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Summary:. Bowel vaginoplasty is a well-described procedure utilizing a pedicled segment of large or small bowel. It has most commonly been used for vaginal agenesis, male-to-female gender affirmation surgery when the phallus skin is not sufficient, or a revision after failure of the primary reconstruction. Our case report describes the usage of a pedicled segment of large bowel to reconstruct the vagina after severe stricture of the original reconstruction. We were able to provide relief of the symptomatic Hartmann’s pouch mucocele, urethral stricture, and provide a functional introitus and vaginal canal. This technique can provide a framework that can be used as a salvage plan in patients with previously irritated and inhospitable defects.

Introduction- The Gall Bladder (GB) is a hollow viscus sac, situated in a fossa in the right hepatic lobe inferior surface. It extends from the right end of porta hepatis to the inferior border of liver. It is 7 - 10cm long, 3 cm broad and capacity is 30 – 50 ml. It has 3 parts Fundus, Body and Neck. Materials and Methods-This study was carried on 50 GB specimens in the Department of Anatomy, GITAM Institute of Medical Sciences & Research, Visakhapatnam. The GB was carefully dissected and cleaned to observe developmental anomalies and morphological variations of GB. Results-The developmental anomalies like Hartmann's pouch, Intrahepatic Hypoplastic GB were observed. The length and breadth GB ranged from 4.9 - 9.5 cm and 2.0 - 4.8 cm, shapes of GB most common pear shaped(64 %), flask shaped(20%), cylindrical shaped(12%) and hour glass(4%). Conclusion- The knowledge of this study will help the laparoscopic surgeon to take preventive measures before cholecystectomy and the radiologist to differentiate the normal from anomalies.

Laparoscopic Hartmann’s reversal is more commonly performed in an open fashion. However, there are selected patients who are excellent candidates for a laparoscopic approach. Surgeon preference usually dictates their comfort level for whether or not this procedure is performed laparoscopically. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.

Background: The gall bladder is a hollow pear shaped sac lying within a fossa on the visceral surface of the right lobe of the liver. In the junction of neck of the gallbladder and the cystic duct, there is a pouch present called Hartman’s pouch or infundibulum of the gallbladder which is a frequent but inconstant feature of the normal gallbladder. It is the common site of lodged gallstones. Objective: To determine the proportion of presence of Hartman’s pouch in our population so that the concerned personnel might have a thought in mind that common pathologies of gall bladder may also involve this pouch. Materials and method: This cross sectional study was carried out in the department of Anatomy, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh, from July 2010 to June 2011. The number of sample was 62 postmortem human gallbladders which were collected from unclaimed dead bodies. Results: Hartmann’s pouch of the gallbladder was found in 45 (72.58%). Conclusion: Hartman’s pouch is present in a good proportion of our population. DOI: http://dx.doi.org/10.3329/dmcj.v2i2.20527 Delta Med Col J. Jul 2014; 2(2): 68-70

Choledochal cysts are rare cystic dilatations of the biliary tree. Most of them are congenital and usually manifest in early childhood but some may manifest later in adult life. Though, the cause is uncertain, these cysts are usually referred for surgical resection because of their association with recurrent inflammation, infection and malignancy [1]. Traditionally choledochal cysts are classified into 5 main types. Cysts of cystic duct are a rare entity which have been sometimes described as Type VI choledochal cyst according to modified Todani′s classification [2]. Till 2009 only 14 such cases have been reported [3]. We describe a rare case of type VI choledochal cyst i.e. cyst of cystic duct, which was treated successfully by laparoscopic resection.

Rupture is a rare but disastrous complication of an arterial aneurysm. Intraabdominal abscess in association with iliac artery aneurysm is uncommon but can predispose to aneurysm rupture. We report the Computed Tomography (CT) findings of an internal iliac artery pseudoaneurysm formed by a pelvic abscess attributed to the perforation of the patient’s Hartmann’s pouch. Rupture of the pseudoaneurysm resulted in the patient’s death.

Hartmann's procedure is widely performed as a first-stage operation in cases of left colon emergencies when a one stage management is judged to be unsafe. Forty per cent of patients with Hartmann's procedure never get their stoma reversed, ending with a permanent stoma. The distal excluded Hartmann's pouch is usually forgotten compared to the proximal functioning colon. A 70-year-old man with Hartmann's procedure carried out previously for complicated diverticular disease presented with bleeding per rectum. Invasive adenocarcinoma was confirmed on histology. Subsequent staging revealed a locally advanced rectal cancer. The tumour progressed despite a course of neoadjuvant chemoradiation. The general condition of the patient deteriorated with development of renal failure. The patient died a few weeks later. By reporting this case, we are revisiting the long forgotten Hartmann's pouch to highlight the potential pathologies in the distal stump and to emphasise that a distal stump should not be forgotten even in asymptomatic patients.

5. Place the table in Trendelenburg position. 6. Retract the sigmoid colon anteriorly and identify the inferior mesenteric artery. 7. Open the peritoneum at a level anterior to the inferior mesenteric artery and isolate the sigmoid vessels. Identify and protect the left ureter. 8. Divide the sigmoid vessels using a vascular stapler, an energy source, or clips. 9. Dissect more superior to identify the left colic vessels which are divided in a similar fashion. 10. Lift the mesocolon off the retroperitoneum from a medial to lateral approach and dissect as far as possible. 11. Place the patient in the reverse Trendelenburg position.

This study discusses the percentage of Hartmann's pouch of gall bladder and whether the Hartmann's Pouch is an anatomical variation or pathological presentation in North Coastal Andhra Pradesh. India. Knowledge of relevant anatomy is important for the safe execution of any operative procedure,specifically in laparoscopic cholecystectomy. It has been recognized since long that misinterpretation of normal anatomy as well as presence of anatomical variations contribute to the occurrence of major post operative complications especially biliary injuries. Apart from this, association of Hartmann's pouch with gall stones is one of the pathological conditions. 102 gall bladders of both gender were obtained from Department of Anatomy ,Andhra Medical College , Visakhapatnam, Andhra Pradesh, India .These Gall bladders were examined for the presence of Hartmann's pouch and its association with gall stones.We found 4.9% of Hartmann'spouch in total specimens and 60% of Hartmann's pouches are associated with gall stones. To conclude percentage of Hartmann's pouch is variable and it is mostly associated with pathological conditions.

Context: Hartmann’s pouch is an out-pouching of the wall of the gallbladder, at the junction of the neck of the gallbladder and the cystic duct. It may be a site where gall stone impacts, which leads to mucocele of gallbladder. So its identification is useful in delineating biliary anatomy while performing a cholecystectomy. Objective: To identify the presence of Hartmann’s pouch in human gallbladder. Study Desig n: A cross-sectional type of study. Place and period of study: The study was carried out in the Department of Anatomy, Dhaka Medical College, Dhaka from July 2008 to June 2009. Materials: 70 postmortem gallbladder were collected from unclaimed dead bodies that were under examination in the morgue of the Department of Forensic Medicine, Dhaka Medical College, Dhaka. Methods: Formalin fixed gallbladder was washed with plain tap water to remove excess formalin and was kept on metallic tray. On observation Hartmann’s pouch in gallbladder was detected and noted. Results: In the present study 70 cadaver’s gallbladder were observed carefully in the neck region for Hartmann’s pouch. The Hartmann’s pouch was detected in 4 cases out of 70 (5.7%). Conclusion: Further studies to find out the gross anatomy and histological study of Hartmann’s pouch is recommended. DOI: http://dx.doi.org/10.3329/bja.v10i2.17283 Bangladesh Journal of Anatomy, July 2012, Vol. 10 No. 2 pp 57-58

El síndrome de Mirizzi es una variante poco frecuente de colelitiasis en la que un cálculo impactado en la bolsa de Hartmann comprime la vía biliar desencadenando una ictericia obstructiva, frecuentemente seguida de fenómenos inflamatorios y de diversas complicaciones (colecistitis, colangitis, fístulas etc). Presentamos dos pacientes con síndrome de Mirizzi, correctamente diagnosticados en el preoperatorio e intervenidos por vía laparoscópica. Un caso fue convertido por adherencias en el triángulo de Calot y tratado con colecistectomía subtotal y coledocorrafia sobre tubo en T de Kher. En el otro enfermo se pudo completar con éxito el procedimiento. Ambos postoperatorios cursaron con normalidad. En el presente artículo, se analizan las técnicas diagnósticas que ayudan a una identificación precoz del síndrome y se discuten las opciones terapéuticas más adecuadas en el momento actual, prestando una especial atención al papel de la colangiopancreatografía endoscópica y del abordaje laparoscópico en el manejo de estos pacientes.

Since 1921, when Henry Hartmann first described his procedure for rectal carcinoma, multiple modifications of the original technique have been proposed. However, the basic principle of a rectal pouch has always been retained. Two cases of carcinoma developing in such a pouch are described; both occurred years after creation of the pouch. One was managed by local resection through a transsacral approach; the other required an abdominoperineal resection. Consideration must be given to careful examination and sigmoidoscopy of these pouches as they tend to be forgotten by the physicians due to their hidden location.

Since 1921, when Henry Hartmann first described his procedure for rectal carcinoma, multiple modifications of the original technique have been proposed. However, the basic principle of a rectal pouch has always been retained. Two cases of carcinoma developing in such a pouch are described; both occurred years after creation of the pouch. One was managed by local resection through a transsacral approach; the other required an abdominoperineal resection. Consideration must be given to careful examination and sigmoidoscopy of these pouches as they tend to be forgotten by the physicians due to their hidden location.