A detailed radiologic and anatomic study of one horseshoe lung syndrome has already been published from this centre. A further case of horseshoe lung, which was also diagnosed prospectively by radiology, is described. Alongside, this is a set of a group of three conditions: we describe a right accessory lung with a peculiar feeding arterial branch originating from the left basal pulmonary artery. The bronchogram and oesophagogram of this case were normal. The other is a case of bridging bronchus where the left lower lobe bronchus originates from the right main stem bronchus. This was discovered at post mortem bronchogram performed on a 19 weeks foetus. Finally, in the dog, we found that the pulmonary angiogram and bronchogram display close similarity to human horseshoe lung though the dog has two separate lungs. The common denominator of all above cases is the presence of a pulmonary arterial branch or bronchus crossing the midline from the ipsi to the contralateral side. Therefore, it may be concluded "in contradiction to the common belief" that pulmonary angiography or bronchography alone is not sufficient for the diagnosis of horseshoe lung. When only one of these investigations is available, computerized tomography is necessary to show the isthmic lung tissue before the diagnosis of horseshoe lung is confirmed.

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Malrotation is part of a spectrum of small and large bowel positional and fixational abnormalities caused by the failure of the fetal intestine to complete a 270-degree rotation around the superior mesenteric artery axis. Rarely, it presents in the adult as a cause of acute small bowel obstruction. Chronic symptoms of malrotation in adults are subtle, and include intermittent abdominal pain, nausea and vomiting. We present two cases of malrotation in octogenarian men presenting acutely with small bowel obstruction. Both patients were treated with emergency surgery. In one case the chronic symptoms resolved postoperatively. Malrotation and midgut volvulus should be considered as a rare differential diagnosis for small bowel obstruction in adults. Suspicions should be increased when there is a history of recurrent presentations with similar symptoms.

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15(5): 522-524Primary vaginal bleeding following abdominal hysterectomy is a known, albeit unacceptable, complication. When this is severe enough to threaten a patient's life, it is most likely the result of failure to control one or more of the large vessels, very often an artery.1 Indeed, vaginal bleeding after abdominal hysterectomy is nearly always the result of a slipped ligature, usually on the ovarian or uterine vessel. 2We report here a case of secondary vaginal bleeding following abdominal hysterectomy where vaginal packing, laparotomy and ligation of the internal iliac arteries failed to control the hemorrhage. It was found during pelvic angiography that the internal iliac artery on the affected side had continued to receive a blood supply below the ligation through an aberrant artery supply from the terminal aorta. Case ReportA 42-year-old female, Para 2+4, was admitted electively for abdominal hysterectomy because of huge uterinefibroids, menorrhagia and severe dysmenorrhea of six months' duration. Otherwise there was nothing remarkable in the history. Clinical examination revealed a mildly pale, normotensive (BP 110/70 mm/Hg) patient. The uterus was enlarged with fibroids to a size compatible with 18 weeks of gestation. All her investigations were within normal limits and the ultrasound scan confirmed uterine fibroids with some foci of calcification. She had total abdominal hysterectomy with preservation of both ovaries. Her postoperative period was uneventful. She was discharged home on the seventh postoperative day and was given a follow-up appointment in six weeks.Twelve days after the surgery, she was admitted through the Accident and Emergency Department with the sudden onset of profuse unprovoked vaginal bleeding. Examination revealed an anxious, pale (Hb=5.3 g/dL), hypertensive (BP=150/100 mm/Hg) but afebrile (36°Q patient. The bleeding stopped spontaneously and pelvic examination revealed no bleeding source. She was transfused with four units of packed red blood cells and was discharged in a stable condition after three days. A week after discharge she was readmitted with a second bout of profuse vaginal bleeding. She was afebrile but hypertensive (BP 150/100 mm/Hg). The coagulation profile and other investigations were normal and the Hb was 12.4 g/dL. Examination under anesthesia revealed a small raw area in the vault of the vagina. A few stitches were put in and the vagina was tightly packed. She was put on antibiotics and discharged after three days of no bleeding.The patient was readmitted 10 days later with the third bout of profuse vaginal bleeding. Her general condition was stable and the BP was 130/110 mm/Hg. Her Hb was 12.4 g/dL and the coagulation profile was normal. Even though vaginal examination revealed no active bleeding, the vagina was tightly packed. After another bout of heavy vaginal bleeding in the night, she was taken to the operating room. Laparotomy and bilateral internal iliac artery ligation were undertaken. She had a total of four units of packed cells for the low h...