A unicornuate uterus with a non-communicating rudimentary horn is a rare Müllerian duct anomaly that is frequently underdiagnosed because of its variable clinical presentation and the limitations of conventional imaging modalities. Although not considered a direct cause of infertility, it may coexist with other reproductive pathologies and contribute to adverse reproductive outcomes. Presented here is a case series of three infertile women aged 30–36 years who were diagnosed with a unicornuate uterus and non-communicating rudimentary horn during fertility evaluation. Patient A presented with primary infertility, cyclic pelvic pain, endometriosis, and bilateral tubal disease; Patient B had a seven-year history of primary infertility and was initially suspected to have unilateral tubal obstruction; and Patient C was referred with a presumed diagnosis of uterine didelphys and was subsequently found to have a unicornuate uterus with a non-communicating rudimentary horn and ipsilateral renal agenesis. In all three cases, preoperative imaging failed to establish the definitive diagnosis, which was confirmed intraoperatively through laparoscopy, chromotubation, and hysteroscopy. Patients A and B underwent laparoscopic excision of the rudimentary horn with ipsilateral salpingectomy, while Patient C underwent only ipsilateral salpingectomy. Hysteroscopic transillumination was utilized in one case to facilitate safe laparoscopic dissection and delineation of the hemiuterine anatomy. All patients had uneventful postoperative recovery and were subsequently counseled regarding fertility options. This case series highlights the diagnostic challenges posed by unicornuate uterus with a non-communicating rudimentary horn, emphasizes the importance of a high index of suspicion during infertility work-up, and demonstrates the value of minimally invasive surgical management and hysteroscopic transillumination in selected cases. Early recognition and individualized treatment may help reduce reproductive complications and improve fertility counseling and management.

Human ; Female ; Adult: 25-44 Yrs Old ; Infertility, Female ; Laparoscopy ; Salpingectomy ; Hysteroscopy ; Pathology ; Endometriosis ; Fallopian Tube Diseases ; Transillumination ; Uterine Didelphys

Appendicitis is one of the most commonly encountered general surgery emergencies worldwide and has been extensively studied. However, anatomical variations in the position of the appendix may result in atypical clinical presentations, leading to diagnostic difficulty and delays in management. Reported here is a case of subhepatic appendicitis in a young adult patient who successfully underwent laparoscopic appendectomy. Subhepatic appendicitis is a rare surgical entity that should be considered in patients presenting with right upper quadrant abdominal pain. Contrast-enhanced computed tomography and laparoscopy are valuable tools in the diagnosis and management of this uncommon condition.

Human ; Female ; Adult: 25-44 Yrs Old ; Laparoscopy ; Appendectomy ; Appendix ; Appendicitis ; Abdominal Pain

Caesarean scar pregnancy (CSP) is a pregnancy where embryo is implanted in the myometrium of a previous caesarean scar and it is a rare type of ectopic pregnancy. Diagnosis and management of CSP is a challenge because caregivers lack awareness about the possibility of implantation in previous caesarean surgery scar. We present here six CSP cases. All patients presented with abdominal pain and/or bleeding per vaginum with history of previous caesarean section. On ultrasonography, caesarean scar pregnancy was diagnosed. We managed them endoscopically at an endoscopic surgery and training center during the year 2019 till the year 2022. The pre-operative and post-operative periods were uneventful and they were discharged on day 2 or 3 of surgery. Hystero-laparoscopic combined approach is a good option for managing CSP in expert hands. Although there are no clear guidelines for managing CSP, we suggest individualizing each patient's treatment plan, depending on their personal characteristics and available facilities at the managing center.

Human ; Female ; Adult: 25-44 Yrs Old ; Pregnancy ; Pregnancy, Ectopic ; Uterine Rupture ; Hysteroscopy

BACKGROUND AND OBJECTIVE

Foreign body (FB) ingestion is a common pediatric concern in the Philippines, but local studies on flexible endoscopic management are lacking. This study aimed to describe the clinical profile and outcomes of children referred for flexible endoscopic management and identify factors associated with poor outcomes.

METHODS

This retrospective cohort study included 145 patients aged

RESULTS

Most FB ingestions (96.55%) were accidental, with coins as the most common FB (56.55%). Patients were admitted an average of 40.42 hours post-ingestion and referred for endoscopy within 9.28 hours. Flexible endoscopy was performed in 44.83% of cases, with a 98.46% success rate and an average procedure time of 32.25 minutes. Spontaneous passage occurred in 50.34% of cases. Poor outcomes were linked to age 48 hours; OR: 15.43, p = 0.0181), and prolonged procedures (>30 minutes; OR: 12, p = 0.0318). Good outcomes were associated with unremarkable physical exams (OR: 0.078; p = 0.0018), early admission (CONCLUSION

Flexible endoscopy is effective and safe for FB extraction in children. Early admission and timely intervention significantly improve outcomes, while delays and prolonged procedures increase the risk of complications.

Human ; Adolescent: 13-18 Yrs Old ; Child: 6-12 Yrs Old ; Foreign Bodies ; Endoscopy ; Child ; Retrospective Studies ; Aged ; Cohort Studies ; Eating ; Methods ; Numismatics ; Patients ; Philippines ; Physical Examination ; Time

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive ; Anesthetics ; Apnea ; Consensus ; Paper ; Patients ; Pharmaceutical Preparations ; Research Report ; Sleep ; Sleep Apnea Syndromes ; World Health Organization

BACKGROUND

Appendicitis is the most common acute surgical disease in children. Due to a nonspecific presentation and progression of the disease, a significantly higher presentation of appendiceal perforation may be expected in young children. With perforation there is an elevated risk of intraabdominal abscess, wound infection, post-operative ileus, higher rates of readmission and longer length of stay. Laparoscopic appendectomy is the recommended first line treatment however many centers from developing countries are still in the early stages of adopting such an approach and do appendectomies in an open manner. This study outlines our institution’s experience with a laparoscopy-first approach in managing pediatric appendicitis. Surgical outcomes from laparoscopic and open procedures during the study period will be compared.

METHODS

This retrospective cohort analysis encompasses all pediatric appendicitis cases at our institution from 2022 to 2023. As a major pediatric surgery referral center, there were a total of 273 cases during that period. Patient records were reviewed for surgical approach and outcomes.

RESULTS

The mean patient age was 11.87 years with a male:female ratio of 1.84. Average duration of symptoms prior to consult was 2.47 days. Most of the patients had complicated appendicitis (57.8% ruptured, 10.2% gangrenous). For the surgical approach, 42.9% underwent open appendectomy (OA) and 57.1% had LA with a conversion rate of 7.14%. Irrespective of disease severity, LA was superior to OA in terms of time to resume feeding (2.84 vs 4.07 days), post-op length of stay (5.29 vs 6.95 days), and surgical site infection rate (3.3% vs 16.2%). Operative times were not statistically different, with cases performed by fellows being faster than their resident counterparts by a few minutes. Other morbidities for LA included intraabdominal abscess (1.9%) and postoperative adhesions requiring adhesiolysis (1.3%), while the OA group reported 1 case each for adhesions, intraabdominal abscess, and incisional hernia.

CONCLUSION

This study highlights the advantages and complications of laparoscopic appendectomy in the pediatric population as implemented in a tertiary government center. It also provides preliminary data on a significant cohort of patients with complicated appendicitis who underwent laparoscopic management in the local setting.

Human ; Laparoscopy ; Appendectomy ; General Surgery ; Philippines

We present the case of a 51-year-old man with an incarcerated left inguinoscrotal hernia. He underwent a successful reduction of the incarcerated hernia at the ER and was admitted for elective hernia repair before discharge. Several hours after admission, re-incarceration of the hernia occurred. At that time, it was non-reducible. Informed consent was secured, and he underwent successful emergency laparoscopy assisted reduction of the incarcerated hernia followed by LAPEC. In this particular case, the reduction of the hernia was more challenging than the LAPEC. There were no intraoperative and post operative complications noted. On post operative physical examination, documented by photographs, no evidence of a previous large inguinoscrotal mass can be traced. The patient was discharged on POD 2 and followed up at 1 week and 5 months. No evidence of recurrence was documented on follow up, cosmesis was excellent and there were no pain-related issues reported.

Laparoscopy assisted percutaneous extraperitoneal closure can be a safe, cosmetic, and effective surgical treatment in adults with reducible incarcerated indirect inguinal hernia. The procedure is simple, quick and easy to perform. Our study is the first to report the application of LAPEC in an adult patient with Incarcerated inguinal hernia.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Laparoscopy ; Herniorrhaphy ; Hernia, Inguinal ; Cosmetics ; Photographs

OBJECTIVE

The study aims to compare the demographic profile, management, and outcomes of patients with foreign body ingestion before and during the COVID-19 pandemic.

METHODS

Design: Retrospective Review of Records

Setting: Tertiary Government Training Hospital

Participants: Records of 156 patients, 81 from the pre-pandemic period (2018-2020) and 75 during pandemic period (2020-2022), diagnosed with aerodigestive foreign bodies

RESULTS

One hundred fifty-six (156) patients, 81 from the pre-pandemic period (2018-2020) and 75 during pandemic period (2020-2022) were included in this study. Median age pre pandemic is 9 years old (Standard deviation = 22.19) and 16 years old (Standard deviation = 19.63) during pandemic. The male-to-female ratio for pre-pandemic and during pandemic is 54:27 and 52:23, respectively. The majority of the patients ingested coins (53% pre-pandemic and 44% during pandemic) followed by dentures (22% pre-pandemic and 35% during pandemic). T-test results show that Time from Ingestion to Consult shows a borderline statistically significant difference between the pre-pandemic and during-pandemic periods for the time from ingestion to consult (t-value = -1.967; p-value of 0.051), implying a slight difference in the time patients took to seek medical help after ingesting a foreign body between the two periods. Time from Consultation to the Operating Room indicates that there is significant difference between the pre-pandemic and during pandemic time from consultation to the operating room (t-value= -2.037; p-value= 0.043, suggesting significant change in the time taken to move patients from consultation to the operating room between the two periods, possibly indicating changes in hospital protocols or patient flow during the pandemic.

CONCLUSION

Results showed that there was a noticeable shift in the age distribution of patients, with older patients encountered during the pandemic period, suggesting changes in healthcare-seeking behavior and accessibility. Data also showed that more patients in both periods were male, consistent with existing literature on foreign body ingestion demographics. The median time (in hours) from ingestion to consultation increased significantly during the pandemic, indicating delays in seeking medical care. This was likely due to travel restrictions, fear of COVID-19 in public, and changes in public health protocols. Despite these consultation delays, the median time from consultation to the operating room remained consistent, reflecting the efficiency of healthcare providers in the tertiary hospital. Operating time and the level of foreign bodies in the esophagus did not differ significantly between the two periods, implying a stable surgical procedure. The significant difference in the overall time across patients from consultation to the operating room during the pandemic suggests changes in hospital protocols and patient flow management.

Human ; Foreign Bodies ; Eating ; Ingestion ; Esophagoscopy ; Covid-19

OBJECTIVE: To investigate the clinical efficacy of thoracoscopic minimally invasive surgery with nickel-titanium shape memory alloy wrap bone plate versus rib periosteal internal fixation in patients with multiple rib fractures (MRF) and flail chest. METHODS: A retrospective analysis was performed on 100 patients with MRF and flail chest treated with thoracoscopic minimally invasive surgery and internal fixation with rib fracture preservation between January 2019 and December 2022, including 54 males and 46 females, aged from 20 to 65 years old, with an average age of (38.0±18.0)years old. The duration of the disease ranged from 8 to 21 days. According to the different surgical methods, the patients were divided into control group and study group, with 50 patients in each group. The control group consisted of 23 males and 27 females, with an average age of (38.35±18.05) years old, who underwent rib preservation periosteal internal fixation. In the study group, there were 31 males and 19 females, with an average age of (38.15±17.99) years old, treated with thoracoscopic nickel-titanium shape memory alloy circumferential bone plate. The pulmonary function indices, electrocardiographic monitoring indices, pain severity, levels of inflammatory factors, complications, rehabilitation indices, and therapeutic efficacy were compared between the two groups before and after treatment. RESULTS: All patients were followed up for 6 months. After 3 days of treatment, the heart rate of both groups was (102.43±13.74) beats per minute vs (86.26±8.06) beats per minute, respiratory rate (28.45±3.40) breaths per minute vs (22.05±2.85) breaths per minute, blood oxygen saturation (89.68±3.66)% vs (98.46±4.84)%, rest pain (3.5±0.5) points vs (2.6±0.6) points, movement pain (3.6±0.5) points vs (2.5±0.5) points, and these differences were statistically significant(P<0.05). The levels of Interleukin-6 (IL-6) (102.30±17.00) pg·ml^-1 vs (85.68±21.20) pg·ml^-1 and tumor necrosis factor-alpha (TNF-α)(33.44±4.85) pg·ml^-1 vs (18.14±4.28) pg·ml^-1 in both groups exhibited an increase post-treatment, while the C-reactive protein (CRP) (75.51±10.54) mg·L^-1 vs (60.75±9.84) mg·L^-1 demonstrated a decrease compared to pre-treatment levels. Furthermore, the study group displayed significantly lower levels than the control group (P<0.05). After 10 days of treatment, the peak expiratory flow rate (3.31±0.52) L·s^-1 vs (5.69±0.74) L·s^-1, forced expiratory volume (1.46±0.29) L vs (2.06±0.38) L, and forced vital capacity (2.68±0.95) L vs (4.26±1.05) L of both groups exhibited significant improvements compared to pre-treatment levels. Moreover, the study group demonstrated significantly higher values than the control group (P<0.05). The incidence of postoperative complications in the study group was significantly lower compared to the control group (6 cases vs 14 cases, P<0.05). Additionally, the duration of bone callus formation(9.50±1.40) days and fracture healing (72.20±8.32) days in the study group was significantly shorter compared to the control group(11.35±2.15) days, (93.70±9.90) days (P<0.001). CONCLUSION Compared with traditional rib-preserving internal fixation, patients with MRF and flail chest treated with minimally invasive internal fixation with thoracoscopic nickel-titanium shape memory alloy surround bone plate have better therapeutic effect, because of less surgical trauma, less pain and inflammatory reaction, fewer postoperative pulmonary complications, faster and better recovery of lung function, and thus promote the recovery of patients.
Humans ; Male ; Female ; Middle Aged ; Adult ; Retrospective Studies ; Rib Fractures/surgery* ; Aged ; Minimally Invasive Surgical Procedures/methods* ; Flail Chest/surgery* ; Thoracoscopy/methods* ; Fracture Fixation, Internal/methods*

OBJECTIVE: To explore the application effect of grid locator in hip arthroscopy for the treatment of femoral acetabular impingement (FAI). METHODS: Total of 50 patients of FAI were treated by arthroscopic hip joint surgery for from January 2020 to January 2021, and were divided into two groups according to intraoperative positioning methods. Among them, 27 cases in the positioner group were treated by hip arthroscopy assisted by grid positioner including 10 males and 17 females with a mean age of (35.91±9.92) years old. In the non-locator group, 23 cases were treated with hip arthroscopy by positioning puncture according to the operator's experience including 12 males and 11 females with a mean age of (36.01±11.03) years old. Intraoperative fluoroscopy times, puncture time, adjusted puncture times and operation time of two groups were compared. The α Angle and lateral central edge(LCE) angle of hip joint were measured and compared before and after operation. Four evaluation indexes were recorded and compared, including pain visual analogue scale(VAS), hip Harris score, non-inflammatory hip joint score (NAHS), hip joint activities of daily living (HOS-ADL). RESULTS: All patients were followed up for 6 to 12 months with an average of (18.69±3.72) months. The α angle and LCE angle of hip joint at 1 month after operation were decreased in both groups(P<0.05), but there was no significant difference between groups(P>0.05). VAS, hip Harris score, NAHS and HOS-ADL score after operation were higher than those before operation(P<0.05), but there was no statistical significance between groups (P>0.05). Intraoperative fluoroscopy times(6.04±1.13), puncture time(13.19±3.52) min, puncture adjustment times(4.59±1.55) and operation time(48.28±3.38) min in the positioner group were less (shorter) than those of (13.43±2.56), (22.39±2.93) min, (10.43±3.33), (62.25±5.73) min in the non-positioner group(P<0.05). No postoperative complications occurred in both groups, and the pain was significantly relieved. CONCLUSION The application of hip arthroscopy in the treatment of femoral acetabular impingement sign can obtain good postoperative results. Compared with the traditional positioning method, the grid locator can improve the accuracy of skin positioning point, shorten the puncture time, reduce the number of fluoroscopy, and improve the efficiency of surgical puncture.
Humans ; Male ; Female ; Arthroscopy/instrumentation* ; Femoracetabular Impingement/physiopathology* ; Adult ; Middle Aged ; Hip Joint/surgery*