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Key content:• In vaginal vault evisceration there is disruption of the vaginal vault or apex with extrusion of intraperitoneal contents. • It is most common in postmenopausal women after vaginal hysterectomy and where there is an enterocele. • It is a gynaecological emergency with the potential for significant morbidity and mortality. • Early diagnosis and appropriate treatment is crucial to ensure intestinal viability and to minimise the risk of intraperitoneal infection and subsequent sepsis. Learning objectives:• To learn about the pathophysiology and the risk factors.• To learn to recognise the condition.• To be able to discuss various management options and choose a definitive surgical option tailored to individual need. Ethical issues:• Should women be informed of this rare complication of hysterectomy?• Should there be annual surveillance of women who have had hysterectomy and who have associated risk factors?Keywords enterocele / hysterectomy / postoperative complications / vaginal cuff dehiscence / vaginal evisceration

Introduction: Deliberation over euthanasia has been enduring for an extended period of time. On one end, there are populaces talking for the sacrosanctity of life and on the other end, there are those, who promote individual independence. All over the world professionals from different areas have already spent mammoth period over the subject. A large number of cases around the world have explored the boundaries of current legal distinctions, drawn between legitimate and nonlegitimate instances of ending the life. The term euthanasia was derived from the Greek words “eu” and “thanatos” which means “good death” or “easy death.” It is also known as mercy killing. Euthanasia literally means putting a person to painless death especially in case of incurable suffering or when life becomes purposeless as a result of mental or physical handicap. Objective: To study the attitude of doctors toward euthanasia in Delhi. Methodology: It was a questionnaire based descriptive cross-sectional study carried out between July 2014 and December 2014. The study population included Doctors from 28 hospitals in Delhi both public and private. Equal numbers of doctors from four specialties were included in this study (50 oncologists, 50 hematologists, 50 psychiatrists, and 50 intensivists). Demographic questionnaire, as well as the Euthanasia Attitude Scale (EAS), a 30 items Likert-scale questionnaire developed by (Holloway, Hayslip and Murdock, 1995) was used to measure attitude toward Euthanasia. The scale uses both positively (16 items) and negatively (14 items) worded statements to control the effect of acquiescence. The scale also has four response categories, namely “definitely agree,” “agree,” “disagree,” and “definitely disagree.” The total score for the EAS was generated by adding all the sub-scales (question's responses). The demographic questionnaire and EAS, a 30 items Likert-scale questionnaire developed by (Holloway, Hayslip and Murdock, 1995) was distributed among the study population to assess the clarity and adequacy of the questions. Reliability and content validity of the questionnaire were established. Reliability was calculated by “Cronbach Alpha” and the value computed was 0.839 the pilot study was conducted in a subset of 30 persons from the same study universe. Data were analyzed using Stata 11.2 and all the P < 0.05 were considered as statistically significant. Association of categorical variables among the groups was compared by using Chi-square/Fisher's exact test. Student's t-test was used to compare mean values in the two independent groups, and one-way ANOVA was used for more than two groups. A total of 200 questionnaires were returned out of 400, giving a response rate of 50%. Analysis and Results: Our study provided the evidence that all doctors who responded to the questionnaire knew term euthanasia. This could be due to the fact that these professionals are in close association with issues pertaining to euthanasia in their day to day work. No significant difference seen in the attitude of doctors of different age group toward euthanasia, although younger doctors endorse robustly for euthanasia. This may be because younger doctors are open for addressing these debatable issues proactively. We found no association between gender and attitude toward euthanasia in our study. Conclusion: It is evident from our study that oncologists, hematologists, psychiatrist, and intensivists do not support active euthanasia at all. There is a strong voice in support of voluntary passive euthanasia among psychiatrists and intensivists in our study. However, oncologists and hematologists are not in favor of passive euthanasia.

Ovarian maldescent is an extremely rare gynecological phenomenon, usually associated with Müllerian abnormalities. We report a 27-year-old woman, presenting with acute, right-sided abdominal pain. She has a history of subfertility and repeated admissions with chronic pelvic pain. Previous hysterosalpingogram and laparoscopy demonstrated unicornuate uterus with absent right fallopian tube and ovary. A right-sided, ectopic ovary was identified on later imaging and suspected as the cause of her symptoms. She underwent laparoscopic excision of the maldescended ovary with remnant fimbrial end and gubernaculum. She was discharged the following day as she was pain-free and remains so 11 months later. This case report prompts a gynecologist to consider diagnosis of maldescended ovary in the women with uterine abnormalities and repeated episodes of abdominal pain. This is the first case report to the best of our knowledge where surgical management of ovarian maldescent was performed via minimal access approach, thus avoiding laparotomy in this acute setting.