A five-month-old girl was brought in with history of not being able to have bowel movement for 3 weeks but was eating (breast feeding) ok and no vomiting but a huge distended abdomen and large veins on the epigastrium.    Rectal exam was normal except one could feel a mass at the tip of the finger outside of the rectum.  Foley was placed with difficulty and noted that the catheter bulb was felt in the large umbilical hernia.  She appeared overall malnourished.  No fever, and did have a small stool after the rectal exam.  An ultrasound revealed a large mass in the abdomen but could not tell what it was attached to.  The patient was brought in Fri evening and the abdomen did not seem tender but was very tight.  We were thinking of partial bowel obstruction secondary to??  Family was told that she needed a surgery but it would be a very high risk with high probability of dying but even higher probability of dying without surgery.   The next morning they were gone so thought they just went home to let her die; but they showed up again Sunday eve and again it was discussed but there seemed to be no change in the baby’s condition.  Father said, "lets take the risk and whatever is the will of Allah would be."   Monday morning we opened the abdomen under Ketamine anesthesia.  The bladder was up in the umbilical hernia and the “uterus” was up above the umbilicus.  The “uterus” was part of a huge mass or cyst that was filled with over 350 cc cloudy fluid.  Ovaries and tubes were present but only the top part of the uterus.  The rest  and the top of the vagina was part of this huge cyst.  I think it was a Mullerian duct malformation.  We removed the “uterus” but left the ovaries and removed most of the sac wall and allowed some of the bottom part to be open with hemostatic suture around the top of the small amount of remainder.  We repaired the large umbilical hernia removing the bladder from it and allowing it to be where it should be.    Pre op we were afraid we would never be able to close the abdomen but it closed nicely.  We had minimal blood loss and the baby is recovering well so far.  I had begun the  case but when I saw what it was, I knew Danae (Ob-Gyn) would want to see this very uncommon abnormality so she got in on it also.  It is great to be able to operate and see unusual things with our daughter.
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Our address is:  Hopital Adventiste de Bere,  52 Boite Postale, Kelo, Tchad, Afrique
Love, Rollin and Dolores