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Successful Treatment of Infertility using Laparoscopic Intraperitoneal Sperm Insemination (LIPSI) with Follicular Puncture

the left side of the anus and extensively involving the perineum and labia. Biopsy showed an invasive moderately differentiated adenocarcinoma. Due to the size of the tumour a wide perineal excision was planned and reconstruction with a rectus abdominis flap. At operation the flap was fashioned on the inferior epigastric pedicle (Figure 2). A proctocolectomy of the defunctioned colon was undertaken leaving the ileostomy intact, and a large perineal defect resulted. The flap was delivered through the pelvis and sutured in position. The patient made an uneventful recovery. Histology showed stenotic areas with flattened mucosa in the defunctioned rectum. The tumour was 7 em in diameter, a moderately differentiated mucoid adenocarcinoma invading perineal and perirectal fat but with excision margins tumour free. At follow-up two years later she remains well with no evidence of recurrence. The perineal flap is healthy and the abdominal wound has healed without an incisional hernia.