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Uterine rupture is a life-threatening complication in pregnancy with no specific signs and symptoms, that requires fast diagnosis and surgical treatment. The main risk factors for uterine rupture are previous caesarean section deliveries and myomectomies, which can lead to improper uterine wall healing. We report a case of a 37-year-old secundigravida in 29 weeks of pregnancy, with prior caesarian delivery that was admitted in our ward for altered general status and abdominal pain. The patient underwent emergency laparotomy during which we found a massive 3500ml hemoperitoneum, 1000 g dead fetus and a rupture in the posterolateral uterine wall. The uterine scar from the previous caesarian section was intact. Uterine rupture is a complication with a growing incidence in past years that is very difficult to predict, which can occur at any time during pregnancy, especially during labour, but also in the second or early third trimester. Fast diagnosis and proper management is imperious because of the catastrophic outcomes uterine rupture is associated with.

Clostridium difficile (CD) is an anaerobic, gram-positive bacterium that can produce a spectrum of gastrointestinal diseases ranging from pseudomembranous colitis to diarrhea to toxic megacolon. The infection is even more difficult to manage as CD produces high-end spores, suggesting that this may be the cause of the dangerous recurrent disease as well as dissemination among healthy members in the community. Spores can be hosted in the digestive tract of both symptomatic and asymptomatic patients. The most relevant risk factor in the development of Clostridium difficile infection (CDI) seems to be the overuse of antimicrobials. Comorbidities are another risk factor that may predispose towards more serious CDI. Treatment options vary from oral antibiotics to extensive surgical interventions. The present study aimed to analyze the prevalence, severity, and management of CDIs in a general surgery department in an effort to determine the correlative elements between the infection and surgical pathology.

Psoriasis is an inflammatory chronic, common skin disease that represents a great burden affecting people of all ages. It has no clear cause and although there are treatments none of them can guaranty remission. This pathology has a significant negative impact on people in all countries, affecting between 0.09% and 11.43%, which means at least 100 million people worldwide. A particular category is represented by pregnant women. Although it is reported that 55% of the patients have improved symptomatology during pregnancy, 21% reported no change and 23% suffered worsening of the illness. Psoriasis can be difficult to manage due to fluctuations in hormone levels. Even if patients can experience improvements during pregnancy, most of the women report worsening in the post-partum period (4-6 weeks). Pregnancy and lactation can also interfere with specific treatment for psoriasis. Psoriasis can increase the risk of gestational, diabetes, pre-eclampsia and hypertension in pregnancy, increased risk of preterm birth, low birth weight and emergency caesarean section. In order to have a positive outcome for the mother and the baby, careful multidisciplinary management is needed. The aim of this review is to summarize the notions in the literature regarding pregnancy with psoriasis and the current treatment trend in this group of patients.

Tubal abortion represents a rare entity in the gynecology practice, defining an ectopic pregnancy with the gestational sac situated in the peritoneal cavity, consequence of the extrusion from the fallopian tube through the terminal ostium. It often complicates with severe internal bleeding causing acute surgical abdomen. The diagnosis is frequently difficult and relies on a combination of ultrasound scanning, serial serum beta-human chorionic gonadotrophin (β-hCG) measurements, whilst observing the clinical status of the patient. We present the case of a 27 years-old woman admitted for lower abdominal pain, having a positive pregnancy test. The level of β-hCG was 1185 mU/mL and transvaginal ultrasound revealed a fluid collection in the pouch of Douglas, an empty uterus and an adnexal mass image of 22/14mm. At first, medical management was preferred, a single dose regimen of Metotrexat was administered. 48 hours later, as the symptoms became more evident and the collection in the Douglas pouch increased, diagnostic laparoscopy was performed. The diagnosis of complete tubal abortion was evident based on sonographic findings, the β-hCG dynamics and the laparoscopic features. Preserving the implicated fallopian tube through a minimally invasive procedure allowed the patient’s rapid recovery and a short hospital stay.

Xanthogranulomatous pyelonephritis (XGP) is characterized by the presence of lipidladen foamy macrophages with both acute and chronic phase inflammatory cells. The aim of the study is to present our experience about patients with Xanthogranulomatous pyelonephritis. 29 patients were evaluated through a complete anamnesis and the preoperative management included routine blood and biochemical tests, urine culture and renal ultrasound, intravenous urography and computed tomography (CT). All patients underwent open nephrectomy followed by the pathological exam. The main symptoms of these patients were fever and flank pain. Preoperative laboratory tests revealed anemia, leukocytosis and increasing levels of blood urea nitrogen (BUN) and creatinine. Kidney failure was noticed in almost half of the cases. This study succeeded to evaluate the demographic, clinical, biological, surgical and histological characteristics. A pathological diagnosis is mandatory mainly for the evaluation of its coexistence with renal carcinoma.

With the increasing number of births by Caesarean section a new pathology has made its presence felt, linked to the scarring of the low uterine transverse incision. It was found that after the birth by caesarean section some patients presented postmenstrual prolonged bleeding, spotting, pelvic pain and infertility. First described in 1995, the isthmocele is a healing defect in the anterior wall of the lower uterine segment at the caesarean hysterotomy site. This faulty scarring could be attributed to physiological peculiarities of the patient, to the suturing technique or ascribed to tissue reaction specifically to the type of suture material used. We found that it may be a correlation between the suture materials used and the appearance of the isthmocele. There are no large studies that asses the long-term outcome of C-section scar on prolonged menstrual bleeding, spotting and infertility and no comparison on the rate of appearance of this pathology by account of the suture material.

Stress incontinence is a major social and health problem for middle-aged and elderly women, with an increasing prevalence as life expectancy increases. Reconstructive surgery techniques using vaginal mesh slings of polypropylene (synthetic grafts) have diversified in recent years, but at the same time various postoperative complications have been reported, among the frequent ones being pelvic pain, thigh pain and dyspareunia. The pain mechanism is not fully understood, but pathophysiological theories describe the pain as closely related to the structure, density, size and elasticity of the vaginal mesh, and the inflammatory response of the host.

Pregnancy in rudimentary horn is a rare clinical entity with an incidence ranging from 1:76.000 to 1:140.000 preg­nan­cies. The symptomatology that accompanies pregnancy de­ve­loped in rudimentary horn is similar to that of ectopic preg­nan­cies or may evolve as a normal pregnancy. It is dif­ficult to diagnose in the first trimester of pregnancy when conservative treatment is possible, with minimal mor­bi­di­ty, frequently evolving until the second trimester when clinically manifests as a uterine rupture syndrome and it is accompanied by intraperitoneal hemorrhage and he­mor­rhagic shock. It is desirable that the diagnosis of these pregnancies to be established as early as possible in the first trimester of pregnancy and they will be terminated as soon as they have been diagnosed with certainty.

Vesicovaginals fistulas are the most common type of urogenital fistulas resulting after radical hysterectomy with or without radiotherapy. In most cases, surgery is necessary for healing. The present study was conducted over a period of 5 years. In all cases, the diagnosis was made on medical history, a complete clinical examination, intravenous pyelography and cystoscopy. Surgical closing technique of fistula tract could be applied in 28 cases (68.29%), out of which in 9 (22%) patients the exicision of the fistula tract and separate suture of the bladder and the vagina were performed while in 19 ( 46.3%) patients a flap was interposed too. All 25 patients who presented fistula after radical hysterectomy were feasible to surgical treatment of demolition of fistula and only 3 of 16 (18.75%) of the cases of hysterectomy and radiotherapy had indication for surgical closing technique of fistula tract. In 4 cases (9.7%) an external urinary diversion as the only therapeutic solution was performed. In 3 cases (7.3%) a percutaneous nephrostomy was inserted. Two patients (4.8%) presented vesicovaginal fistula and rectovaginal fistula as well. 24 (85.71%) of the 28 cases that have benefited from surgery remained continent, without loss of urine vaginally after the removal of urethro-bladder catheter. In 13 (31.7%) cases the success could not be obtained due to radiotherapy associated with hysterectomy. In the 25 cases where radiotherapy was not enforced, the success rate of surgery was 92%, while in patients who have benefited from radiotherapy too it goes down drastically (33%).The surgical closing technique of the vesicovaginal fistula has a very high success rate. The success of the operation can be obtained from the first surgery. The associated radiotherapy has a big influence in the approach of this pathology surgery.