Search

A 52-year-old woman, para 2, presented with pain in her lower abdomen and a bleeding vaginal swelling. The night before she had fallen on her buttocks at a dancing party. The medical history listed a vaginal hysterectomy with anterior and posterior repair. On physical examination a mildly bleeding, red lobulated tumour protruded through the vaginal orifice. On closer inspection appendices epiploicae were seen to be bulging through a 3 cm wide, but narrow rupture in the vaginal vault. The patient denied having had sexual activity or any specific trauma. As some appendices epiploicae showed signs of necrosis, repositioning and repair was performed by laparotomy. Evisceration through a vaginal wall defect is a very rare, but potentially life threatening situation. Predisposing factors are postmenopausal status, a history of uterus extirpation and vaginal prolapse. In premenopausal women it is most often associated with coitus or trauma. The vaginal wall defect can be closed from a vaginal approach but if there is any doubt about the viability ofthe viscera, a laparotomy should be carried out.

A 27-year-old healthy woman suffered from dyspnoea and retrosternal pain after a spontaneous vaginal delivery due to a pneumomediastinum and subcutaneous emphysema caused by labour.

In two women, aged 47 and 58 years, who suffered from longstanding urinary bladder complaints, various urologic treatments had been carried out, which however had had only a partial therapeutic effect. They also suffered from allergic rhinitis and multiple arthralgia. Allergologic investigations including nasal challenges with inhalant allergens and food ingestion challenges revealed the causative participation of the inhalant allergens and the food components in the urinary complaints. The all-round allergologic management, including dietary measures, avoidance of the relevant allergens and nasal as well as oral administration of disodium cromoglycate therapy, led to the almost complete disappearance of the urinary and other complaints. Interstitial cystitis is a regularly appearing urinary disorder, especially in female patients. In practice, the possible causative role of allergy and especially of food allergy is only rarely included in the differential diagnosis of this disorder.

A 22-year-old male suffering from bronchial obstruction, in whom the usual anti-allergic treatment was almost ineffective, had a high degree of blood eosinophilia and migrating pulmonary infiltrates. These infiltrates were strongly suspected to be of eosinophilic origin, in view of the results of bronchoalveolar lavage. Unfortunately, no clear cause of the disorder was found. Corticosteroid treatment per os and by inhalation clearly improved his condition. However, the treatment with inhalation corticosteroids has to be continued indefinitely.

A meanwhile 10-year old girl, suffering from diurnal and nocturnal enuresis and encopresis since she was a baby, had been repeatedly examined and treated by various medical specialists and a homeopathic doctor without any significant improvement. The incontinence persisted. Finally her problem was solved after an allergological examination. The skin tests and specific IgE antibodies were positive for various foods, some of them confirmed later by food ingestion challenge. She was put on a complete elimination diet, combined with oral disodium cromoglycate, and has been free of all complaints since 1 1/2 years.