https://www.ijsurgery.com/index.php/isj/issue/feedInternational Surgery Journal2024-02-29T18:27:43+0530Editormedipeditor@gmail.comOpen 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 https://www.ijsurgery.com. 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="mailto:medipeditor@gmail.com" target="_blank" rel="noopener">medipeditor@gmail.com</a> / <a href="mailto:editor@ijsurgery.com">editor@ijsurgery.com</a></p> <p><strong>Print ISSN:</strong> 2349-3305</p> <p><strong>Online ISSN:</strong> 2349-2902</p> <p><strong>Publisher:</strong> <a href="http://www.medipacademy.com/" 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="http://www.crossref.org/" 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="https://www.ijsurgery.com/index.php/isj/about/submissions" 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="https://www.ijsurgery.com/index.php/isj/user/register" target="_blank" rel="noopener">Registration</a></li> <li><a href="https://www.ijsurgery.com/index.php/isj/login" 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="https://youtu.be/YHX7eUWH7bk" target="_blank" rel="noopener">https://youtu.be/YHX7eUWH7bk</a></p> <p>Problem Logging In-Clear cookies:<br /><a href="https://youtu.be/WVjZVkjB2SQ" target="_blank" rel="noopener">https://youtu.be/WVjZVkjB2SQ</a></p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="mailto:medipeditor@gmail.com" target="_blank" rel="noopener">medipeditor@gmail.com</a> / <a href="mailto:editor@ijsurgery.com">editor@ijsurgery.com</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="https://journals.indexcopernicus.com/search/journal/issue?issueId=all&journalId=31390" target="_blank" rel="noopener">Index Copernicus</a></strong> </p> <p><a title="https://www.scilit.net/journal/325414" href="https://www.scilit.net/wcg/container_group/11075" target="_blank" rel="noopener"><strong>Scilit (MDPI)</strong></a></p> <p><strong><a href="https://imsear.searo.who.int/handle/123456789/156148" target="_blank" rel="noopener">Index Medicus for South-East Asia Region (WHO)</a></strong></p> <p><a href="https://www.journaltocs.ac.uk/index.php?action=browse&subAction=pub&publisherID=3072&local_page=1&sorType=&sorCol=1&pageb=1" target="_blank" rel="noopener">JournalTOCs</a></p> <p><a href="http://www.crossref.org" target="_blank" rel="noopener">CrossRef</a></p> <p><a href="http://www.journalindex.net/visit.php?j=9595" target="_blank" rel="noopener">Journal Index</a></p> <p><a href="http://scholar.google.co.in/" target="_blank" rel="noopener">Google Scholar</a></p> <p><a href="http://jgateplus.com/" target="_blank" rel="noopener">J-Gate</a></p> <p><a href="http://www.directoryofscience.com/site/4548839" target="_blank" rel="noopener">Directory of Science</a></p> <p><a href="http://journalseeker.researchbib.com/view/issn/2349-3305" target="_blank" rel="noopener">ResearchBib</a> </p> <p><a href="http://www.icmje.org/journals-following-the-icmje-recommendations/" target="_blank" rel="noopener">ICMJE</a></p> <p><a href="http://www.sherpa.ac.uk/romeo/journals.php?id=2295&fIDnum=|&mode=simple&letter=ALL&la=en" target="_blank" rel="noopener">SHERPA/RoMEO</a> </p> <p> </p>https://www.ijsurgery.com/index.php/isj/article/view/10174Resolution of halitosis following repair of a primary parahiatal diaphragmatic hernia2024-01-07T17:34:31+0530James N. Sellarsjamessellars1212@gmail.comRyan Greenryan.green275@gmail.comEshwarshanker Jeyarajaneshwarshanker.jeyarajan@health.qld.gov.au<p>Parahiatal diaphragmatic hernias are uncommon and often diagnosed incidentally on imaging, or in the emergency setting. Symptoms related to these defects can be like those of hiatus hernias (HH), however this is not always the case. We present a unique case of parahiatal diaphragmatic hernia that was characterised by severe halitosis which resolved with surgical repair.</p>2024-02-05T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10234An unusual cause of biliary obstruction: a case report2024-02-09T09:03:41+0530Bethany K. Matthewsbethany.matthews@health.qld.gov.auPranavan Palamuthusingampranavan.palamuthusingam@health.qld.gov.au<p>Abdominal aortic aneurysms are considered as an unusual cause of extraductal biliary obstruction with less than 30 case studies found within the literature. This case report will discuss an 81-year-old female with an incidental initially asymptomatic finding of extrahepatic biliary obstruction and gallbladder distension secondary to an abdominal aortic aneurysm in routine computed tomography staging scan. Extraductal biliary obstructions can require alternative or additional interventions to that of treatment for intraductal obstruction. Subsequently, the aetiology of biliary obstruction is important for clinicians to consider and recognise, to allow for the implementation of appropriate and timely management.</p>2024-02-22T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10250Clonorchis sinensis: a mimic of hepatic mucinous cystic neoplasm or just a fluke?2024-02-14T19:33:23+0530Tushar L. Agrawaltushar.agrawal@health.qld.gov.auBrielle E. Williamsbrielle.williams@health.qld.gov.auBryan M. Tranbryanminhtran@gmail.comRamesh Damodaran Prabharamesh.damodaranprabha@health.qld.gov.auSooraj Pillaisooraj.pillai@health.qld.gov.auCraig SommervilleTushar.Agrawal@health.qld.gov.au<p>Liver flukes, endemic in East Asia, are parasites that can infect humans and cause liver and bile duct disease. While most infected individuals are asymptomatic, chronic infection can lead to structural hepatobiliary manifestations including hepatomegaly, intrahepatic bile duct dilatation, epithelial hyperplasia, periductal fibrosis, and potentially cholangiocarcinoma. There are no reports of human cases of liver fluke infection presenting as a hepatic cystic lesion. We present the case of a 52-year-old asymptomatic Chinese immigrant presenting with a suspected mucinous cystic neoplasm of the liver. CT and Ultrasound examinations demonstrated an enlarging complex cyst involving segments II and III. Liver function tests, hydatid serology and tumour markers were normal. He underwent elective laparoscopic left hemi-hepatectomy with liver fluke discovered on histology. Subsequent genetic testing confirmed <em>Clonorchis sinensis </em>infection. The patient made an uneventful recovery from surgery and was treated with anthelminthic therapy. This case highlights the importance of considering liver fluke as a differential diagnosis for hepatic cystic lesions in patients from endemic regions. Appropriate diagnosis could avoid surgery, whilst targeted anthelminthic therapy minimises the risk of chronic infection and associated complications, including cholangiocarcinoma.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10206Perforated mucinous diverticulitis of the appendix: a case report2024-01-24T05:35:41+0530Matthew L. Basamatthew.basa@uqconnect.edu.auAndrew Riddellmatthew.basa@uqconnect.edu.au<p>Acute right lower quadrant (RLQ) abdominal pain typically raises the suspicion of appendicitis and must be ruled out, as the treatment is primarily surgical. Other differentials, many of which are medically treated, ought to also be considered. Right sided diverticulitis, although uncommon, often mimics appendicitis due to its inflammatory nature and its location of pain. A 37-year-old woman with a history of recurrent right-sided diverticulitis presented with rapidly escalating RLQ pain. While appendicitis was a prime suspect, additional imaging was refused due to radiation concerns, hence clinical judgement had to be aptly applied. Facing diagnostic ambiguity, Hickam's dictum (seeking the most probable cause) pointed towards appendicitis, while Ockham's razor (favouring the simplest explanation) supported recurrent right sided diverticulitis. This uncertainty necessitated a definitive approach, weighing up the risks and benefits of medical vs surgical treatment for an unconfirmed pathology. To resolve the uncertainty, a diagnostic laparoscopy was performed. Contrary to expectations, it revealed a perforated diverticulum of the appendix with a mucinous tip and free-floating mucin, making both leading differentials, that is, right sided diverticulitis and appendicitis, correct. We explore the diagnostic reasoning used in the case, including the anticipated management strategies and outcomes, if other differentials were encountered. This case aims to support clinicians in pursuing further investigations, or need be, a diagnostic laparoscopy, in order to prioritise patient safety, if clinical concern is present.</p>2024-02-05T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10218Epidural venous plexus enlargement secondary to left iliac vein occlusion: case report2024-02-02T01:09:35+0530Sierra Juárez Miguel A.sierrajuarez@gmail.comRamos-Peralta Mariely I.marielys_ramos@hotmail.comGonzález-Martínez I.itatimss@gmail.comBurgos-Arriaga L.burguimss@gmail.com<p>We present a 34-year-old male case, with a history of primary thrombophilia under treatment with rivaroxaban, deep vein thrombosis of the left leg and extremities plus pulmonary thromboembolism 10 years ago. He reported digestive symptoms and chronic low back pain with left leg edema. Phlebography diagnoses occlusion of the left iliac vein with dilated veins of more than 3 cm on the left peri-vertebral side. Angioplasty plus stent placement is performed, the collateral venous network and the patient's symptoms disappear.</p>2024-02-20T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10224A giant, recurrent, subpectoral breast lipoma: case report2024-02-05T04:17:17+0530Sahar M. Alnefaiedrsahar22@gmail.com<p>Lipomas are mesenchymal tumors composed of mature fat tissue and are considered one of the most common benign tumors. They are usually small in size, and giant lipomas are rare. The exact etiology of lipoma development is unclear, though several factors have been proposed. Intramuscular or subpectoral lipomas involving the pectoralis major muscle are uncommon. In this report, the author has described the case of a 52-year-old female patient who presented with an uncommon form of subpectoral, giant, recurrent breast lipoma. The patient had undergone a complete surgical excision. The author suggests an individualized assessment and treatment of each case.</p>2024-02-14T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10239Management of colorectal large cell neuroendocrine carcinoma: case report and literature review2024-02-11T23:31:58+0530Marcio B. Coelhombcoelho86@gmail.comThomas M. Kovacsthomas.kovacs@health.qld.gov.auBree D. Stephensenbree.stephensen@health.qld.gov.au<p>Large cell neuroendocrine carcinoma (LCNEC) of the colorectum is a rare, aggressive subtype of neuroendocrine cancer with a dismal prognosis. Accounting for a mere 0.25% of colorectal cancers, LCNEC is associated with a median overall survival of 4 to 16 months, and nearly all patients succumb within a year. Pure colorectal LCNEC reports are scarce, and this review and case study presents a 40-year-old male, the youngest reported patient, diagnosed with rectal LCNEC. A comprehensive PubMed search for “large cell neuroendocrine carcinoma” and “colorectal” was conducted. Titles were meticulously screened for relevance to the nuanced management of colorectal LCNEC. Despite aggressive therapeutic interventions, including chemotherapy with carboplatin and etoposide, the patient experienced rapid disease progression, emphasizing the challenging nature of LCNEC. The paper discusses the evolving classification of NEC, morphological features, and immunophenotypic characteristics that differentiate LCNEC from other neuroendocrine tumours. Survival rates underscore the aggressive nature of colorectal NEC, and treatment options, primarily relying on retrospective studies, reveal limited efficacy. While surgery remains the preferred approach for localized disease, the optimal chemotherapy regimen for LCNEC is yet to be established. Current evidence suggests platinum-based therapy as a common first-line treatment, but the demand for more effective options persists. The paper highlights the need for additional research, including prospective trials, to elucidate the genuine benefits of adjuvant chemotherapy and to explore emerging therapies, such as immunotherapy, in the context of LCNEC.</p>2024-02-22T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10124Isolated and fistulized primary appendicular tuberculosis: when a great pretender disguises herself2023-12-09T16:20:21+0530Riyad Abbasriyadabbasmenara@gmail.com<p>Tuberculosis in all its forms remains a public health problem in Morocco, despite the efforts of the state in terms of prevention and treatment. Recently, there has been an increase in the number of extra-pulmonary forms of TB. Isolated appendicular localization is very rare, especially since intestinal localization is only ranked 6th among extra-pulmonary localizations. We report the case of a 39 year old female patient admitted for right iliac fossa (RIF) pain evolving for two months, the clinical examination on admission objective a digestive fluid outlet through a fistulous orifice at the level of the RIF; the abdominal CT scan found a plastron with the presence of a fistulous path between a digestive segment and the wall, the surgical exploration found a fistula between the body of the appendix and the wall, an appendectomy was done and the anatomopathological examination confirmed the tuberculosis origin. Our work sheds light on an often-misunderstood form of a well-known pathology.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10177Choledocholithiasis secondary to a remnant gallbladder post cholecystectomy more than 20 years ago2024-01-10T18:19:49+0530James N. Sellarsjamessellars1212@gmail.comRyan Greenjamessellars1212@gmail.comOmar Moulinejamessellars1212@gmail.com<p>Remnant gallbladders have been described following incomplete and sub-total cholecystectomy (TC) and have the potential to harbour gallstones and even produce new calculi over time. We present a case of choledocholithiasis in a patient with a remnant gallbladder following a presumed incomplete cholecystectomy more than 20 years prior.</p> <p><strong> </strong></p>2024-02-05T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10235Pancreatic tuberculosis: a case report2024-02-09T09:10:22+0530Bethany K. Matthewsbethany.matthews@health.qld.gov.auPranavan Palamuthusingampranavan.palamuthusingam@health.qld.gov.au<p>Tuberculosis is a bacterial infection secondary to <em>Mycobacterium tuberculosis</em> with highest burden within low socioeconomic communities. Most individuals with tuberculosis infection are immunocompromised due to underlying medical conditions such as human immunodeficiency virus. However, tuberculosis can manifest in immunocompetent individuals although the incidence is significantly less. Pancreatic tuberculosis is exceedingly rare with autopsy series revealing pancreatic tuberculosis <5% of tuberculosis infected individuals. This case report will discuss a 16-year-old female presenting with pancreatic tuberculosis masquerading as possible pancreatic malignancy. Emphasis is placed on the challenging diagnostic nature of pancreatic tuberculosis as it presents with non-specific clinical symptoms which are in keeping with a wide range of differential diagnoses. Once correctly diagnosed pancreatic tuberculosis presents the potential of cure. It is for this reason whilst a rare diagnosis clinicians should be mindful of pancreatic tuberculosis to ensure timely correct treatment is pursued and unnecessary surgical procedures avoided.</p>2024-02-22T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10265Endo the line: stricturing terminal ileum endometriosis2024-02-21T11:47:35+0530Tushar L. Agrawaltushar.agrawal@health.qld.gov.auRichard Maguirerichard.maguire@health.qld.gov.auSooraj PillaiTushar.Agrawal@health.qld.gov.auArun D. NaikTushar.Agrawal@health.qld.gov.au<p>Endometriosis is the implantation and proliferation of endometrial tissue outside the uterus, and while involvement of the small bowel is rare, it is particularly unusual for it to present with terminal ileum stricture mimicking Crohn’s ileitis. We present the case of a 38-year-old female with recurrent mechanical small bowel obstruction with transition point in the terminal ileum. She was struggling with infertility issues and was not previously known to have endometriosis. The presumptive diagnosis was Crohn’s disease due history of previous anal fissure, high faecal calprotectin level, and imaging findings of terminal ileitis with stricture, despite lacking tissue confirmation from colonoscopy. She underwent laparoscopic ileocolic resection with histology showing endometrial stricture and secondary mucosal inflammation, without any established features of Crohn’s disease. This case demonstrates the potential diversity in presentation of endometriosis, including small bowel manifestations that can mimic Crohn’s ileitis. If endometrioma can be confidently diagnosed based on characteristic imaging features or tissue sample, unnecessary treatment may be avoided, whilst appropriate specialist management improves endometriosis symptoms and fertility outcomes.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10246Rectal perforation secondary to invasive cervical cancer presenting as perineal necrotizing fasciitis with subsequent hindquarter amputation: a case report2024-02-13T19:10:35+0530Matthew L. Basamatthew.basa@uqconnect.edu.auAndrew Riddellmatthew.basa@uqconnect.edu.au<p>Necrotizing fasciitis (NF) is a life-threatening soft tissue infection rarely associated with gynecological malignancies. We present a unique case of NF arising from a locally advanced cervical cancer eroding into the rectum, causing occult fecal spillage leading to severe infection and necessitating a hindquarter amputation. A 39-year-old woman presented with sepsis and a necrotic gluteal wound. Extensive debridement revealed "dishwater"-like discharge throughout the left leg fascial compartments, necessitating hindquarter amputation. Despite initial suspicion of a primary skin infection, further investigation revealed a posterolateral rectal perforation secondary to advanced cervical cancer, confirmed by biopsy and imaging. Microbiology identified Streptococcus constellatus, intermedius, and anginosus. This case highlights the atypical presentation of NF associated with advanced cervical cancer. High clinical suspicion and early surgical intervention are crucial for survival. This case expands the understanding of NF etiology and emphasizes the importance of considering rare causes, even in the absence of traditional risk factors.</p>2024-02-20T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10127Internal hernia a preoperative diagnostic challenge in virgin abdomen: case report2023-12-10T00:36:49+0530Jesús A. Montero-Pugamontero140992@gmail.comFrancisco J. Pat-Cruzfranciscopatcruz@icloud.comGuillermo Padrón Arredondogpadronarredondo@hotmail.com<p>Internal hernias are classified in congenital or acquired. Congenital arises from abnormalities during embryonic development, whereas acquired result from trauma, surgical procedures, or another. Gastric surgical procedures can increase susceptibility to internal hernias. A 85-year-old female, denies previous surgeries. Went to the emergency department due to vomiting, adding colicky abdominal pain. Was discharged with a diagnosis of acute gastroenteritis. Came back 12 hours after discharge due to mesogastric pain accompanied by general malaise, abdominal distention and hyporexia, reporting a lack of evacuation. She was algid, pale, abdomen globose, distended, tympanic colonic frame, peristalsis increased. An evaluation was requested from general surgery for probable appendicitis in the elderly vs. secondary ileus. Went to operation room, finding an internal hernia. Transomental herniations are rare conditions. An abnormal omental opening can be either acquired following abdominal surgery, trauma, inflammatory conditions, low body mass index (BMI) and be associated with a long mesentery, intestinal malrotation, or abnormal peritoneal attachments. Although internal hernias are extremely rare (between 1 and 4% of acute or intermittent intestinal obstructions) it is essential not to miss this diagnosis, even in patient whit no previous surgeries. Management of omental hernias are critical as the postoperative mortality rate is over 30% and even 50% if strangulation is present. The lack of current literature on this rare condition, particularly for lesser omental hernias (because can present with nonspecific signs and symptoms) makes diagnosis and management difficult.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10130Application of Meek micro-grafting technique in severe burn injury: a case report 2023-12-11T15:05:52+0530Benjamin Choo Wee Keatbenchoo92@gmail.comSalmi Binti Mohamed Sukurdrsalmihkl@yahoo.com<p>Wound closure is often a challenge in patients with major burns due to the limited amount of healthy skin available for harvesting and grafting. As a result, this often yields severe morbidity and mortality amongst said patients. This case report presents the successful use of the Meek micro-grafting technique on a patient with extensive major deep dermal to full-thickness burn injuries in the Burn Unit of the Kuala Lumpur Hospital of Malaysia. The Meek micro-grafting method, involves the creation of micro-grafts from a small and limited donor site, and proved to be effective in promoting wound healing and minimizing donor site morbidity.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10157Buffalo chest in a not so high fall: a case report 2023-12-31T20:58:12+0530Maria Gualtermaria.gualter@hotmail.comInês Gonçalvesigoncalves@chtmad.min-saude.ptLeandro Lajutllajut@chtmad.min-saude.ptMargarida Rouxinolmpmrouxinol@chtmad.min-saude.ptMargarida Dupontamsdupont@chmtad.min-saude.ptJoão Pinto-de-Sousajsousa@chtmad.min-saude.pt<p>Bufallo chest refers to an anatomical variation characterized by an ongoing connection between the two pleural spaces, a unique feature found in these animals, since they possess a single pleural space due to an incomplete mediastinum. When this condition is found in humans, a unilateral chest trauma can cause bilateral pneumothorax. We reported a case of a 91 year old male who, after a fall resulting in right ribs fractures, presented at the emergency department with an extensive bilateral pneumothorax. We described clinical and imagiological features and our approach. This case demonstrates an unusual presentation of a rare anatomical anomaly.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10162Never too late: Lynch syndrome diagnosed at the age of 71 2023-12-31T23:38:43+0530Margarida S. Dupontmargaridasilvadupont@gmail.comGonçalo J. Guidigjlima@chtmad.min-saude.ptNádia Tenreirontalmeida@chtmad.min-saude.ptRita A. Marquesritara@chtmad.min-saude.ptJoão A. Pinto-de-Sousajsousa@chtmad.min-saude.pt<p>Lynch syndrome is an autosomal dominantly inherited disease characterized by a mutation in one of the deoxyribonucleic acid mismatch repair genes. In consequence of this defect, patients have higher risk of developing early colorectal and endometrial cancer (among others types of cancer). This syndrome accounts for 3% of all colorectal cancers and 10% to 19% of colorectal cancers diagnosed before the age of 50. Total abdominal colectomy is the best treatment for patients with Lynch syndrome who develop colorectal cancer.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10166Biliary ascariasis: an unusual cause of acute cholecystitis 2024-01-03T07:31:38+0530Guillermo A. Macías-Gonzálezmemo.26amg@hotmail.comAlberto Santillán-Arroyo memo.26amg@hotmail.com<p>Ascariasis is one of the most common gastrointestinal parasitic infections in developing countries. In humans, these parasites reside in the jejunum but can lodge in any part of the small intestine and can migrate to the biliary tract. We present the case of a 45-year-old female patient, with no relevant history, from a rural town in Mexico, who presented to the emergency department for abdominal pain in the right hypochondrium, nausea and vomiting of one week's evolution, acute cholecystitis was suspected and an ultrasound of the liver and biliary tract was requested, which reported acute cholecystitis and ascaris was observed in the gallbladder, was evaluated by the general surgery service and cholecystectomy was performed, anthelmintic treatment was started, the patient was cured without complications and was discharged home after 48 hours.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10171Occult small bowel adenocarcinoma in Crohn's disease-more than a simple stricture2024-01-05T03:31:59+0530Carolina Marquescarolina9marques@gmail.comCátia Ferreiracferreira@chtmad.min-saude.ptRicardo Vaz Pereirarjpereira@chtmad.min-saude.ptGonçalo Guidigjlima@chtmad.min-saude.ptJoão Pinto-de-Sousajsousa@chtmad.min-saude.pt<p>Small-bowel adenocarcinoma (SBA) accounts for less than 5% of all gastrointestinal cancers. It is generally linked to genetic disorders and immune-mediated inflammatory conditions like Crohn's disease (CD). Despite advances in oncology, SBA has a poor prognosis and high relative risk in this subgroup of patients. Risk factors for the development of SBA in patients with CD include a stricture phenotype and a long- standing disease. This article aims to expose a case of association between CD and SBA and its management. A 66-year-old woman with long-standing terminally ileum-affected CD with multiple admissions due to sub-occlusive episodes and weight loss. CT and MRI revealed intestinal thickening in the small bowel, suggesting an inflammatory stenosis and entero-enteric fistulous tracts. An ileocolectomy was performed, and the patient's histopathological evaluation revealed a mucinous invasive adenocarcinoma of the terminal ileum. The patient was treated with adjuvant chemotherapy and has been under surveillance for two years, without malignant recurrence. Although it is a relatively rare neoplasm, CD patients have a significant risk of developing SBA, when compared to the general population. Diagnosis is challenging due to the occult nature of CD-associated SBA, and imaging and endoscopy alone make it difficult to detect the pathology. Treatment involves a high index of suspicion for the diagnosis and a balance between extended mesenteric resection and CD surgery's primary idea of bowel length preservation. Despite recent advances in oncology, the survival rate in CD-SBA patients remains low. Long-standing CD patients should have the terminal ileum monitored regularly and surgeons should be aware for occult SBA. Post-resection patient surveillance involves regular abdominal exams, serial surveillance, cross-sectional imaging, and monitoring for obstructive symptom recurrence. There is a lack of clear guidelines for primary prevention and surveillance of SBA, with a focus on inflammation management. Preoperative diagnosis techniques are scarce, and patients risk suboptimal treatment if incidental cancer is found. Strategies include right mesenteric-based surgical techniques and/or frozen section exam, always balancing cancer treatment and bowel preservation which is of high relevance in this subgroup of patients.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10186A case of retained surgical mop in abdomen with partial intragastric migration: a case report2024-01-15T13:51:45+0530M. Muktar Hossaindrmuktar@yahoo.com<p>Though not uncommon, to retain a foreign body in the abdomen is a preventable error that makes the life of a patient miserable. One of the commonest retained foreign bodies is surgical mop or sponge. Retained mop may cause either an early septic reaction or a late fibrotic reaction. They often cause sinus or fistula and even can transmigrate in to the lumen of viscera. In case of upper abdominal retained mops, they usually erode the thin duodenal wall and rarely stomach. In this case, a mop was retained in the deep subhepatic space 2.5 months ago following open cholecystectomy. It caused an aseptic fibrotic reaction resulting in encapsulation of the mop. It then eroded the antral part of stomach through the lesser curvature and caused luminal obstruction. The patient presented with vomiting after each meal. Upper gastrointestinal tract (GIT) endoscopy revealed a woven fabric object that was impacted and occluded the lumen. The retained mop was removed after laparotomy and the antral wall was repaired well. This case is noteworthy due to its less symptom and penetration into the stomach.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10178Vernix caseosa peritonitis: a mimic for post-partum appendicitis2024-01-11T05:54:04+0530James N. Sellarsjamessellars1212@gmail.comRyan Greenryan.green275@gmail.comEshwarshanker Jeyarajaneshwarshanker.jeyarajan@health.qld.gov.au<p>Vernix caseosa peritonitis is an uncommon pathology predominantly affecting post-partum women who have undergone caesarean section and has symptomatology identical to common intra-abdominal surgical pathology. Cross-sectional imaging may not differentiate this from an alternative aetiology, thus a broad range of differentials must be considered in the early post-partum patient. This case of a 26 year-old post-partum patient who underwent an appendicectomy for CT-confirmed appendicitis had a histological diagnosis of vernix caseosa peritonitis. This case demonstrates the diagnostic challenge of acute abdominal pain in the early post-partum period and the high index of suspicion that clinicians must have to reach these uncommon diagnoses.</p>2024-02-09T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10236Femoral hernia in a 37-year-old male with COVID-19: a case report2024-02-09T18:19:59+0530Bethany K. Matthewsbethany.matthews@health.qld.gov.auReuben Ndegwareubenn100@hotmail.com<p>Left sided femoral hernias in male patients are considered very uncommon, with femoral hernia’s accounting for less than 5% of abdominal wall hernias and 4:1 female to male ratio of occurrence. This case report will discuss a 37-year-old male who presented with a symptomatic incarcerated left femoral hernia following coughing in the setting of an active coronavirus 19 infection. Emergency surgical repair was pursued given incarcerated presentation of the femoral hernia. Whilst rare in men the diagnosis of femoral hernia is important for clinicians to consider ensuring appropriate surgical management is undertaken in a timely manner.</p>2024-02-22T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10267Facklamia hominis isolated from infected sebaceous cyst on the breast2024-02-22T06:20:27+0530Tushar L. Agrawaltushar.agrawal@health.qld.gov.auJennifer W. Changjennifer.chang2@health.qld.gov.au<p><em>Facklamia hominis</em> is a gram-positive, catalase-negative, facultatively anaerobic coccus that is a rare human pathogen, with fewer than 15 cases isolated in the literature. We present the case of a 62-year-old female with an infected left breast sebaceous cyst treated successfully with surgical excision and flucloxacillin. Subsequent culture and microscopy isolated the organism <em>Facklamia hominis</em>. To the best of our knowledge, this is the first reported case of <em>Facklamia hominis</em> isolated from the breast, and the first reported isolate of the organism from a clinical specimen in Australia.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10266Incarcerated infraumbilical incisional hernia: a surgical challenge 2024-02-21T13:09:26+0530Ketan Vagholkarkvagholkar@yahoo.com<p>Incisional hernia continues to be the most challenging type of hernia. Variability in the anatomy and supervening complications add to its complexity. Infraumbilical incisional hernias are usually due to gynecological operations. This may range from a scar of tubal ligation procedure to a Pfannenstiel incision or an infraumbilical scar of caesarian section. The sparse volume of strong anatomical structures in this region poses the biggest challenge during repair. A 54-year-old lady presented with a hernia arising from a scar of previous tubal ligation surgery. The hernia was irreducible with a large mass of omentum in the hernial sac. Laparoscopy was difficult to perform in view of the current state. Hence open surgery was performed. The technique used was creation of a preperitoneal space followed by creation of space between external oblique aponeurosis and underlying muscle. A mesh as placed between the muscular and aponeurotic layer. The post-operative course was uneventful with no recurrence. The anatomical basis of placing the mesh between the muscular and aponeurotic layer or intermediate placement technique is discussed. Creation of space below the aponeurotic level is pivotal in managing infraumbilical incisional hernia. Placing a mesh at this layer below the aponeurosis ensures least complications with excellent result.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/3558Silent neuroendocrine tumor of biliary confluence2024-01-11T15:33:23+0530Supreet Kumarsupreet.mvj@gmail.comRigved Guptarigvedgupta@yahoo.co.inNeerav Goyalsupreet.mvj@gmail.comAlok Kumar Pandeysupreet.mvj@gmail.comVivek Tandonsupreet.mvj@gmail.comNeerav Goyaldeepakgovil@gmail.com<p>Neuroendocrine tumors (NETs) of the extrahepatic bile ducts are extremely rare. They are heterogeneous entities of varied histopathological features. The pathological types vary greatly with regards to biological behavior and prognosis. We presented such a case of silent tumor of the biliary tract of neuroendocrine origin in a middle-aged female with nonspecific abdominal pain without any clinically obvious signs which on radiological imaging revealed a tumor of hepatic confluence with metastatic deposits in liver for which she underwent left trisectionectomy with segment 7 metastatectomy. As per the literature reviews regarding extrahepatic bile duct NET these tumors are more common in the middle age population with a female preponderance. The tumors were symptomatic in majority of patients and the symptoms are mostly related to tumor mass and its invasion of adjacent structures or metastases rather than hormone and vasoactive peptide secretions. The low incidence and uncommon modes of presentation makes the diagnosis tough and management challenging.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/9706Negative pressure wound therapy: our experience of a polytrauma with degloving injury2023-05-01T15:32:00+0530Mangipudi Surya Pratappratap.mangipudi97@gmail.comMahak Goelmahakgoel24@gmail.comJanitta Kundaikarjanittakudaikar786@gmail.comKusum Meenakusum.meena@gmail.com<p>Degloving injuries are uncommon serious conditions occurring in high-velocity traumas with high mortality and morbidity. The lack of standard guidelines for the diagnostic and therapeutic management of such injuries provides a challenge to the surgeon. We present a case of a 35-year-old male with an extensive degloving injury who underwent primary closure unsuccessfully. The necrotic area was debrided and negative pressure wound therapy was used for the management of the wound. The patient was managed with split skin grafting and post successful recovery on all fronts has been completely rehabilitated. Though primary suturing is always tried, the viability of the degloved skin remains questionable and might need extensive debridement. Negative Pressure Wound dressing is seen to be accelerating wound healing and improving the treatment outcome.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10098A rare ectopic localization of pleomorphic adenoma of lip2023-11-27T10:37:24+0530Birbal Kumarbirbalkumar90@icloud.comBalkishan Guptabirbalkumar90@icloud.comD. S. Mitrabirbalkumar90@icloud.com<p>This case report described a rare and unusual lesion found in a 68-year-old male, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 2 cm in diameter, characterized by slow growth. Complete excision was performed and the histopathologic analysis showed pleomorphic adenoma.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10158Case report of high-grade pleomorphic sarcoma (rhabdomyosarcoma): a missed diagnosis in the non-healing post-traumatic wound of the elderly 2023-12-30T01:38:55+0530Shashank Jainnikbeldar33@gmail.comShraddha Damanikbeldar33@gmail.comNikhil L. Beldarnikbeldar33@gmail.comAbhishek G. Mahadiknikbeldar33@gmail.comAbhijeet Budhkar nikbeldar33@gmail.com<p>Rhabdomyosarcoma (RMS) is known to be common childhood soft tissue sarcoma (STS). RMS is infrequent in adults. STS constitute <1% of all adult solid malignant sarcomas and RMS accounts for 3% of all STS. The tumor is divided into three main subtypes-embryonal, alveolar, and pleomorphic (most common in adults). The most common primary sites are extremities. It’s an aggressive lesion with a high rate of metastasis. The patient presented with a non-healing wound over a posterior-medial aspect of the right leg with features suggestive of cellulitis. The patient gave a history of fall 5 months ago for which he took treatment at a local doctor, he continued to have severe pain for which an orthopedic opinion was taken and advised conservative management for an un-displaced fracture of the fibula. He later developed swelling over the lower-middle part of his right leg 3 months ago for which an ultrasound was done suggestive of a large amount of fluid suspicious of hematoma secondary to A-V malformation, an attempt for drainage of fluid was made leading to an evacuation of blood clots further procedure was abandoned and the patient transferred to our center. CT-angio demonstrated it as a heterogeneously attenuating solid cystic lesion. After appropriate consents-wound exploration was done with the evacuation of soft gelatinous material with pus discharge and blood clots. HPE-suggestive of high-grade pleomorphic rhabdomyosarcoma. The patient was advised amputation but denied any further treatment. Post-operative recovery was uneventful with no recurrence for the first 6 months after which the patient did not follow up. Post-traumatic mass at extremities should be evaluated with a high index of suspicion of STS. In case of doubt, either a preoperative biopsy or an intraoperative frozen section is a safe practice.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10159Ancient schwannoma in posterior triangle of neck: a rare tumor case report and literature review2024-01-03T17:17:06+0530Devisha R. Gandhigandhidevisha12@gmail.comNaveenraj R.gandhidevisha12@gmail.com<p>Ancient Schwannoma is a rare variant of Schwannomas, a type of benign nerve sheath tumor arising from Schwann cells, hence giving it its name Schwannoma. The term ancient represents the tumor undergoing degenerative changes such as calcification, hyalinization, hemorrhage, cystic degeneration and necrosis and characteristically the loss of Antoni type A tissue. This case report describes a patient having an ancient schwannoma and the management done. Detailed management and findings starting from history and extending to USG, FNAC, CT scan, MRI and excisional biopsy have been described with positive findings supporting the diagnosis like presence of degenerative material in FNAC, peripheral enhancement on CT with the classical Target sign also visible on MRI. The following case reports helps to show how to connect the dots of different findings that may start from the patient’s basic history to eventual confirmation by biopsy.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10161Complex management of larger strangulated incisional hernia in a post-multiple abdominal surgery in a morbidly obese patient-a case report and surgical review2023-12-31T21:10:00+0530Sandeep Vermadrsandeepverma2201@gmail.comViditvidit.poria007@gmail.comGaurav Katariadr.katts@outlook.comRituparna Chatterjeerituparna.chatterjee0402@gmail.comBhavinder K. Aroradrbhavinderarora@gmail.com<p>Strangulated incisional hernia following a post-hernia repair is a serious and potentially rare life challenging condition that can occur after surgical intervention. Incisional hernias accounts for 15-20% of all abdominal hernias which occur at the site of a previous surgical incision where the integrity of the fascia has not been fully restored. We are presenting a case report of a 49 years lady who came with complaints of abdominal swelling and pain abdomen following multiple abdominal surgeries diagnosed with strangulated incisional hernia following post hernia repair. It was managed by emergency surgical intervention that is removal of previously kept mesh and resection of gangrenous segment of bowel with end ileostomy after keeping overall patient’s condition.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10202Complex stab related injuries involving the diaphragm, bowel and cystic duct: a case report2024-01-20T12:31:55+0530Yash Jainyashandyash152@gmail.comAbdul Haque M. Quraishiabdulquraishi63@gmail.comPankaj Tongsepankaj301088@gmail.com<p>Penetrating abdominal trauma is a major killer worldwide. Biliary duct injuries resulting from penetrating stab wounds are rare but potentially life-threatening occurrences. This case report outlines a rare case, diagnosis, surgical management, and postoperative outcomes of a patient who sustained a cystic duct injury due to a penetrating stab wound. There is paucity of such cases in the literature. A 55-year-old man sustained a penetrating wound and was found to have cystic duct injury intra-operatively along with other multi-visceral injury. The patient underwent a cholecystectomy with the management of associated injuries. The report aims to highlight the rarity yet the possibility of such injuries and emphasize the importance of a high index of suspicion.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10164Chondroma of right great toe2024-01-02T09:56:35+0530Pushkar L. Davhaleprachi.salunke1698@gmail.comPrachi P. Salunkeprachi.salunke1698@gmail.comKiran M. Patilprachi.salunke1698@gmail.comAnanta A. Kulkarniprachi.salunke1698@gmail.com<p>Chondromas are benign neoplasms arising from hyaline cartilage cells or mesenchymal cells often solitary, slow-growing masses. They may grow to a size that causes clinical problems, depending on the location. These are not locally invasive. Some chondromas may undergo malignant transformation; however, most chondrosarcomas are thought to arise <em>de novo. </em>We present a case of a 33 years old male patient who presented with chronic swelling on the dorsal aspect of the DAP joint of right great toe. The patient underwent surgical excision of the painless lesion. Post operative period was uneventful and the swelling resolved immediately. After a follow up of 1 year the patient has no complaints of pain or swelling.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10165An inguinal surprise: strangulated femoral hernia2024-01-02T19:40:03+0530Syed Saadsyedsaad183x2@gmail.comMansoor Ahmedsyedsaad183x2@gmail.comMilind H. Iddalagisyedsaad183x2@gmail.com<p>Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery. This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. There are few reports of strangulated femoral hernia. Femoral hernias, often, are usually delegated to a secondary differential or if even rarer not considered at all during dubious presentations as groin swellings which are irreducible without the classical features which have usually been described in our surgical literatures, Inguinal being forefront for diagnosis. We herein present a 45-year-old female had come to the outpatient department at MVJ MC and RH with the complaints of swelling in the left groin for 5 years and pain for 8 days sudden onset with irreducibility, with no features of small bowel obstruction. She was diagnosed as having a left side obstructed inguinal hernia after appropriate radiological investigations and underwent inguinal exploration. Intraoperative diagnosis of left sided strangulated femoral hernia with omentum as its content was made. Omentectomy with herniorrhaphy was done and post-operative period was uneventful, and patient was discharged with regular follow up. Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10169Case report of rare gastrointestinal non-Hodgkin's lymphoma presenting as intussusception in adults2024-01-04T16:33:07+0530Sumanthareddy B. H.sumanthreddy97.sr@gmail.comManoj Andleymandley@hotmail.comSudipta Sahasudipta2067@gmail.comRanvir Singhranvirsingh347@gmail.comMustkimDr.mustkim0408@gmail.comKatyayni Singhkatyayni.20@gmail.comShashank Mishrashashankgm856@gmail.com<p>Gastrointestinal lymphomas comprise a group of distinct clinicopathological entities of B- or T- cell type, with primary gastrointestinal Hodgkin’s lymphoma being extremely uncommon. The gastrointestinal tract is the predominant site of extra-nodal non-Hodgkin's lymphoma accounting for 30-40% of all extra- nodal lymphomas.1 Most common non-Hodgkin’s lymphoma causing intussusception is diffuse large B-cell lymphoma (DLBCL). We herein report a rare case of ileo-colic Intussusception due to diffuse large B-cell lymphoma in a 42-year-old female. Computed tomography showed ileo-colic intussusception. Open hemicolectomy with ileo-colic anastomosis was done with postoperative chemotherapy. </p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10194Percutaneous nephrolithotomy in case of crossed fused renal ectopia: a case report2024-01-16T20:07:14+0530Ankit AnandDr.ankitanand19@gmail.comPrakriti GuptaDrprakritigsvm@gmail.comSumit GuptaDr.Sumit989@gmail.comArpit TripathiDrarpit205@gmail.comShailja MishraShailjasachinmishra@gmail.com<p>Crossed renal ectopia is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital, and bone malformations. To best of our knowledge, there aren't many cases of inferior crossed fused renal ectopia of the right kidney documented in the literature at this time. A case of crossed-fused renal ectopia is presented here. A 32-year-old man arrived at our hospital complaining of pain in the right flank. Diagnosis: We suspected a single right kidney based on abdominal ultrasonography. An inferior left to right crossed-fused ectopic kidney with calculus in the right (normal) renal pelvis was the patient's diagnosis when combined with 3D computed tomography. Interventions: percutaneous nephrolithotomy with DJ stenting. Because the management of renal stone in this uncommon malformation is complicated, a preoperative assessment with contrast computed tomography is required before moving forward with surgery in order to explore a single kidney with calculi and avoid missing the diagnosis of crossed fused renal ectopia.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10163Spontaneous common bile duct perforation: a rare case report2024-01-01T13:28:10+0530Viditvidit.poria007@gmail.comManish Jangravidit.poria007@gmail.comHansraj Rangavidit.poria007@gmail.comBhavinder K. Aroradrbhavinderarora@gmail.com<p>Spontaneous common bile duct (CBD) perforation is a rare and life threatening clinical condition. The course of management and choice of surgical intervention depends on clinical presentation; site, size, nature of defect. It is usually reported in infants and adults due to congenital anomalies and following invasive procedure respectively but spontaneous CBD perforation in older age groups is rare without underlying cause presenting as acute abdomen. In this case report, an 82-year-old female presented to the emergency room with an acute abdomen diagnosed as spontaneous CBD perforation and its prompt management and its successful outcome.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10258Enterobius vermicularis infection at time of appendicectomy: is it a neglected risk factor?2024-02-16T22:03:45+0530Bethany K. Matthewsbethany.matthews@health.qld.gov.auMichael Auldmichael.auld@health.qld.gov.au<p>Obstruction of the appendiceal orifice is well established as a potential cause of appendicitis. However, it remains debated as to if appendiceal orifice obstruction secondary to <em>Enterobius vermicularis</em> is considered a risk factor for appendicitis or appendiceal colic. <em>Enterobius vermicularis</em> maintains an increased prevalence within lower socioeconomic and human development index regions. Whilst Australia has an overall high human development index it has significant variability in health literacy and socioeconomics. The purpose of this literature review is to evaluate the relationship between <em>Enterobius vermicularis</em> and appendicitis, to review the prevalence of <em>Enterobius vermicularis</em> appendicectomies in lower human development index and socioeconomic status communities, and to review the Australian based <em>Enterobius vermicularis</em> literature available. A comprehensive review of the literature was performed to review the prevalence of <em>Enterobius vermicularis</em> at time of appendicectomy. PubMed, Scopus, and Google Scholar databases were investigated for applicable studies published until December 2023. <em>Enterobius vermicularis</em> within the appendiceal lumen may cause irritation and lymphoid hyperplasia resulting in appendiceal colic with a similar clinical presentation to that of acute appendicitis. An increased association between <em>Enterobius vermicularis</em>, low human development index, and socioeconomic status is suggested. Public health interventions reduce Enterobius prevalence. A single Australian based study from 1994 was identified. <em>Enterobius vermicularis</em> infection is a neglected risk factor for appendiceal colic. A high index of suspicion for <em>Enterobius vermicularis</em> infection should be taken for clinically stable patients with normal inflammatory biochemistry and low human development index. Further research is required to assess if there is a disparity in <em>Enterobius vermicularis</em> in relation to human development index, socioeconomic status, and remoteness within Australian communities.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10203Diabetic foot and lower limb amputations at tertiary hospitals underscore the need for organised foot health services at primary healthcare level2024-01-20T22:48:11+0530Tshepang Arthur Motsepeart86epe@yahoo.comAndrew Machowskiart86epe@yahoo.comShaan Marthinus Maritzart86epe@yahoo.com<p>An epidemiological link between diabetes and early mortality has been reported in literature with the cause of death being mainly ischaemic heart diseases. However, a diabetic foot is a common and serious complication of diabetes with a lifetime risk of developing a foot ulcer estimated at 15-25%. Therefore, local (foot disease) and systemic (cardiovascular disease) issues should be attended to in the management of diabetes, and this emphasizes the need for a multidisciplinary team approach. A diabetic foot is defined as worsening sepsis, ulcerations, necrosis or destruction of tissues of the foot in a diabetic patient due to a complex interaction of disorders in the immune function, in the nervous and vascular systems. An improved clinical outcome is associated with wound adjunctive treatments in complementing the standard management protocol which embodies the TIME principles (tissue debridement, infection control, adequate moisture balance to promote tissue granulation in the wound bed and edges of the wound should be free from undermining).</p> <p> </p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10231Prevalence and predictors of hypercoagulability detected by rotational thromboelastometry in peritoneal malignancy patients undergoing cytoreductive surgery2024-02-08T10:49:41+0530Elizabeth Skalkoselizabeth.skalkos@health.nsw.gov.auMina Sarofimdrsarofim@gmail.comStephany Gamedrstephanygame@gmail.comRuwanthi Wijayawardanaruewij@gmail.comNima Ahmadidr.nima.ahmadi@gmail.comDavid L. MorrisDavid.Morris@unsw.edu.au<p><strong>Background: </strong>Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for peritoneal malignancy. A hypercoagulable state in these patients and the associated risk of venous thromboembolism (VTE), remains the most common cause of 30-day mortality. This study aimed to evaluate the prevalence and perioperative factors associated with baseline hypercoagulability detected by rotational thromboelastometry (ROTEM), a point-of-care haemostatic assay, in peritoneal malignancy patients.</p> <p><strong>Methods: </strong>A retrospective cohort study was performed in a peritoneal malignancy unit on patients undergoing CRS between 2019 and 2023, who underwent preoperative ROTEM testing. Patients were divided into group A (hypercoagulable) and Group B (normal coagulation). Baseline characteristics, pathology results, operative details and post operative outcomes were reviewed. Univariate and multivariate analysis were used to identify factors associated with baseline hypercoagulability.</p> <p><strong>Results: </strong>The 70 patients were included, 23 patients in group A (32.9%) and 47 patients in group B (67.1%). Group A had a lower preoperative haemoglobin (p<0.001), higher platelet count (p<0.001) and median peritoneal carcinomatosis index (33 vs 10, p=0.003). Appendiceal primary was associated with hypercoagulability (47.8% vs 23.4%, p=0.039). Group A required more intraoperative transfusion with red blood cells (p=0.014) but not platelets (p=0.6) or cryoprecipitate (p=0.8). Although group A had a higher incidence of VTE events (30.4% vs 23.4%) this was not statistically significant.</p> <p><strong>Conclusions: </strong>Baseline hypercoagulability exists in one-third of patients with peritoneal malignancy and was associated with increased tumour burden and appendiceal primary. The increasing use of ROTEM is a valuable tool for perioperative management of complex peritoneal malignancy patients.</p>2024-02-19T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10201Self-perceived preparedness of junior doctors for internship in regional far North Queensland2024-01-18T18:15:35+0530James N. Sellarsjamessellars1212@gmail.comMichael van der Markmichael.vandermark@health.qld.gov.auJoanna Nealjoanna.neal@health.qld.gov.auTom Palesytom.palesy@health.qld.gov.auLani Palesylanipalesy@hotmail.comEshwarshanker Jeyarajaneshwarshanker.jeyarajan@health.qld.gov.au<p><strong>Background</strong>: Objective of the study was to determine the self-perceived preparedness and concerns of newly graduated junior doctors beginning their internship year in a regional based hospital in far North Queensland.</p> <p><strong>Methods</strong>: A questionnaire investigating the basic demographics, future vocational intentions, perceived medical strengths, and greatest hopes and fears for the upcoming intern year was formulated. The survey was undertaken by all interns starting work in 2023 at Cairns Hospital in regional Far North Queensland. Basic statistical analysis was conducted in Microsoft Excel.</p> <p><strong>Results</strong>: There were 52 total participants. Overall, 40 (76.9%) were aged 23 to 32 years, 45 (86.5%) had graduated from a Queensland university, and 25 (48.1%) had previous exposure to the medical field prior to internship, through a family member or previous work. New interns felt least prepared for discussions regarding dying and palliative care, N=14 (26.9%) at least “prepared”, certification of death, N=11 (21.2%) at least “prepared” and nasogastric tube insertion, N=14 (26.9%) at least “prepared”. The main concerns were feeling unsupported (N=31, 59.6%), tiredness and stress (N=28, 53.8%), and interacting with rude staff or experiencing bullying (N=27, 51.9%). Overall, interns felt least prepared for surgical (N=21, 40.4%) and after-hours rotations (N=19, 36.5%).</p> <p><strong>Conclusions</strong>: The intern year can be daunting for recent graduates, particularly feeling a sense of isolation and fatigue, heightened by potential staff conflict and high-pressure settings in surgery and after-hours. Better preparation and support should be provided for interns to ensure a comfortable transition from university to work to optimise safe and effective patient care.</p>2024-02-09T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10211 Incidence and characteristics of breast cancer in patients 40 years of age or younger: a study of a tertiary center in Saudi Arabia2024-01-27T04:56:06+0530Sahar M. Alnefaiedrsahar22@gmail.comNisreen R. Kanbarnisreen.kanbar@hotmail.comReem A. Alshourareem.alshora@gmail.comAmal Y. Alhefdhidram200@gmail.comSaif S. Alsobhisobhi@kfshrc.edu.sa<p><strong>Background</strong><strong>:</strong> Breast cancer in young women has a higher mortality rate, can show adverse outcomes, and is more likely to recur after treatment. This study evaluated the incidence and characteristics of breast cancer in female patients 40 years of age or younger.</p> <p><strong>Methods:</strong> This is a descriptive study of 234 patients, 40 years of age or younger, diagnosed with breast cancer in the period January 2010–December 2015.</p> <p><strong>Results:</strong> We included 234 out of 1026 patients (22%) that met our inclusion criteria. At the time of the diagnosis, the mean age of the patients was 34±5 years; 32 (14%) of them had a positive family history of breast cancer, and more than a fifth were found to have advanced stages of the disease. One-third of our patients were hormone receptor (HR)-positive with HER2 negative, 61 (26%) were triple negative, and a total of 98 (42%) of our patients had HER2 overexpression. Lumpectomy was performed for 89 (38%) of them. Recurrence was documented for 40 (17.4%), and approximately half of the patients, 105 (45%), had recurrence in their first two years of diagnosis.</p> <p><strong>Conclusions:</strong> Breast cancer in young patients is a very challenging entity, as they tend to be more aggressive than the older age group. The incidence of breast cancer in female patients younger than 40 is higher than that in Western countries. However, our findings align with regards to their pathology type and hormonal status.</p>2024-02-05T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10237Early or mild appendicitis on CT imaging and its correlation with a negative appendicectomy: an observational retrospective study2024-02-10T13:58:54+0530Matthew L. Basamatthew.basa@uqconnect.edu.auLiam Conviematthew.basa@health.qld.gov.au<p><strong>Background: </strong>A computerized tomography scan is frequently performed to confirm or exclude appendicitis. The interpretation of such CT scans is crucial in determining which patients should be offered surgery. In a subset of patients with undifferentiated abdominal pain, the radiological diagnosis of “early” or “mild appendicitis” is encountered. It is unclear, based on the current literature, how to manage this entity and hence it may be exposing patients to unnecessary surgery. This raises the question if “early” or “mild appendicitis” on CT imaging correlates with an increased rate of negative appendicectomies.</p> <p><strong>Methods:</strong> All laparoscopic appendicectomies from 2018 to 2023 at a single Australian tertiary hospital were reviewed retrospectively for pre-surgical imaging, appendix histopathology, age, gender, and white cell count. The CT early/mild appendicitis group was compared with the CT uncomplicated appendicitis group.</p> <p><strong>Results:</strong> Of 599 patients who had uncomplicated appendicitis on CT imaging, 63 of these patients received a diagnosis of early or mild appendicitis. Twenty-two in this group had a normal appendix on histological assessment. The “early” or “mild” appendicitis group had a significantly increased likelihood (OR>10, p<0.001) of having a normal appendix on histology, compared to the CT uncomplicated appendicitis group. Women and lower WCC were associated with early appendicitis (p<0.05).</p> <p><strong>Conclusions:</strong> Results of this study suggest that the diagnosis of “early” or “mild appendicitis” on CT imaging results in a greater number of negative laparoscopic appendicectomies.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10242Outcome of varicose vein surgery in a general surgical unit 2024-02-12T11:18:31+0530M. Shahinur Rahmanshahin_jui@yahoo.comM. Abu Sayemshahin_jui@yahoo.comMohammad Khayrul Bashar Khanshahin_jui@yahoo.comM. Reazul Alamshahin_jui@yahoo.comM. Abul Kalam Azadshahin_jui@yahoo.com<p><strong>Background:</strong> Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. In our country, we do have not sufficient vascular surgery centers or vascular surgeons. So general surgeons have training in vascular surgery and performing operations of varicose veins. This study aimed to show the operative procedure, results of treatment in terms of symptom improvement, and complications of varicose vein surgery done by general surgeons in a rural medical college hospital in Bangladesh.</p> <p><strong>Methods:</strong> This retrospective study was conducted at the Department of General Surgery in Sheikh Hasina Medical College, Jamalpur, Bangladesh from January 2017 to December 2022. A total of 20 patients were selected as study subjects by simple random sampling. Operative procedure depended upon pre-operative duplex imaging findings, and patients were kept under 6 months follow-up. The outcome was based on the cure and recurrence rate of varicose veins. Collected data were analyzed using descriptive statistics. Analysis of data was carried out by using a statistical package for social science (SPSS) 22.0 for Windows. After analysis, the data were presented in tables and charts.</p> <p><strong>Results:</strong> It was observed that 3 (15.0%) patients experienced ulceration after surgical procedure, followed by 2 (10.0%) developed DVT, 1 (5.0%) patient had wound hematoma, and 1 (5.0%) patient showed recurrence. Concerning the outcome of varicose veins after surgical procedures, the majority (18,20.0%) of the patients showed complete cure, 1 (5.0%) patient presented with recurrence, and 1 (5.0%) patient developed complication.</p> <p><strong>Conclusions:</strong> Despite the relatively low occurrence of complications and recurrence following surgery for varicose veins, the substantial 90% cure rate it offers is noteworthy. This study underscores the feasibility of conducting varicose vein surgery by general surgeons equipped with training in vascular surgery, ensuring safety and minimizing complications.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10172Retrospective study in a single unit: outcomes of delays in reversal of loop ileostomy2024-01-05T18:37:42+0530Kevin Kah Wai Yoongkevinkwyoong@gmail.comMichelle Zhiyun Chenchenzhiyun@gmail.comAmos Nepacina Liewliewamos@gmail.comSenali Weeratungasenali.weeratunga@gmail.comYeng Kwang Tayyktay2@gmail.com<p><strong>Background:</strong> Formation of loop ileostomy is common after anterior resection to reduce the sequalae of an anastomosis leak. Delays to reversal of ileostomy is associated with complications.</p> <p><strong>Methods:</strong> Retrospective study between 1 July 2017 to 30 June 2023. Patients were included: >18 years old, loop ileostomy formed as part of anterior resection surgery (benign and malignant). Exclusion criteria: loop ileostomy performed during other colonic resections, patients with inflammatory bowel disease, de-functioning ileostomy for obstructions. Primary outcome measures included complications associated with delayed closure of loop ileostomy and readmissions after reversal surgery. Secondary measures included reasons for delay to surgery, complications prior to reversal surgery, and morbidity and mortality associated with it.</p> <p><strong>Results:</strong> 135 patients were included. 85.9% of patients experienced delays in reversal surgery. Those without delays in surgery had higher rate of stoma-related complications (p=0.002). Delays were due to a long waitlist (p<0.01) and adjuvant chemotherapy (p=0.598). There were no significant differences in the delays to surgery during COVID pandemic. Delays were associated with higher rate of wound infection (6.04%), post-operative ileus (12.07%), anastomotic leak (1.72%), and <em>Clostridium difficile</em> (C. diff) infection (3.45%). Handsewn end to end anastomosis was associated with higher proportion of post-operative ileus compared to the stapled side to side anastomosis group.</p> <p><strong>Conclusions:</strong> Reversal of ileostomy within 6 months of index surgery after adjuvant therapy could potentially reduce post-operative complications, and alleviate the burden on our healthcare system in the long run. A stapled side to side anastomosis should also be considered.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10050Humeral shaft fractures in adults: management and evaluation of treatment in 50 cases2023-11-05T23:08:22+0530Abdoulaye Camaraalphacinessat@gmail.comNouhou M. Camaraalphacinessat@gmail.comMamadou M. Dialloalphacinessat@gmail.comLéopold Lamahalphacinessat@gmail.com<p><strong>Background:</strong> The management of humeral shaft fractures is a real challenge in our regions.</p> <p><strong>Methods:</strong> This was a prospective, descriptive single-center study involving 50 patients meeting our inclusion criteria. Inclusion criteria focused on adult patients, received for fractures of the humeral shaft, treated and followed up, then evaluated during the study period. Exclusion criteria included humeral shaft fractures in children, patients not having been evaluated during the study period.</p> <p><strong>Results:</strong> We enrolled 50 patients, 43 men (86%) and 7 women (14%), with a sex ratio of 3.07. Mean age was 32.3 years, with extremes of 18 and 79 years. The left side was affected in 46 cases (92%). Lesions were predominantly located in the middle 1/3 in 39 cases (78%). Treatment was orthopedic in 30 patients (60%). Surgical treatment was performed in 20 patients (40%), with screw-plate predominating in 14 cases (28%), followed by hackethal pinning in 5 cases (10%) and combined treatment in one case (2%). At six months' follow-up, our results were very good and good in 36 cases (72%) according to the modified Stewart and Hundley functional score.</p> <p><strong>Conclusions:</strong> Humeral shaft fractures are rare fractures for which orthopedic treatment is still indicated. Complications include radial nerve paralysis and pseudarthrosis.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10213Early outcomes of minimally invasive hybrid coronary revascularization2024-01-29T16:31:23+0530Vigneshwar Bakthavachalamdrvigneshwarb@gmail.comM. M. Yusufdrvigneshwarb@gmail.com<p><strong>Background:</strong> Coronary artery bypass graft (CABG) surgery has been the gold standard for the treatment of coronary artery disease over the years. It is recommended for patients with multi-vessel coronary artery disease, left main disease, diabetics, severe left ventricular dysfunction, unsuitable anatomy for percutaneous coronary intervention (PCI), and failed PCI. The usage of the left internal mammary artery (LIMA) in the CABG to the left anterior descending (LAD) artery has proven to be superior compared to PCI. Minimally invasive hybrid coronary revascularization (MIHCR) is gaining growing interest.</p> <p><strong>Methods:</strong> This is a hospital-based prospective observational study with 200 patients followed up for a period of 30 days. This study aims to assess the early outcomes of MIHCR in the Indian population.</p> <p><strong>Results:</strong> The 30-day mortality was comparable to other studies, and the number of days in the ICU and hospital stay was shorter than the routine CABG. There was no incidence of a wound infection or stroke. Blood product usage and the need for repeat revascularization and re-exploration were less. The short-term outcomes were promising.</p> <p><strong>Conclusions:</strong> MIHCR has excellent short-term results and is safer than conventional OPCABG, as it is less invasive and avoids midline sternotomy. It also reduces the incidence of stroke and lesser usage of blood products, promoting early return of patients to their routine activities.</p>2024-02-19T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10146An observational study of predictive factors for fever and sepsis following percutaneous nephrolithotomy2023-12-26T17:40:33+0530Vishnu Pratapvishnupratap1401@gmail.comAli Abbas Sayedvishnupratap1401@gmail.comManoj Kharadevishnupratap1401@gmail.comPrakash Pawarvishnupratap1401@gmail.comAjit Sawantvishnupratap1401@gmail.comM. Hamid Shafique Ahmedvishnupratap1401@gmail.comRaunak Shewalevishnupratap1401@gmail.comUmang Trivedivishnupratap1401@gmail.comSanjay Dangevishnupratap1401@gmail.comJaydeep Dalvivishnupratap1401@gmail.comAmit Chiddarwarvishnupratap1401@gmail.comSanket Chaudharivishnupratap1401@gmail.com<p><strong>Background: </strong>Although percutaneous nephrolithotomy is considered a safe procedure, it is not without complications. Certain preoperative and intraoperative factors if not identified and adequately treated in time can lead to complications ranging from post operative fever to urosepsis which may seldom lead to mortality. The aim of our study is to identify those factors so as to prevent complications and promote patient safety.</p> <p><strong>Methods:</strong> Retrospective analysis of medical records of the patients undergoing PCNL from January 2020 to January 2023 was done. A total of 235 patients were included in the study and associated factors analyzed statistically. Statistical analysis was performed by Chi-square test.</p> <p><strong>Results:</strong> We found five factors which significantly correlated with postoperative sepsis, namely, stone size >30 mm, staghorn calculus, prolonged operative time >120 min, significant bleeding requiring transfusion and pre operative urine culture positive.</p> <p><strong>Conclusions:</strong> Sepsis following PCNL is not uncommon. Progression to urosepsis maybe life threatening. Decreasing operative time decreases bleeding and related complications as well. Prophylactic antibiotics is recommended in PCNL procedure owing to its clean contaminated/contaminated surgical procedure.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10150Evaluation of unenhanced three-dimensional endoanal ultrasound scan in preoperative assessment of perianal sepsis2023-12-25T22:12:28+0530Someswara Rao Meegadasomeshmeegada28@gmail.comKishore V. Alapatikvalapati@gmail.comMathai Varughesedrvmathai@yahoo.co.in<p><strong>Background:</strong> Perianal sepsis which includes perianal fistula and abscess is a common clinical condition that requires thorough preoperative evaluation to decrease the recurrence rate and to plan relevant surgery according to the anatomy of the fistula. MRI and 3D EAUS are two important preoperative investigations that delineate the anatomy of simple and complex fistula tracts. Due to lower cost and easier use 3D EAUS is a safe and reliable first-line investigation in evaluating perianal abscess.</p> <p><strong>Methods: </strong>This is a retrospective and prospective analysis of patients with perianal sepsis who underwent pre-operative unenhanced 3D-EAUS in the departments of Colorectal surgery, Gastrointestinal surgery, and General surgery in our hospital. A B-K medical 2052 transducer was used for the study and the surgical assessment was done by multiple surgeons from multiple departments.</p> <p><strong>Results: </strong>A total of 255 patients were assessed. The accuracy for primary fistula tracts and internal opening was 83.53% and 88.62% respectively. The kappa coefficient of correlation was k=0.70 (substantial agreement) for the fistula tract and k=0.81 (near perfect agreement) for the internal opening. The sensitivity, and specificity of primary tracts and internal openings were calculated. Transphincteric fistulas were 57% in our study.</p> <p><strong>Conclusions:</strong> Unenhanced 3D EAUS is a reliable first-line investigation in preoperative evaluation of perianal fistula and abscess. Transphincteric fistula is the most common type of fistula. There is a high chance of correlation for the primary tract if a non-colorectal specialist performs the fistula surgery after 3D-EAUS without blinding.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10219The association between complementary and alternative medicine use with breast cancer recurrence in Taif city, Saudi Arabia2024-02-02T18:02:39+0530Sahar M. Alnefaiedrsahar22@gmail.comYousif A. Asiriyasiri@tu.edu.saRazan S. Alqahtanirazan.mails@gmail.comMaha O. Alshareefmahaalshareef98@gmail.comKhalid M. Alzahranidr_khalid1ks@hotmail.comSarah M. Albogamis.m.2010albogami@gmail.com<p><strong>Background</strong><strong>:</strong> Breast cancer (BC) is the most common cancer among women worldwide. Among all types of cancer, 11.7% of cases diagnosed in 2020 were BC. Compare this to Saudi Arabia, where 28.8 out of every 100,000 women were diagnosed with BC. Furthermore, BC patients are more likely than other cancer survivors to use complementary and alternative medicine (CAM). Study aimed to investigate association between CAM use and BC recurrence rates in Saudi Arabia.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted on 106 participants recruited from breast surgery clinics. Targeted women were diagnosed with BC and treated at Al Hada armed forces hospital. The data were collected by interviewing the patients using a validated questionnaire.</p> <p><strong>Results: </strong>The prevalence of CAM usage among BC patients was 35.8%. The recurrence rate of BC was 26.4%. CAM users accounted for 28.57% of the total, while non-CAM users comprised 71.43%. In addition, 50% of recurrences were distant metastases, and 50% occurred more than two years after diagnosis. </p> <p><strong>Conclusions:</strong> In conclusion, more than one-third of BC patients in this region incorporate CAM into their treatment regimen. Our findings reveal a practical but not statistical significance of a lower recurrence rate of BC among CAM users compared to non-CAM. These results emphasize the importance of healthcare providers engaging in detailed discussions with BC patients regarding CAM usage in conjunction with planned medical and surgical therapies. </p> <p> </p>2024-02-08T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10152Association of salted tea (noon chai), Helicobacter pylori infection and gastric carcinoma2023-12-27T19:47:04+0530Mir Fazil Illahimubashir.gani72@gmail.comMubashir Ganimubashir.gani72@gmail.comSameer H. Naqashmubashir.gani72@gmail.comMubashir A. Shahmubashir.gani72@gmail.com<p><strong>Background:</strong> Gastric cancer remains the second leading cause of cancer-related deaths worldwide. Various dietary and environmental factors have been implicated in the pathogenesis of gastric cancer. <em>Helicobacter pylori </em>has strong association with peptic ulcer disease and gastric cancer.</p> <p><strong>Methods</strong>: This study was conducted in department of general and minimal invasive surgery SKIMS Srinagar, from May 2019 to April 2022 comprising of 50 patients. All the patients were studied prospectively using set of questionnaires about the quantity and quality of salted tea. Final inferences were drawn after analysing the data using various statistical tools.</p> <p><strong>Results:</strong> The most common age group was >60 years of age with male preponderance. Majority of patients had no comorbidity. About 50% of the patients were smokers. The most common histology found was intestinal type. 20% patients had proximal (cardia) tumor and 80% had distal location. Only 14% of the patients came positive for intra-operative <em>H. pylori</em> testing. Among the <em>H. pylori</em> positive patients, 14.3% were <40 years of age and 85.7% were >40 years of age. The most common histological grade found in <em>H. pylori</em> positive patients was poorly differentiated with signet ring cell type. About 88% of all the patients had a history of Noon chai intake with 14% positive and 86% negative for H. Pylori.</p> <p><strong>Conclusions</strong>: There is a positive relation between Noon chai and gastric carcinoma and an inverse relation between ca stomach and presence of <em>H. pylori</em> intraoperatively at the time of surgical intervention.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10155Clinical spectrum study of female patients with benign breast diseases in surgery department of tertiary care centre2023-12-29T01:25:16+0530Supriya Baguldrsupriyabagul0403@gmail.comJunaid Minhaj Shaikhjunaidms123@gmail.comSurajit Dasdassurajit102@gmail.comRasika Vivek Jadhavrasika2194j@gmail.com<p><strong>Background:</strong> Benign breast disorders are classified as congenital disorders, injury related inflammatory conditions infective conditions, aberration of normal differentiation and involution, duct ecstasies and congenital breast conditions such as inverted nipple etc. Aberration of normal differentiation and involution of breast consist of cystic nodularity, mastalgia, cysts and fibroadenoma.</p> <p><strong>Methods:</strong> Aim of the study is to study the co-relation of clinical, pathological and radiological parameters in benign breast diseases and study detail the different modes of presentations of benign breast disease respect to age, marital status, religion, clinical features, menstruation, presentation of lump, diagnostic modalities used.</p> <p><strong>Results:</strong> The 200 patients diagnosed with benign breast disease. Most of the cases belong to the age group of 20-29 years, fibroadenoma is the most common benign disorder in that age group followed by fibroadenosis. The presentation is breast lump without pain in most of the time.</p> <p><strong>Conclusions:</strong> Benign breast disease occupy majority of the total breast diseases. Majority of the benign breast diseases occur in the reproductive age group with fibroadenoma as the most common lesion. Lump is the most common presentation of all of the benign breast diseases.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10190A prospective observational study of predictive factors for conversion of laparoscopic to open cholecystectomy2024-01-16T14:16:27+0530Ajeet Kumar SinghAjeet.manglore@gmail.comPartha Sarathi Nayakparthpriya.nayak1@gmail.comKomal Prasad Dewangandrkomaldewangan1986@gmail.com<p><strong>Background: </strong>Cholelithiasis affects about 10 to 15% of general population. LC became the procedure of choice for management of symptomatic gallstone disease for its minimally invasive nature, minimal pain and earlier recovery.</p> <p><strong>Methods: </strong>This study was carried out on 300 consecutive patients who underwent LC for gall stone disease (patients falling under inclusion criteria) in the Department of General Surgery, The Calcutta Medical Research Institute, Kolkata.</p> <p><strong>Results: </strong>In this study 9% patient were converted to open cholecystectomy while 91% of the patient underwent successfully LC. Increased wall thickness of gall bladder (p=0.01), pericholecystic fluid collection (p=0.04), stone impaction at gall bladder neck (p=0.001), pain abdomen (acute cholecystitis, recurrent acute cholecystitis) (p=0.03), previous abdominal surgery (p=0.001), pre-operative jaundice (p=0.005) were found significant in this study for conversion to open surgery. Increased TLC, total bilirubin, alkaline phosphatase, alanine transaminase and aspartate transaminase (p<0.05) were also risk factors for conversion to open surgery.</p> <p><strong>Conclusions: </strong>We conclude that LC is the gold standard treatment for gall stone disease. Identification and safeguarding the bile ducts and arteries is of utmost importance while performing LC.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journalhttps://www.ijsurgery.com/index.php/isj/article/view/10199Post operative pancreatic fistula rate following pancreaticojejunostomy with Heidelberg technique versus classical duct to mucosa technique: a comparative study2024-01-19T15:01:21+0530Sumanth Subhramaniyamsubramaniam.sumanth@gmail.comBharghav J. KalariyaSubramaniam.sumanth@gmail.comGuruprasath S.Subramaniam.sumanth@gmail.comArul Jothi R. D. R.Subramaniam.sumanth@gmail.com<p><strong>Background:</strong> The best technique for pancreatic anastomosis is still a debate and unanswered by multiple RCTs and meta-analyses, done over past two decades. This study intends to compare the outcomes of pancreatico-jejunostomy (PJ) using Heidelberg technique vs classical duct to mucosa technique</p> <p><strong>Methods:</strong> All patients who underwent pancreaticoduodenectomy meeting criteria were included in study. Outcome of PJ done by Heidelberg technique evaluated by occurrence of POPF, as defined by ISGPF and results were compared to historical cohort of patients who had underwent PJ by classical duct to mucosa technique in our institution,</p> <p><strong>Results:</strong> PJ reconstruction was done with Heidelberg and classical duct to mucosa technique in 20 patients each. POPF rates in Heidelberg and duct to mucosa techniques when calculated using ISGPS-2005 definition (30% vs. 40%, p=0.677 and 10% vs. 10%, p=0.514 respectively) and ISGPS-2016 definitions (10% vs. 10%, p=0.514). There is no statistical difference between the two techniques in terms of DGE, infection, and days of hospital stay or duration of drain requirement. But Heidelberg technique is superior to DM technique with respect to shorter operating time (p=0.0001) and lower Clavien-Dindo morbidity grades (p=0.0004). Though a statistical significance could not be reached, there is an increased tendency of higher grade POPF with respect to increased age (>57 years), softer texture and smaller duct size (<3 mm).</p> <p><strong>Conclusions:</strong> There is no significant difference of CR-POPF rates between Heidelberg and classical duct to mucosa techniques of PJ. However, Heidelberg technique is better in terms of simplicity, reduced operating time and lower post-operative morbidity when compared to duct to mucosa technique.</p>2024-02-29T00:00:00+0530Copyright (c) 2024 International Surgery Journal