Heterotopic pregnancy is defined as the simultaneous presence of intrauterine and ectopic pregnancies. It is a rare condition, but due to the increasing use of artificial reproductive techniques, the incidence of heterotopic pregnancy is increasing. Most of the patients with heterotopic pregnancy have a previous history of infertility or tubal diseases. In this case series, we are presenting six cases of heterotopic pregnancy. Three of them had a history of assisted reproductive technique: one patient had in vitro fertilization with three embryos transferred, and two patients received follicular stimulating hormone therapy. In one of the cases, heterotopic pregnancy was missed on an initial transabdominal scan, and in the following weeks, it was diagnosed on transvaginal ultrasound. Five patients underwent laparoscopic salpingectomy, and one patient had laparotomy and then a salpingectomy was done. Follow-up ultrasound scans for intrauterine pregnancy (IUP) showed abortion of the IUP, except in one patient who delivered a healthy full-term baby via spontaneous vaginal delivery. Therefore, there is a need to develop diagnostic criteria to rule out heterotopic pregnancy if the patient underwent any type of assisted reproductive techniques. We are emphasizing the need for more careful scanning of the adnexa via transvaginal ultrasound, especially in high-risk patients, even if the intrauterine gestation is confirmed.
Hereditary multiple osteochondromas (HMO) is an autosomal dominant disease diagnosed by the presence of two or more than two osteochondromas on radiographs. The majority of cases are asymptomatic. The presence of bony growth, pain, and compression of the surrounding structure are the usual presentations. Malignant transformation into chondrosarcoma is the most feared complication. A rapid increase in size, recurrence after the surgical excision, and infiltrating mass may suggest the conversion into chondrosarcoma. Radiological imaging helps in diagnosing malignant transformation. MRI is the investigation of choice to exclude cancer. We hereby present a case of multiple osteochondromas with suspected malignant transformation due to rapidly increasing painful osseous swelling.
Meckel's diverticulum (MD) is the most frequent congenital abnormality of the digestive tract. Although it is silent, it can rarely come up as a complicated case including but not limited to obstruction, inflammation, and neoplasm. Perforation as a consequence of MD is extremely infrequent and mostly related to foreign objects. We report a case of a 24-year-old man who presented to the emergency department with signs and symptoms suggestive of acute appendicitis. Computed tomography (CT) of the abdomen demonstrated foreign body perforation from a protrusion outside the small bowel. The patient underwent laparoscopy and a fish bone perforating MD was found which was removed.
Biliary Ascariasis occurs when Ascaris lumbricoides worms invade the biliary system. It may cause biliary obstruction, cholangitis, cholecystitis, or acute pancreatitis. We report a case of a 37-year-old female patient who presented with a history of upper abdominal pain, nausea, vomiting, and weight loss for two weeks. Ultrasound showed dilated common bile duct with linear tubular echogenic structure in the common bile duct and bowel loops. Endoscopic Retrograde Cholangio pancreatography (ERCP) revealed large adult worms confirming the diagnosis of Ascariasis.
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