A 45-year-old lady presented with left lower quadrant abdominal pain and hematochezia of 1 month duration. She had Copper-T, an intrauterine contraceptive device (IUCD) inserted in the immediate post-partum period 25 years ago elsewhere and was lost to follow up. CT abdomen done 2 weeks earlier before reporting to us revealed a migrated and translocated IUCD embedded in the right lateral wall of the rectum. On colonoscopy, an area of friable mucosal nodule was noticed in the right lateral wall 10 cm from the anal verge but the IUCD was not visible intraluminally. Fluoroscopy showed the horizontal limb lying in close approximation with the rectal wall and the vertical limb of the IUCD embedded at the site of mucosal nodule in the rectum. After a careful endoscopic mucosotomy, the vertical limb was exposed and the Copper-T in its entirety was retrieved using a polypectomy snare. The mucosal defect was closed with hemoclips. She became asymptomatic after the procedure.
Synovial chondromatosis is an uncommon, benign neoplastic nodular cartilaginous lesion of the synovium that can lead to lose bodies and arthritic degeneration if left untreated. We report the case of 2 patients with primary Synovial chondromatosis of the ankle with 139 and 12 loose bodies, respectively, who were treated arthroscopically. Both patients had successful outcomes without recurrence or malignancy, after excision of the lesions. We have reported the highest number of loose bodies (i.e. 139) in the ankle extracted arthroscopically. To conclude, Synovial chondromatosis, although benign, needs detailed investigations to rule out secondary causes and timely intervention to prevent further consequences. Arthroscopic treatment provides easy access and allows early return to activities.
Level of clinical evidence: 4- Case Report.
Antiphospholipid antibody syndrome (APS), a hypercoagulable state, affects organ by causing venous or arterial thrombosis. We present an unusual case of a 58-year-old male who presented with diffuse abdominal pain and on evaluation diagnosed as having portomesenteric venous thrombosis due to primary APS. Upon successful treatment with enoxaparin followed by anticoagulants for 6 months, recanalization of the portal vein was documented by endoscopic ultrasonography. Early identification and treatment of portomesenteric thrombosis is crucial to prevent bowel ischemia. Lifelong anticoagulation with vitamin K antagonists should be considered in those patients with major thrombosis and established APS.
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