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Background Locally advanced periorbital cutaneous squamous cell carcinoma (cSCC) may require orbital exenteration, which is highly morbid. As immunotherapy develops, orbit preservation may become widespread, and data benchmarking survival with current standard-of-care surgery and radiotherapy are essential to the integration of this emerging method into modern treatment paradigms. This study aimed to determine the survival of patients after orbital exenteration for cSCC and investigate contributing factors. It was hypothesized that postoperative radiotherapy would be associated with improved survival. Methods This was a retrospective cohort study of patients with T3 and T4 cSCC undergoing orbital exenteration. Survival analysis was performed using Cox proportional hazards. Results The study enrolled 40 patients with a median age of 61.5 years who met the criteria. None of the patients had received preoperative radiotherapy. Age (hazard ratio [HR], 1.09; p = 0.019) and residual disease (HR, 9.00; p = 0.003) were associated with worse survival. Postoperative radiotherapy (HR, 0.003; p < 0.001) was associated with improved survival. Perineural, lymphovascular, and bony invasion and T and N stage were not associated with survival. Survival with postoperative radiotherapy was 94 % at 1 year, 87 % at 2 years, and 84 % at 5 years. Conclusions The oncologic outcomes of orbital exenteration with postoperative radiotherapy for locally advanced head and neck cSCC are good. However, amelioration of the morbidity caused by resection of the eye would be ideal. Data to support immunotherapy as a sole therapy are currently limited, but a combination of neoadjuvant immunotherapy and surgical treatment may facilitate orbit-preserving treatment in the future.

Background/ObjectivesTo evaluate the outcomes of orbital evisceration with primary implant placement in acutely infected/inflamed eyes, using implant exposure/extrusion as a surrogate of success. To contextualise this with previously published literature.Subjects/MethodsA retrospective case series of all patients with acutely infected/inflamed eyes undergoing urgent orbital evisceration with primary implants, at a British tertiary centre between January 2006 and August 2018. A systematic literature review of orbital eviscerations with primary implant placement in acute endophthalmitis/infection and recent trauma.ResultsTwenty-six eyes were eviscerated in the context of acute infection/inflammation. Twenty-four eyes had primary orbital implants. Indications for evisceration included endophthalmitis (18/26, 69%), microbial keratitis with corneal perforation (4/26, 15%), non-infectious corneal perforation (3/26, 12%), and recent trauma (1/26, 4.8%). The implants used were acrylic (15/24, 63%), MEDPOR (5/24, 21%), and silicone (4/24, 17%). The follow-up period was 15 months to 14 years. Implant exposure occurred in two (8.3%), managed with implant exchange and scleral reformation in one, and implant removal with dermis fat grafting in the other. One patient (4.2%) had conjunctival wound dehiscence with spontaneous healing. Six (25%) required further surgery for minor complications as follows: conjunctival prolapse, upper lid ptosis with slight sulcus loss, lower lid entropion with shortened fornix, and lower lid ectropion. The systematic literature review showed that the mean rate of orbital implant exposure/extrusion in this subset of patients was 7.8% (95% CI: 2.7%, 12.9%, SD 8.0%), range 0–27%.ConclusionsIn acutely infected/inflamed eyes, the implant exposure/extrusion rate following orbital evisceration with primary implant placement is acceptable.

Objectives This study reports the surgical outcomes of evisceration with primary orbital implant placement in patients with endophthalmitis and analyses the association with implant exposure and extrusion. Methods A retrospective, multicentre, Chinese cohort study. Review of medical records and orbital images of patients who underwent evisceration with primary orbital implant placement between January 2005 and January 2021. Results Out of 79 patients who underwent orbital evisceration with primary orbital implant placement, 26 (26 eyes) of them (male = 13) suffered from endophthalmitis. The duration from endophthalmitis diagnosis (19 = exogenous, 7 = endogenous) to evisceration was 9 standard deviation ± 5 (range: 1–15) days. The follow-up was 70 ± 46 (24–180) months after operation. The orbital implant size was 17 ± 3 (14–20) mm, and silicone was the most used material (69%, 18/26 of patients). The most frequent post-operative complication was orbital implant exposure (42%, 11/26), followed by orbital implant extrusion (12% 3/26) and ptosis (8%, 2/26). Implant exposure or extrusion was more commonly associated with endophthalmitis in comparison to non-endophthalmitis patients that required evisceration and primary orbital implant placement (54% versus 17%, P  < 0.05). Univariate analysis showed single scleral closure technique (100% versus 58%, P  < 0.05) and endogenous endophthalmitis (50% versus 0%, P  < 0.05) were associated with implant exposure or extrusion, and only endogenous endophthalmitis was significant with multivariate analysis ( P  < 0.05). Conclusions Primary implant placement during evisceration should be avoided in eyes with endophthalmitis especially in those with an endogenous source, and double scleral closure technique may be a better alternative for primary orbital implant placement in infected eyes.

Vaginal evisceration is a rare surgical emergency in which intra-abdominal contents protrude through a dehisced vaginal cuff, which can lead to bowel ischemia and abdominal sepsis. This condition occurs due to vaginal cuff weakness secondary to prior surgeries or trauma. Recurrence after repair is rare and few cases have been documented. Here we present a young woman with multiple prior gynecologic surgeries who presented with eviscerated small bowel and omentum from her vagina five months following surgical treatment of a previous vaginal evisceration. Via a transabdominal surgical approach, general surgery and gynecology teams reduced the intra-abdominal contents, resected a pedicle of necrotic omentum, suture repaired the vaginal cuff, and placed a dehydrated placental allograft. This extremely rare case of recurrent vaginal evisceration demonstrates the importance of taking appropriate preventative surgical measures, maintaining a healthy level of suspicion for recurrence, knowing potential complications, and educating patients to prevent recurrent vaginal evisceration.

Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of etiologies, currently there is no guideline or consensus on how to approach therapeutically these patients, and most treatments are experience-based. We summarized the evidence from available studies to investigate the current state of PBE treatment strategies. This review revealed that the information available about therapeutic approaches in patients with PBE is insufficient and outdated, therefore, new experimental and larger studies are needed to reach an agreement about this condition.

•Though statistically rare, 15 FAMAE cases warrant scrutiny as planned homicides.•All 15 abductors were female, targeting a near-term younger woman of the same race.•14 abductors were in a relationship, but half believed themselves to be infertile.•7 steps to a FAMAE murder were identified, involving premeditation and deception. Fetal abduction by maternal evisceration (FAMAE) cases are statistically rare but warrant closer scrutiny as planned homicides. This study reports lessons regarding abductor modus operandi, motivation, intent, planning, and the dynamics in the attack to inform public safety. The fifteen FAMAE cases reported to the National Center for Missing and Exploited Children from 1987 to 2011 were reviewed. Court documents for the cases were retrieved, and investigators and attorneys were called to verify information where necessary. All abductors were female, between 19 and 40 years of age. Seven stages of the structure of the crime were identified: targeting and making contact with a pregnant woman, securing weapons, determining the location, subduing the mother, securing the newborn, disposing of the victim mother’s body, and informing others that they birthed a child. The case histories analyzed demonstrate how FAMAE perpetrators target an unsuspecting pregnant woman, and entrap and murder her in the service of fetal kidnapping. Awareness of FAMAE promotes public safety from those who would do anything to claim they have borne a child.

Purpose To describe our experience over 6 years using a new high-density polyethylene-based spherical integrated porous orbital implants (Oculfit). Methods This is an observational retrospective case series study analyzing all cases requiring Oculfit implants between February 2015 and September 2021. Clinical information regarding the population included, the characteristics of the implant, and the outcomes and complications during the follow-up were noted. The success of the implant was defined according to anatomical and functional parameters. Results The study analyzed 90 cases of anophthalmic patients. The main causes for enucleation or evisceration were ocular decompensations (36.7%) and neoplasms (27.8% uveal melanoma and 7.8% retinoblastoma). Anatomical success was identified in 63 (70.0%) cases, functional success in 79 (87.8%) and complete success (anatomical + functional) in 61 (67.7%) cases. Factors associated with the functional success were age and exposure of the primary orbital implant. Complications appeared in 11 (12.2%) cases, which were completely resolved without sequelae in 4 (4.4%). Orbital explant was required in 5 (5.6%) cases. Conclusion In our experience, Oculfit can be considered a useful alternative among the currently available options for orbital implants and has a good efficacy/safety profile.

Vaginal evisceration is an exceedingly rare and poorly documented complication following vaginal hysterectomy. Prompt detection and surgical intervention are critical to prevent severe complications such as bowel ischemia, perforation, and secondary sepsis. We present the case of an 84-year-old woman with a history of vaginal hysterectomy two years prior, who presented with acute abdominal pain and a significant portion of her small bowel protruding through a defect in the vaginal vault. The patient was urgently transferred to the operating room, where the loops of the small bowel were manually reduced through the vaginal defect. As the bowel appeared viable, no resection was required. The etiology of this condition is unclear and likely multifactorial. Various surgical approaches, including laparoscopic, abdominal, transvaginal, and combined techniques, have been described, all offering comparable outcomes. Therefore, the choice of surgical procedure should be tailored to the patient’s clinical presentation.

Carrion is a valuable resource in forests, providing sustenance for vertebrate and invertebrate scavenger communities and contributing to ecosystem functions, such as nutrient cycling. Intensive ungulate hunting, and thereby extraction of carcasses, removes large quantities of potential carrion from the system, denying a valuable resource from scavenger fauna. It may be possible to reduce the loss and negative consequences to forest biodiversity by retaining evisceration residues from hunted deer, where full carcasses cannot be retained. However, what roll evisceration residues play as a resource for scavengers in temperate forests is not well understood. In this study, we exposed 47 carrion samples from hunted roe deer, in front of triple sets of camera traps, to examine how hunting remains are removed and fed upon by vertebrate scavengers. Overall, 70% of the samples were completely removed from experimental sites by vertebrates. We detected twelve vertebrate taxa feeding on evisceration residues, including martens (Martes spp.), red kites Milvus milvus and garden dormice Eliomys quercinus. Common buzzards Buteo buteo and Eurasian jays Garrulus glandarius were the most frequent feeders on carrion samples, while red foxes Vulpes vulpes displaced the largest proportion of samples. Finally, we found a range of insectivorous bird and mammal species using hunting remains as a source for invertebrate prey, while not scavenging on the remains directly. We demonstrate that evisceration residues can be a valuable resource for a wide range of taxa and suggest that viscera retention from hunted game may contribute to resource provisioning for scavengers in forest ecosystems.

Purpose We compared the rates of implant exposure and extrusion after evisceration with single and double scleral closure techniques. Methods This retrospective cohort study included all patients who underwent evisceration with an implant insertion over the past 18 years at Tung Wah Eastern Hospital and Pamela Youde Nethersole Eastern Hospital. Clinical documents and operation records were reviewed. Results A total of 81 ethnic Chinese patients (44 male) who underwent evisceration with primary implant insertion were reviewed. 39 (48%) patients underwent the double scleral closure technique with an implant placed posterior to the posterior sclera, and 42 (52%) patients underwent the single scleral closure technique with an implant inserted in the intra-scleral cavity. The follow-up interval was 70 months. The surgical indications were endophthalmitis (35%), painful blind eye (23%), traumatic disfigured globe (22%) and phthisis bulbi (20%). Silicone was the most used implant material (69%). The patients who underwent double scleral closure had a larger size of the implant (19.7 vs 17.9 mm, p  < 0.05). Both implant exposure (26% vs 3%, p  < 0.05) and implant extrusion (26% vs 0%, p  < 0.05) were more common in patients who underwent single scleral. Conclusions Double scleral closure technique allows a larger implant, and it is associated with a lower rate of implant exposure and extrusion. The double scleral closure technique is a superior technique of choice in these patients with primary implant placement.