Journal of Evolution of Medical and Dental Sciences

Placental Site Subinvolution Leading to Secondary Postpartum Hemorrhage - A Rare Case

Anitha S., Amritha Bhandary, Trisha Shetty — Sat, 31 Jan 2026 00:00:00 +0000

G4P1L1A2 with polyhydramnios underwent Elective LSCS. Intraoperatively dense adhesions noted. On pod-8, the patient presented with increased bleeding p/v. On examination, a uterus of 24 weeks’ size, intermittently relaxing. Her coagulation profile was deranged [PT-45.3, APTT-93, INR-4.04]. Portable ultrasound suggested a probability of retained products of conception.

The patient was stabilized with blood and blood products. USG-guided suction and evacuation were attempted, but the procedure was abandoned as the uterine cavity enlarged and no products obtained.

Emergency Subtotal Hysterectomy with B/L internal iliac artery ligation performed. The patient withstood the procedure well. Post-operatively she was managed with blood and blood products. Histopathology report-grossly postpartum uterus measuring 15x15x5 cm without cervix and adnexa. The endometrial cavity appears shaggy brown and the right posterior aspect shows adherent dark brown hemorrhagic tissue measuring 1.5 cm in thickness adherent to the myometrium. Microscopically, the endometrium has large ectatic blood vessels which display scattered trophoblasts within the wall. Many of these vessels show a lack of endothelial lining.

Some of the vessels show fibrin thrombi; chorionic villi are not seen. Consistent with placental site vessel sub involution. There is no evidence of retained products of conception. Risk factors in this patient are previous LSCS with dense adhesions, and inflammation affecting blood vessels. Conservative management like uterine artery embolization can be done where facilities are available.

Placental site subinvolution is a rare form of secondary PPH that has always been underdiagnosed. Incidence of postpartum haemorrhage from subinvolution is most common in the second week postpartum. Diagnosis confirmed by histopathology.

A Rare Case of Duplication Cyst along with Carcinoma Sigmoid Colon Presented as Acute Abdomen - A Case Report

Rahul Jain, Suprabha Hegde — Sat, 31 Jan 2026 00:00:00 +0000

Gastrointestinal duplications are rare congenital malformations which can occur anywhere in the GIT (Gastrointestinal Tract).^[1] They are bounded by a common wall with or without a connection with the bowel.

The cyst contains one outer muscular layer which is lined with different types of GI mucosa. GIT duplications may present as either solid or cystic tumours, intussusception, perforation, obstruction, or Gl bleeding. Cysts are managed surgically depending on their size, shape and site of adherence.^[2]

Integration of Ultrasonic and Laser-Assisted Techniques in the Surgical Management of Dens Invaginatus - A Case Report

Sat, 31 Jan 2026 00:00:00 +0000

Dens invaginatus (DI) is a developmental dental anomaly that predisposes teeth to early pulp necrosis and periapical pathology, often thereby complicating conventional endodontic therapy. This report presents the successful surgical management of a maxillary lateral incisor with Type I DI and chronic apical periodontitis in a 20-year-old patient. Following root canal treatment, periapical surgery was performed incorporating adjunctive techniques, ultrasonic retrograde irrigation using ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) gels, and postoperative low-level diode laser therapy to enhance disinfection and healing. At the two-year follow-up, the tooth demonstrated complete clinical and radiographic healing with reformation of the lamina dura and periodontal ligament space. This case underscores the diagnostic value of cone-beam computed tomography (CBCT) and highlights the role of surgical endodontics augmented with adjunctive disinfection and Photobiomodulation in optimizing outcomes for complex cases of dens invaginatus.

Dens invaginatus (DI) is a rare morphogenic aberration caused by an inward folding of the enamel organ into the dental papilla during odontogenesis, occurring prior to hard tissue formation.^[1] The prevalence of DI has been reported to range from 0.3% to 10% and it exhibits a predilection for permanent maxillary lateral incisors.^[2]

Oehler’s classification remains the most widely accepted system, categorizing Dens invaginatus into three types: Type I confined to the crown, Type II extending into the root but not communicating with the periapical tissues, and Type III extending through the root with a separate apical foramen.^[3] The abnormal internal anatomy associated with DI not only predisposes the tooth to early pulp necrosis and periapical pathology but also poses significant therapeutic difficulties.

The complexity of these malformations often compromises conventional root canal treatment, as canal negotiation, biomechanical preparation, and obturation are technically challenging or in some cases impossible.^[4] Various treatment strategies have been proposed, tailored to the type of invagination and the stage of pulp involvement. Preventive measures include prophylactic sealing of the invagination in clinically accessible cases.^[5] Once pulp or periradicular pathology develops, endodontic therapy is indicated, with approaches ranging from conventional nonsurgical treatment and guided endodontics to intentional replantation or endodontic microsurgery.^[6]

When nonsurgical approaches are limited by complex anatomy or fail to achieve healing, surgical endodontic management enables direct visualization and management of the apical area, effective debridement of periapical pathology, and precise retrograde filling.^[7]

This report aims to describe a combined surgical and adjunctive approach for managing Type I dens invaginatus with chronic apical periodontitis, while highlighting diagnostic and therapeutic considerations.