratory discomfort. This case aims to highlight the importance of early diagnosis, allowing prompt initiation of the immunomodulatory treatments which have been shown to improve outcome alongside multidisciplinary care.

In this study we assessed the effectiveness of the NovaSure Impedance Controlled Endometrial Ablation System for the treatment of menorrhagia in pre-menopausal women. A total of 125 pre-menopausal women with menorrhagia, which was secondary to dysfunctional uterine bleeding and unresponsive to medical therapy, had endometrial ablation using the NovaSure system between June 2004 and October 2005. A postal questionnaire was sent to all patients and the response rate was 80% (110 patients). The clinical data were analysed in 105 case notes (84%). The mean age was 43.91 +/- 5.45 SD, and mean parity was 2.09 +/- 0.65. The median treatment time was 71.00 s, ranging between 45.00 and 105.00 s. Results from a period of 18 months demonstrated that the NovaSure system was effective in reducing excessive uterine blood loss in 90.5% of patients and there were no intraoperative adverse events reported. Some 87% of patients were satisfied with the procedure and 90% of patients would be happy to recommend the treatment. We conclude that the NovaSure system is effective and safe in the treatment of symptomatic menorrhagia.

Endometriosis is defined as the presence of endometrial tissue outside the uterus, which induces a chronic inflammatory response. Its prevalence remains unknown, but it has been estimated to affect up to 10% of women of reproductive age. Although it is a benign oestrogen-dependent gynaecological condition, women may describe painful symptoms such as cyclical pelvic pain, dysmenorrhoea and dyschezia. Intestinal endometriosis may affect the ileum, appendix, sigmoid colon and rectum. It may present with a myriad of symptoms such as abdominal pain, vomiting, diarrhoea, constipation and haematochezia. Caecal endometriosis can present as an acute appendicitis, making the diagnosis challenging to establish in pregnancy. Transmural involvement and acute occlusion are very rare events. The gold standard for diagnosis remains laparoscopy with tissue sampling for histological confirmation. Although endometriosis improves during pregnancy under the effect of progesterone, the ectopic endometrium becomes decidualised with a progressive reduction in size. The authors present the case of a multiparous woman in her mid-30s with acute onset of right-sided abdominal pain at 35 weeks gestation. Physical examination was suggestive of an acute appendicitis and MRI showed an inflamed caecum. She became acutely unwell requiring an emergency caesarean section. A mass in the caecum was observed with impending perforation at the caecal pole. A right hemicolectomy was performed. Histopathological examination confirmed the diagnosis of endometriosis with decidualisation. Although endometriosis improves during pregnancy, this case shows the unexpected complications of the disease and demonstrates the importance of considering endometriosis in the differential diagnosis of an acute abdomen in women of childbearing age to prevent maternal morbidity and fetal loss.

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