International Surgery Journal 2024-03-27T18:44:47+0530 Editor Open Journal Systems <p>International Surgery Journal (ISJ) is an open access, international, peer-reviewed surgery journal. The journal's full text is available online at The journal allows free access to its contents. International Surgery Journal (ISJ) is dedicated to publishing research on all aspects of surgery. International Surgery Journal (ISJ) focuses on General Surgery, Robotic Surgery, Orthopedic Surgery, GI Surgery, Neurosurgery, Plastic Surgery, Cardiothoracic Surgery, Vascular Surgery, Urology, Surgical Oncology, Radiology, Ophthalmology, Pediatric Surgery, Anaesthesia, Trauma Services, Minimal Access Surgery, Endocrine Surgery, ENT, Colorectal Surgery, Laparoscopic and Endoscopic techniques and procedures, Preoperative and postoperative patient management, Complications in surgery and new developments in instrumentation and technology related to surgery. International Surgery Journal (ISJ) is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, editorial, case reports, short communications, point of technique, correspondence and images in surgery. It is published <strong>monthly</strong> and available in print and online version. International Surgery Journal (ISJ) complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 12 per year</strong></p> <p><strong>Email:</strong> <a href="" target="_blank" rel="noopener"></a> / <a href=""></a></p> <p><strong>Print ISSN:</strong> 2349-3305</p> <p><strong>Online ISSN:</strong> 2349-2902</p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix:</strong> 10.18203</p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Surgery Journal accepts manuscript submissions through <a href="" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>Registration and login are required to submit manuscripts online and to check the status of current submissions.</p> <ul> <li><a href="" target="_blank" rel="noopener">Registration</a></li> <li><a href="" target="_blank" rel="noopener">Login</a></li> </ul> <p>Please check out the video on our YouTube Channel:</p> <p>Steps to register and submit a manuscript:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>Problem Logging In-Clear cookies:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="" target="_blank" rel="noopener"></a> / <a href=""></a></p> <p><strong> </strong></p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int Surg J.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The International Surgery Journal is indexed with </p> <p><strong><a href=";journalId=31390" target="_blank" rel="noopener">Index Copernicus</a></strong> </p> <p><a title="" href="" target="_blank" rel="noopener"><strong>Scilit (MDPI)</strong></a></p> <p><strong><a href="" target="_blank" rel="noopener">Index Medicus for South-East Asia Region (WHO)</a></strong></p> <p><a href=";subAction=pub&amp;publisherID=3072&amp;local_page=1&amp;sorType=&amp;sorCol=1&amp;pageb=1" target="_blank" rel="noopener">JournalTOCs</a></p> <p><a href="" target="_blank" rel="noopener">CrossRef</a></p> <p><a href="" target="_blank" rel="noopener">Journal Index</a></p> <p><a href="" target="_blank" rel="noopener">Google Scholar</a></p> <p><a href="" target="_blank" rel="noopener">J-Gate</a></p> <p><a href="" target="_blank" rel="noopener">Directory of Science</a></p> <p><a href="" target="_blank" rel="noopener">ResearchBib</a> </p> <p><a href="" target="_blank" rel="noopener">ICMJE</a></p> <p><a href=";fIDnum=|&amp;mode=simple&amp;letter=ALL&amp;la=en" target="_blank" rel="noopener">SHERPA/RoMEO</a> </p> <p> </p> Spontaneous pneumomediastinum: case series and literature review 2024-02-28T19:32:22+0530 Aleksandra Polikarpova Ngee-Soon Lau David J. Coker <p>Spontaneous pneumomediastinum (SPM) is a condition characterised by presence of air in the mediastinum that is not iatrogenic or secondary to trauma. We conducted a retrospective review of 4 cases, treated at our hospital for SPM in 2023. The mean age of the patients was 35 years (range, 28-58 years), with 3 male (75%). Only one of the patients (25%) had precipitating projectile vomiting followed by hematemesis. Chest pain was by far the most common symptom (75%). One patient presented with haematemesis, raised inflammatory markers and fever. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In all cases a computed tomography (CT) scan of the chest with on table contrast was performed with half of the patients needing fluoroscopy swallow later in the admission. Half of the patients were treated for suspected oesophageal perforation and received antibiotics and kept nil by mouth, the other two patients only required supportive care. The mean length of hospital stay was 3.4 days (range, 1.2-4.7 days). SPM is a benign process primarily affecting young otherwise healthy males. There is a growing body of evidence to suggest that CT of the chest with on table contrast should be reserved for patients presenting with red flags such as abdominal pain, hematemesis, fever and raised inflammatory markers.</p> 2024-03-11T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Caesarean section scar pregnancy: a case series 2024-01-09T14:36:32+0530 Tan Ying An Kavitha Nagandla Krishna Kumar Akshatha Daniel <p>Cesarean scar pregnancy is a rare type of ectopic pregnancy but potentially life threatening. The incidence of this ectopic pregnancy continues to rise due to global increase in cesarean sections rates as well as the diagnosis with wide use of transvaginal ultrasound. Delay or wrong diagnosis may result to uterine rupture and life-threatening bleeding with potential maternal morbidity and mortality. Endo-vaginal ultrasound has a reported sensitivity of 85-90% for detection. In difficult cases, magnetic resonance imaging is often useful as second line imaging. Treatment may be ranging from conservative to medical therapy or surgery. We present a series of three illustrative cases successfully managed with medical management and sequential treatment of medical and surgical management. We discuss diagnostic challenges and review of literature on updates on management strategies.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Barbed suture related small bowel obstruction in bariatric surgery: a case series 2024-03-07T17:42:13+0530 Kirra G. Parks Nicholas E. Williams <p>Bariatric surgeries are amongst the most commonly performed yet technically demanding laparoscopic procedures in Australia. The use of barbed suture has been widely adopted for use in gastric bypass surgeries to avoid the need for intracorporeal knot tying while maintaining tension and improving surgical efficiency. Whilst barbed suture has been reported as safe with similar outcomes to traditional suture use in bariatric surgery there is a risk that the barbs on the tail of the suture can grasp other tissues and form band adhesions resulting in small bowel obstruction (SBO). We present a series of four cases of barbed suture related SBO post Roux-en-Y gastric bypass (RYGB) surgery. In all four patients the SBO was caused by a band adhesion related to the tail of the non-absorbable (permanent) barbed suture used to close the mesenteric defect adjacent to the jejunojejunostomy. The time to presentation with SBO ranged from 1 day to 20 months post RYGB and all patients underwent diagnostic laparoscopy where the adhesion was divided and the tail of the suture trimmed. To avoid this uncommon complication, we recommend the use of absorbable barbed suture with two extra passes beyond the completion of the suture line and the tail cut almost flush with the tissue. Further data is needed to determine if the recommended modified technique still poses a risk of SBO or if use of absorbable suture to close the mesenteric defect increases the risk of internal hernia.</p> 2024-03-16T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Impact of microporous polysaccharide haemostatic agent on patients undergoing mastectomy or axillary dissection on seroma formation and timing of drain removal 2024-02-15T17:46:29+0530 Sarah Mahmood Alen Maximillian Brodaric Rajkumar Srinivasan Ruben Cohen-Hallaleh <p><strong>Background:</strong> Seroma formation is a known complication following mastectomy and axillary lymph node dissection (ALND) leading to morbidity and financial implications for patients. ARISTA<sup>TM</sup> AH has been designed to prevent postoperative seromas formation <em>in vitro</em>.</p> <p><strong>Methods:</strong> We performed a single institution, single surgeon retrospective study from January 2017 to December 2022 in patients undergoing mastectomy/axillary dissection to evaluate seroma formation rates and timing of drain removal.</p> <p><strong>Results:</strong> A total of 72 cases were included in our retrospective review of electronic medical records. Of these, 40 patients underwent ipsilateral mastectomies with sentinel node biopsies, 8 patients underwent bilateral mastectomies, and 18 patients underwent axillary dissections without concurrent mastectomy. Our analysis showed a non-significant decrease in seroma formation when ARISTA<sup>TM</sup> AH was used intra-operatively (10%) compared to standard care (24%), (p=0.14). The ARISTA<sup>TM</sup> AH group had a statistically significantly longer mean drain removal time than the standard care group (12.9 vs 7.6 days, p=0.002).</p> <p><strong>Conclusions:</strong> There was a trend towards lower seroma formation and a significantly longer requirement for drain placement after mastectomy in ARISTA<sup>TM</sup> AH group. Further research including randomised controlled multi-centre study evaluating the benefit of topical haemostatic agents in reducing seroma formation in breast surgery is warranted.</p> 2024-03-11T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Exploring the causes of obstructive jaundice: a single-centre retrospective analysis 2024-03-07T01:26:04+0530 Mohsin Yahya Murshid Abdulellah Talal Al-Alhazmi Farrukh Alim Ansari <p><strong>Background:</strong> Obstructive jaundice is a condition caused by bile flow blockage and has various benign and malignant etiologies. Accurate and timely diagnosis is essential for effective treatment, particularly in cases of possible malignancy. Advances in diagnostic methods have improved our understanding and management of diseases. This study aimed to investigate the causes and clinical presentation of obstructive jaundice in Saudi Arabian population.</p> <p><strong>Methods: </strong>This study included 193 patients diagnosed with obstructive jaundice admitted to the surgical wards from January 2019 to December 2022. Methods involved comprehensive clinical evaluations, medical history reviews, physical examinations, laboratory tests, and diagnostic imaging to identify the underlying disease. Data were collected systematically and statistically analyzed.</p> <p><strong>Results: </strong>The study included 193 patients with a male-to-female ratio of 1:1.4, and an average age of 54.10 years. Malignant causes, primarily carcinoma of the pancreatic head, accounted for 59.4% of cases, while benign causes, notably choledocholithiasis, accounted for 41.6%. Symptoms included jaundice, abdominal pain, and loss of appetite, with treatment varying according to the identified cause.</p> <p><strong>Conclusions: </strong>The study highlights that obstructive jaundice is more commonly found in females and tends to be caused by benign conditions in younger people, while malignant causes are more prevalent in older individuals. The most common malignant cause is carcinoma of the pancreatic head, and leading benign cause is choledocholithiasis. For diagnosing obstructive jaundice, key imaging techniques include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and computed tomography (CT).</p> 2024-03-16T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Acute appendicitis in pregnancy, is there a role for conservative management? 2024-01-25T03:33:10+0530 Jane Tian Tabark Altai Shubham Bhatia Youssef Mourad Andrew Miele R. Jonathan Robitsek Katherine Mckenzie Martine A. Louis Nageswara R. Mandava <p><strong>Background:</strong> Although rare, acute appendicitis is the most common general surgery problem encountered in pregnancy. A chief concern is timely and accurate diagnosis. Traditionally, delayed diagnosis of appendicitis in pregnant patients can quickly lead to appendiceal rupture associated with miscarriage, premature delivery, or even fetal loss. Hence, appendectomy has been the gold standard. However, emerging evidence suggests conservative management may be more effective than previously thought, after accounting for maternal and fetal characteristics.</p> <p><strong>Methods:</strong> This retrospective study included a sample of pregnant women diagnosed with acute appendicitis presenting for treatment to two hospitals in Queens, NY, between Jan 2012 and Dec 2021. The characteristics, presentation, and outcomes of conservatively versus surgically treated patients were compared.</p> <p><strong>Results:</strong> The cumulative incidence of acute appendicitis was 0.11% (n=44/28,000). Forty were treated surgically: 78% underwent laparoscopic appendectomy, 15% open appendectomy, and 8% underwent an initial laparoscopy which was converted to an open appendectomy. Four (14%) patients were managed conservatively with IV antibiotics. Eight percent of patients treated surgically had postoperative complications. Neither surgical nor conservatively treated groups reported any instance of mortality or fetal demise.</p> <p><strong>Conclusions:</strong> Our study adds to the literature on treatment decisions for pregnant patients with acute appendicitis. Although surgical intervention remains the gold standard, it carries the potential risk of peri- and postoperative complications. These findings suggest conservative management with antibiotics can sometimes be used without a negative impact on maternal or fetal outcomes.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Knowledge, awareness, and attitudes toward hemorrhoids and related surgical treatments among the general population in the Western region, Saudi Arabia: a cross-sectional study 2024-02-12T00:25:08+0530 Abdullah Al Sawat Hanan S. Althobaiti Ayman S. Almukhlifi Zainab B. Alkhmis Mohammed M. Alqarni Ammar M. Aljohani Emad S. Alhazmi Saleh S. Aljohani <p><strong>Background: </strong>Hemorrhoids, or swollen veins in the anal canal, can result from factors such as chronic straining during bowel movements. While categorized as internal or external, they typically manifest as painless rectal bleeding, swelling, or a lump. Despite their significant global prevalence and impact, research on hemorrhoids in Saudi Arabia remains limited. This cross-sectional study aimed to evaluate public knowledge and attitudes toward hemorrhoids, anticipating prevalent misconceptions.</p> <p><strong>Methods: </strong>It is a cross-sectional study conducted in the Western region of Saudi Arabia. Self-administered questionnaires will assess demographic data and perceptions about hemorrhoids. Data is analyzed by IBM SPSS 29.</p> <p><strong>Results: </strong>Our study indicated that 97.7% were aware of hemorrhoids, with 18.9% citing pushing during excretion and 16.4% mentioning prolonged sitting as the leading cause. 30.1% perceived surgery as the primary treatment, and 85.9% agreed on hemorrhoids' negative impact on quality of life. Significant predictors of better knowledge included (OR=1.726) for the 21-40 age group, (OR=2.024) for Taif residents, (OR=3.393) for Ph. D. holders, (OR=1.567) for an income of 5000-10000 SAR, and (OR=8.542) for participants with prior knowledge of hemorrhoids.</p> <p><strong>Conclusions: </strong>Our study sheds light on the knowledge, attitudes, and perceptions about hemorrhoids among the general population in the Western region of Saudi Arabia. There is good awareness but inadequate knowledge regarding hemorrhoids and their surgical treatment in the Western region of Saudi Arabia. The findings underscore the need for targeted educational interventions.</p> <p><strong> </strong></p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Need for a paradigm shift? Survival post-pancreatoduodenectomy remains poor despite surgical and oncological advances 2024-02-12T13:25:17+0530 Mia Shepherdson Daniel Kilburn Matthew Marshall-Webb Shahid Ullah John Chen Mark Brooke-Smith <p><strong>Background:</strong> Despite advances in surgical techniques and chemotherapy, poor outcomes persist in pancreatic malignancy. This study aimed to investigate clinical outcomes and describe the impact of factors like the closest resection margin on overall survival following open pancreatoduodenectomy at a tertiary referral centre over a ten-year period.</p> <p><strong>Methods:</strong> Patients who underwent a pancreaticoduodenectomy at a tertiary hospital in South Australia between 2009-2019 were included in this retrospective study. Patient demographics, systemic treatments, complications, and histological features were analysed for their role in overall survival. Kaplan-Meier survival curves were used to assess patient survival and estimate median survival time.</p> <p><strong>Results:</strong> There were 134 open pancreaticoduodenectomy procedures during 2009-2019. Majority of patients were male (54.7%) between 65-75 years of age (41%) with an ASA physical status classification grade of 3 (63.3%). 56.7% of patients experienced a complication with 5 in-hospital deaths recorded and 12 ISPGF grade B or C pancreatic anastomotic leaks (n=5, n=7 respectively). 88% of resected specimens were malignant with an overall 5-year survival of 32%. A resection margin of &gt;2 mm had a significantly improved overall survival compared to 0 mm (p=0.01). There was no survival benefit for a resection margin of &lt;1 mm or 1-2 mm compared 0mm margin (p=0.6 and p=0.2 respectively). 65 patients (54.6%) experienced either local or distal disease recurrence by the end of the study period.</p> <p><strong>Conclusions:</strong> There has been no improvement in overall survival post pancreatoduodenectomy for pancreatic malignancy. Further research into the clinical significance of the R status classification is required.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Assessing the use habits and efficacy of intracavernosal alprostadil: is it tolerable and sustainable? 2024-02-16T18:53:12+0530 Mehmet G. Sönmez Eren Erol Leyla Ö. Sönmez Arif Aydın <p><strong>Background:</strong> The aim of this study was to evaluate the efficacy of intracavernosal alprostadil treatment for erectile dysfunction and the evaluation of factors such as ease of drug use, duration of use, and difficulties in habituation.</p> <p><strong>Methods:</strong> The data of 40 patients who were treated for erectile dysfunction, had inadequate response from first-line treatment modalities, received intracavernosal alprostadil in second-line treatment and continued treatment for more than 12 weeks without interruption were analyzed. Sexual function status was evaluated by 15-question international ındex of erectile function (IIEF-15) form and degree of erection (1-10 points). In addition, duration of use, self-administered dose, reasons for difficulty, and reasons for treatment interruption were investigated.</p> <p><strong>Results:</strong> The mean duration of use was 21.38 months. Patients switched to self-administration after an average minimum dose of 2.23 doses. After 12 weeks, 50% of the patients discontinued self-administration, 10% because of difficulty in administration, 55% because of inadequate erection response, 25% because of time, and 10% because of additional health problems. IIEF-15 parameters and the degree of erection were found to improve significantly after administration (p&lt;0.05 for all parameters).</p> <p><strong>Conclusions:</strong> Intracavernosal alprostadil provides significant improvement in sexual function, but since it is an invasive application, patients have difficulty in getting used to it, self-administration is started after a minimum of 2 doses, and the reason for discontinuation is mostly due to inadequate erectile response.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Extrahepatic and extrapulmonary hydatid cysts as primary lesions 2024-01-04T00:28:35+0530 Hepi V. Patel Dharmesh P. Vasavada <p><strong>Background:</strong> Hydatid cyst disease, caused by the larval stage of the parasite <em>Echinococcus granulosus</em>, commonly affects the liver and lungs but can also manifest in various extrahepatic and extrapulmonary locations. Splenic hydatid disease, despite being rare, is the third most common location. This paper presents a case series highlighting the clinical presentation, diagnostic challenges, and management strategies for patients with extrahepatic and extrapulmonary hydatid cysts. Several studies already postulated on sites of hydatid cysts which have statistically significant results.</p> <p><strong>Methods:</strong> Patients who were operated on for hydatid disease or cystic lesions, which were later diagnosed as hydatid disease, between September 2022-August 2023 were retrieved retrospectively. Patients with lesions localized outside the liver and the lung as well as in liver and lung were enrolled in the study. Fifty-Two patients with extra-hepatic primary hydatid disease were treated surgically at our clinic. The cysts were located in different part of body. Results has undergone statistical methods like Z-test and Mann-Whitney U test. Any patient of any gender admitted with diagnosis of hydatid cyst in any part of body with age &gt;18 but less than 70 years irrespective of any comorbidities.</p> <p><strong>Results:</strong> Surgical techniques like partial or total cystectomy with or without tube drainage are good option for management of extrahepatic and extrapulmonary primary hydatid cysts. There were no complications or mortality in the postoperative period. Hydatid cyst is considered in the differential diagnosis of cystic lesions, especially in endemic areas. Surgical technique planned according to the location of the cyst.</p> <p><strong>Conclusions:</strong> Cystectomy is a surgical option in extrahepatic and extrapulmonary hydatid cyst which is evaluate better in this study.</p> <p><strong> </strong></p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Outcome of primary ventral hernia repair with monofilament polyester composite ventral patch in a community-based hospital 2024-02-05T21:24:31+0530 Hareesh Kumar R. Alfred Arulraj Solomon Rajakumar Veeraraghavan <p><strong>Background: </strong>Ventral hernia repair (VHR) is one of the common surgical procedures carried out in general surgery. This study assessed the post operative outcomes in patients with primary ventral hernia undergoing repair using monofilament polyester composite ventral patch Parietex™ Covidien (PCO-VP).</p> <p><strong>Methods: </strong>A prospective single proportion observational study of 54 patients undergoing open VHR for primary ventral hernia with the PCO-VP in a community-based hospital was carried out. The patients were followed up for a period of one year from day of surgery. Primary outcome was recurrence, and secondary outcomes were reoperations and complications including seroma, hematomas, abdominal wall abscess, wound infections, and mesh infections.</p> <p><strong>Results: </strong>Our sample size of (n=54) included 35 (65%) females and 19 (35%) males with a mean hernia defect diameter of 3.5±0.4 cm. 83% (45) underwent elective surgery (EL) and 17% (9) underwent emergency surgery with a mean operative time of 98.5 minutes, 11% (n=6) patients needed alteration of the technique and 20% (n=11) patients needed mesh repositioning, 12 adverse events were noted during the hospital stay. No mesh infections, early recurrences, readmissions or revision surgeries were noted. Patients had a average Carolina comfort scale score of 4/115 noted at the end of study.</p> <p><strong>Conclusions: </strong>The use of PCO-VP to repair primary ventral hernia yielded nearly nil early recurrence rate, low postoperative complications and high satisfaction ratings, PCO-VP repair is a highly effective method for small and moderate size ventral hernias in both elective and emergency setting.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Splenic hydatid cyst: a case report 2024-02-13T23:48:53+0530 Dakshita Adlakha Subhash Chawla Maneshwar S. Utaal Shivam Sharma Ankita Khurana Mrugen Thakor Sakshi Ramnani <p>Hydatid cyst (HD) disease is a parasitic infection caused by <em>Echinococcus granulosus</em>. It occurs worldwide, but its prevalence is higher in the rural communities where sheep and cattle raising constitute a crucial component of the agricultural industry. This is a zoonotic disease which spreads via close contact of humans with sheep and dogs. The most common organs involved in hydatid cyst are the liver and lungs. However, other organs may also foster it, such as the spleen which is a rare clinical condition, with an incidence rate of between 0.5% and 4%. In this study, a 46-year-old male with a primary splenic HC is reported with chief complaint of pain and non-tender palpable mass in left hypochondrium. A 9.7×10.6×11 cm splenic cystic mass was detected on ultrasonography (US) and confirmed by abdominal computed tomography (CT) scan, without involvement of other organs. Splenectomy was done along with excision of intact hydatid cyst. Pathological examinations revealed cystic hydatidosis. We describe this case of an isolated splenic HC, which was successfully treated with total splenectomy, focusing on the management and outcome of this disease.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Asymptomatic marginal zone lymphoma detected on routine mammogram, an unusual presentation 2024-02-22T09:58:47+0530 Ryan J. Green Sarath Vennam Max Ireland Grant Withey Amelia Melloy <p>A patient in her 60 years presented for routine mammographic screening. A lesion was identified, which on biopsy was proven to be marginal zone lymphoma (MZL). MZL is a group of indolent non-Hodgkin’s B-Cell lymphomas. Involvement of breast tissue is rare and can mimic more common breast pathology. In addition, the patient had widespread subcutaneous lesions which is also atypical of the cutaneous form of MZL lymphoma. This case describes the multi-modality radiological findings of this uncommon presentation of diffuse cutaneous MZL.</p> <p><strong> </strong></p> 2024-03-08T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Navigating endoscopic challenges in situs inversus totalis: strategies for optimal procedure completion and patient safety 2024-02-22T19:54:41+0530 Simone H. Mangan Justin Ng Jessica Ng <p>Flexible endoscopy is a gold standard diagnostic test for the evaluation of the gastrointestinal tract and an accessible intervention in clinical practice. Completion rates are generally high while perforation rates are low in experienced hands. Situs inversus totalis (SIT) is a rare congenital abnormality that involves the complete transposition of all the viscera. In less-experienced hands, incompletion and perforation rates may increase in patients with SIT due to unfamiliarity with anatomy. The purpose of this case report is to present methods such as reverse manoeuvres to assist in the safe completion of an endoscopy in SIT when technical difficulties arise. Using a case of a patient in a rural hospital who presented for a colonoscopy who had SIT, we discuss the use of adjuncts, variations in segment specific manoeuvres, traditional positioning and abdominal pressure points in-order to perform a safe and successful endoscopy in a patient with SIT.</p> 2024-03-05T00:00:00+0530 Copyright (c) 2024 International Surgery Journal A rare case of bowel perforation in an adult with antithyroid medication induced neutropaenic enterocolitis 2024-02-25T08:06:39+0530 Alexander Yuen <p>Neutropaenic enterocolitis (NE) is a life-threatening complication of neutropenia rarely seen in adults. Cases of NE arising outside the context of haematological malignancies or oncological treatments remain extremely infrequent. We present a case of bowel perforation secondary to NE in a female adult patient who developed agranulocytosis after commencement of thionamide antithyroid medications for hyperthyroidism. Patients recently commenced on thionamides should be educated on the symptoms of agranulocytosis and present to the hospital. Emergency physicians and surgeons alike should have a high index of suspicion for NE in this group of patients and prompt surgical intervention may be required to reduce the significant mortality rate.</p> 2024-03-05T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Pneumatosis intestinalis as a manifestation of chronic intestinal volvulus: case report 2024-02-27T13:45:56+0530 Ricardo-Raziel Peña-González Ricardo-Paul Arellano-López Erick Fernando Hernández Brandon-Rafael Contreras-Díaz Williams O. Ramírez-Miguel Eduardo Aguilera-Callejas Jonathan Quiroz-Alvarez Gabriela E. Gutiérrez-Uvalle <p>The pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by presence of gaseous cysts containing nitrogen, hydrogen and carbon dioxide in the intestinal wall that can be idiopathic or associated with other diseases. There are 5 theories about the pathophysiology: mechanic (obstruction), immunosuppression (atrophy of Peyer's patches), bacterial (<em>Clostridium </em>spp.), pulmonary (chronic pulmonary disease) and chemical (exposure to trichloroethylene). The aim of this paper is to present a clinical case of a patient with rheumatic comorbidity admitted to the emergency service and diagnosed with acute abdomen secondary to intestinal volvulus associated with pneumatosis intestinalis.</p> 2024-03-08T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Pediatric acute urinary retention due to impacted urethral meatal calculus: a rare case report 2024-02-28T12:15:25+0530 Arief Fadli Putra Fajar Awalia Yulianto <p>Urethral calculus is rare in pediatrics, especially with acute urinary retention. The diagnosis of urethral calculus is made by proper history taking, physical examination, and imaging studies. In this case, the diagnosis was made mainly by anamnesis, inspection, and palpation of the calculus in the external urethral meatus. Invasive and less invasive procedures such as open surgery, meatotomy, or laser lithotripsy procedure, can be a management of urethral calculus. In this case, simple extraction was performed without meatotomy or other invasive procedures. A 5-year-old, boy was reported to come to the emergency department because of severe pain in his penis and acute urinary retention. The patient had a history of dysuria, a habit of delaying urination, and low fluid intake. On physical examination, it was found a distention in the suprapubic area and a green-white solid mass at the external urethral meatus. A 10-millimeter calculus was successfully extracted from the external urethral meatus with simple extraction procedures under local anesthesia. This case report demonstrated a rare case of pediatric acute urinary retention secondary to impacted urethral meatal calculus in an emergency setting of a low-level hospital. Immediate and proper management was required due to the patient's condition and considering the lack of facilities. The extraction of calculus with minimal urethral damage was the recommendation.</p> 2024-03-08T00:00:00+0530 Copyright (c) 2024 International Surgery Journal A rare case of extra adrenal retroperitoneal paraganglioma: case report 2024-02-14T11:40:37+0530 Sakshi Ramnani Subhash Chawla Maneshwar Singh Utaal Mrigendra Singh Dakshita Adlakha Mrugen Thakor <p>Extra adrenal retroperitoneal paragangliomas are neuro endocrine neoplasms with extremely rare incidence and a wide plethora of clinical presentations. They originate from the neural crest cells interspersed throughout the body. They can present with vague symptoms of pain abdomen, hypertension, palpitations and in severe cases with renal failure, and shock owing to catecholamine excess. On the other end of the spectrum they can be totally asymptomatic and detected incidentally. The multitude of clinical presentations and lack of specific diagnostic tests hence pose a great difficulty in the pre-operative diagnosis of the disease. We are presenting a case of a 20-year-old female with vague symptoms to highlight the management and clinical diagnosis of extra adrenal retroperitoneal paraganglioma.</p> <p> </p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Skin graft on a collagen and elastin matrix fixed with negative pressure in a complicated pediatric dog bite: case report 2024-01-27T07:06:14+0530 Omar S. Fattel-Servin Osvaldo I. Guevara-Valmaña Sebastian Trigueiros-Guzmán Valentina Prieto-Vargas Ximena I. Ramirez-Morales Armando Apellaniz-Campo <p>Animal bites represent a significant source of morbidity in the pediatric population, with dogs being the primary cause. Highlighting the need for innovative solutions to effectively tackle the issue and enhance both functional and aesthetic outcomes. Dog bites, marked by a heightened morbidity rate, present an inherent infection risk owing to the considerable bacterial load present in saliva. The fundamental approach to treatment revolves around preventing infection through meticulous washing, debridement, and the timely implementation of early primary closure. We detail the management of a pediatric patient with a dog bite on the pelvic limb, resulting in a challenging-to-manage wound. This case was successfully treated with a skin graft on a bed of collagen matrix, secured with negative pressure therapy. The choice of the appropriate technique for reconstructing skin defects depends on their depth and size. Consequently, combining these three techniques yielded a favorable functional and aesthetic outcome for the patient. This case report emphasizes the relevance of employing different techniques in managing complicated dog bites.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Small bowel obstruction caused by transmesosigmoid internal hernia 2024-02-08T16:15:18+0530 Ata M. Ghaith Ahmad A. Al-Kharabsheh Mohammad I. Al-Sakarneh Osama M. Ghaith <p>Internal hernia is an uncommon occurrence contributing to intestinal obstruction, posing diagnostic challenges. Among the infrequent manifestations, one noteworthy type is associated with the sigmoid colon, categorized into three subtypes: inter-sigmoid, trans-mesosigmoid, and intra-mesosigmoid. We present a case of a 48-year-old female who presented with small bowel obstruction as an emergency. CT showed intestinal obstruction with translational point at mid jejunum without any mass identified. At laparotomy we identified an internal hernia in the sigmoid mesocolon with full thickness mesentery defect (transmesosigmoid), bowel was viable and reduced where the defected was closed. Early identification of internal hernia and early management prevent mortality and morbidity; sigmoid related hernia is rear type of internal hernia. Most internal hernia diagnosed during laparotomy searching for case of acute intestinal obstruction.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Rectal malakoplakia simulating a locally advanced rectal cancer: a case report 2024-02-07T02:09:46+0530 André A. Silva Guida C. Pires Liliana V. Simões Beatriz R. Lourenço Catarina C. Rocha Lília J. Meireles <p>Malakoplakia is a rare and chronic granulomatous disease, resulting from the accumulation of large granular macrophages containing basophilic inclusion bodies in the cytoplasm named Michaelis-Gutmann bodies. The gastrointestinal tract is the second most common site after the urinary tract, though malakoplakia has the potential to manifest in multiple organs. Rectal malakoplakia is difficult to diagnose due to its unspecific clinical and radiological presentation, usually mimicking a malignancy. Most report cases are associated with immunosuppressive diseases or chronic prolonged illness. We present the case of a 64-year-old male with a history of anal pain. A pelvic magnetic resonance imaging showed a rectal mass with 38 mm invading the mesorectum. Colonoscopy was performed confirming a mass-like lesion and biopsies were taken. Histopathological examination revealed features consistent with malakoplakia. The patient underwent long-term oral antibiotic treatment and during follow-up there was a regression of the lesion and resolution of symptoms.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Spontaneous superficial femoral artery pseudoaneurysm: a rare case report 2024-01-22T23:38:58+0530 Naveenraj R. Bhavin Patel Hiten Patel Ajay Tiwari <p>Spontaneous femoral artery pseudoaneurysm (PSA) is a rare disease and there are few reported cases. We report a case of a 45 year-old male with painless, non-pulsatile swelling in the medial aspect of left lower thigh, which is gradually increasing in size for a period of 2 months. He had no history of trauma or surgery. CT Angiography confirmed a large pseudoaneurysm of the left distal superficial femoral artery (SFA). Then patient had sudden rupture of the pseudoaneurysm and it was treated surgically by ligation of SFA proximal and distal to pseudoaneurysm with excision of large surrounding hematoma.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Massive diaphragmatic eventration: plication 2024-01-26T19:22:05+0530 Ashok S. Gajbhiye Lalit V. Tamgadge Sarita Durge Ayyappa Sai Kumar Kolasani <p>Diaphragmatic eventration (DE) is a distinctive condition characterised by the abnormal elevation or displacement of a portion of the diaphragm, often leading to a protrusion of abdominal contents into the thoracic cavity. Unlike diaphragmatic hernias, eventrations involve a congenital or acquired weakness of the diaphragmatic muscle itself rather than a structural defect. Congenital eventrations typically arise from the incomplete development or muscular hypoplasia of the diaphragm, while acquired forms may result from trauma, surgery, or neurological disorders affecting the phrenic nerve. Clinical manifestations vary widely, with some individuals remaining asymptomatic, while others may experience respiratory difficulties, especially when lying down. The case involves a 65-year-old female with a history of breathlessness exacerbated in the lying position, improved when upright. Examination revealed low oxygen saturation, absent breath sounds on the left chest, and bowel sounds in that region. Chest X-ray and HRCT indicated bowel loops in the left chest due to eventration of the left hemidiaphragm. Surgical intervention involved thoracotomy, identifying a lax left hemidiaphragm, mobilising abdominal contents, and performing plication with proline 1-0. Closure was completed with an intercostal drainage (ICD) in the left thoracic cavity. Postoperative period was uneventful. This case emphasises the significance of prompt diagnosis and surgical intervention in managing DE, showcasing the effectiveness of thoracotomy, hemidiaphragm plication, and ICD placement.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Incidental wandering gall bladder: a rare case report 2024-02-15T22:01:17+0530 Ankita Khurana Maneshwar Singh Utaal Anmol Singh Ahluwalia <p>The pre-operative diagnosis of wandering gallbladder is challenging until complicated by torsion or necrosis. Ultrasonography remains the mainstay radiological investigation for gall bladder pathologies. Computed tomography can be used in complicated cases like gall bladder torsion. Free floating gall bladder may not be appreciated on ultrasonography as in our case report which has been discussed below.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal A comprehensive case study of cholecystectomy in a patient with a gallbladder laden with 442 stones 2024-01-31T17:58:16+0530 Prashant Kedari Milind Joshi Vaibhav Kapoor Sushant Khurana <p>Cholelithiasis (gallstones), crystalline formations in the gallbladder, presents a common yet intricate medical concern. These stones can vary in size and composition, ranging from cholesterol to pigment-based stones. Treatment often involves surgical intervention, with laparoscopic procedures being a minimally invasive and effective option. However, complications arise when multiple stones are present, leading to heightened inflammation and recurrent symptoms. In this study, we present a case of a 34-year-old, male who came with complaints of abdominal pain and bloating, intermittent nausea, vomiting, and jaundice for more than 5 days. He was diagnosed with multiple calculi in the gallbladder (acute cholecystitis with cholelithiasis) based on ultrasonography. Since the patient had jaundice, he was suggested to get a magnetic resonance cholangiopancreatography (MRCP) to rule out any pathoanatomy. He received treatment by laparoscopic cholecystectomy and showed improvement within 5 days of surgery.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal An unusual case report of metastatic periampullary carcinoma 2024-02-01T00:53:21+0530 Suryalok Pratap Shah Shahbaz Ahmad Pandit Alok Kumar Pandey Supreet Kumar Rahul Gautam Aishwarya Bhalerao Vivek Tandon Deepak Govil <p>Pancreatic cancers usually metastasize through the lymphoid system to organs such as the lung, liver, bone and spleen. Ovarian metastasis in pancreatic cancers is extremely rare, hence, it is difficult to distinguish between primary and metastatic ovarian tumors, especially in tumors with a primary source from the GIT &amp; Hepatobiliary system. We present the case of a periampullary carcinoma with ovarian metastasis in a middle-aged female who presented with complaints of abdominal pain, constipation, yellowish discoloration of eyes and dark colored urine along with loss of appetite and weight loss for a duration of 6 to 8 weeks. Radiological examination revealed right adnexal lesion and nodular thickening along periampullary region. ERCP guided biopsy of the growth in periampullary region revealed moderately differentiated adenocarcinoma. She underwent pancreatico-duodenectomy with bilateral salpingo-oophorectomy. The histopathological examination revealed invasive carcinoma in both the ovaries, and moderately differentiated adenocarcinoma in periampullary and intra-ampullary region. As per the findings in previous studies, bilateral ovarian tumors of any size, or a unilateral tumor less than 10 cm likely represents metastatic disease rather than primary ovarian tumor. The rarity of co-presentation of pancreatic and adnexal mass makes the diagnosis tough however it is important to differentiate between primary ovarian mucinous cancers and ovarian metastasis from primaries in GIT for further treatment and follow up.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Principles of dressing and debridement in modern rural surgery: experience of a case of Fournier’s gangrene 2024-02-03T22:41:59+0530 Arijit Rumu Baruah Darpana Kalita <p>Fournier’s gangrene is a rare and rapidly progressive necrotising fasciitis of the external genitalia and perineum. It is characterised by obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the subcutaneous tissue and the overlying skin. Rural surgery refers to the practice of surgery serving people in rural communities and geographically remote areas. Rural surgery faces multiple challenges like limitation of resources and manpower, poverty, multiple co-morbidities and superstitions. We present such a case of Fournier’s gangrene treated in a secondary care centre of rural Assam. A 45 year old male presented with pain and discharge from the scrotum since two weeks. No other co-morbidities were present. Initially, wound debridement and dressing with hydrogen peroxide and povidone iodine is done. Necrosed tissue is sent for microbial culture and sensitivity. Initially, empirical antibiotics was started and was converted to fluoroquinolones as it showed sensitivity. Serial dressing and debridement were continued till healthy granulation tissue appeared. Then, the wound was closed by loose approximation method. Wound was successfully apposed and viability of both the testis was also found to be intact. Thus, the age-old principle of dressing and debridement still serves as the background of wound care in modern rural surgery.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Lessons learnt from uncommon events during robotic assisted minimally invasive oesophagectomy 2024-02-14T13:24:11+0530 Suraj B. Pawar Kiran G. Bagul Rishikesh D. Nilapwar Hitesha Bhandari Aditya S. Pawar <p>Esophagectomy is the mainstay treatment for cancer of the esophagus. Over the last two decades robotic assisted minimally invasive oesephagectomy (RAMIE) have become increasingly popular in esophageal surgery. We present a rare complication of an air leak following RAMIE. Our patient underwent a robotic assisted total esophageal mobilization, lymph node dissection transthoracically for a lower oesophageal tumour. He developed persistent air leak and needed oxygen support. Following which thoracoscopic bullectomy was done, lung was successfully re-inflated. To the authors’ knowledge, this rare complication has only handful cases reported in the medical literature; other surgeons should be made aware of this problem.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal Mucinous cystadenoma of both ovaries and appendix: a case report 2024-02-15T16:35:38+0530 Sujan N. Agrawal Manisha Goyal Sanjay Prasad <p>Epithelial neoplasm of ovaries is common and almost 40% of them are benign. Cystadenoma of ovary is the commonest epithelial neoplasm. They can be serous or mucinous. They arise from the surface epithelium of ovary, some of them may have germ cell origin. They are multilocular. 80% of ovarian mucinous cyst are benign cystadenoma. They are unilateral in 95% of cases. In this case presentation, it was bilateral and appendix was also showing mucinous cystic degeneration. The mucinous cystadenoma of the appendix is the most common mucinous cyst of the appendix, but the definite diagnosis is made at the time of surgical intervention only. The confirmation is reached by histopathology examination of specimen. This interesting case report is that of a giant bilateral ovarian mucinous cystadenoma of ovary along with the cystic degeneration of appendix. This is a rare case presentation scenario where bilateral giant cyst is found along with same pathology in appendix.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal A rare case of gastric perforation caused by Candida infection 2024-02-15T23:13:11+0530 Mrugen Thakor Subhash Chawla Maneshwar Singh Utaal Rijuta De Sakshi Ramnani Dakshita Adlakha <p>Fungi are usually a rare cause of gastric perforation (about 0.65%), with most cases of gastric perforation occurring as complications of peptic ulcer disease (PUD), nonsteroidal anti-inflammatory drugs (NSAIDs) and gastric neoplasms. Here, we report the case of a 60-year-old male who presented to our hospital with severe epigastric pain, multiple episodes of vomiting and no history of PUD, NSAIDs use or gastric neoplasm. Exploratory laparotomy revealed a pre-pyloric gastric perforation which was repaired with modified graham’s patch repair. Histopathological examination of the gastric perforation edge biopsy revealed an intense <em>Candida</em> colonization invading and destroying the gastric wall. Intra-operative fluid sends for culture and sensitivity also revealed growth of candida species. He was subsequently treated with fluconazole antifungal and discharged home after an uneventful postoperative period.</p> 2024-03-27T00:00:00+0530 Copyright (c) 2024 International Surgery Journal