International Surgery Journal

Perforation of colonic interposition graft in a patient with prior esophagectomy: a case report

2025-04-26T08:25:33+0530

Colonic interposition is an established technique for esophageal replacement when gastric pull-up is not feasible. While it provides functional long-term results in selected patients, complications such as ischemia, redundancy, and perforation may occur. We report the case of a 47-year-old male with a history of esophageal perforation and colonic transposition who presented nine years later with acute abdomen. Imaging revealed a complicated diaphragmatic hernia, and exploratory laparotomy showed ischemic and perforated neoesophagus. The patient required urgent resection of the colonic graft, esophagostomy, and negative pressure wound therapy for surgical site infection. Complications of colonic transposition may be early (ischemia, leakage) or late (stenosis, reflux, redundancy, and perforation). Graft ischemia remains a major contributor to postoperative morbidity. Adequate vascularization, careful anastomotic technique, and long-term monitoring are crucial for favorable outcomes. This case highlights a rare but severe late complication of colonic interposition, emphasizing the need for vigilance in long-term follow-up and timely surgical intervention.

Spontaneous resolution of non-occlusive mesenteric ischemia in the setting of hemodialysis: a case report

2025-04-26T08:27:54+0530

Non-occlusive mesenteric ischemia (NOMI) is a rare yet serious cause of acute abdominal pain, particularly affecting critically ill and dialysis-dependent patients. Unlike occlusive mesenteric ischemia, NOMI results from mesenteric hypoperfusion without vascular obstruction, making early diagnosis challenging. We report a case of a 46-year-old female with end-stage renal disease (ESRD) on hemodialysis who presented with severe abdominal pain and hypertensive emergency following dialysis. Initial imaging revealed portal venous gas (PVG) without evidence of bowel obstruction or bowel ischemia. Despite intractable pain, her condition improved with supportive care, including blood pressure management, without the need for invasive intervention. A repeat CT scan showed resolution of PVG, correlating with clinical improvement. Hemodialysis-associated hypotension is a known risk factor for NOMI due to transient mesenteric hypoperfusion. This case highlights the role of blood pressure fluctuations in NOMI’s pathophysiology, with post-dialysis hypertension potentially aiding in recovery. Additionally, the transient presence of PVG on imaging, which resolved alongside symptom improvement, suggests its utility in diagnosing and monitoring NOMI. This case underscores the importance of recognizing NOMI in dialysis patients with abdominal pain, close blood pressure monitoring, and utilizing serial CT imaging for non-invasive disease management. Our findings suggest that in select patients with rapid clinical recovery, PVG disappearance may serve as a marker for NOMI resolution, potentially avoiding unnecessary laparotomy.

Tricky lipoma or bad neighborhood: a case of ileocolic intussusception

2025-04-26T08:27:47+0530

Colonic lipomas (CLs) are an infrequent, benign, non-epithelial, adipose tissue tumour. Most of the CLs are asymptomatic, but around 25% of patients may develop symptoms, such as ileocolic intussuception. Surgical or endoscopic resection of the lesion is the treatment of choice. We present a case of ileocolic intussusception caused by colonic lipoma in an adult patient. The patient underwent surgical resection, and the diagnosis was confirmed by histopathological examination of the specimen.

Female paraurethral leiomyoma: a case report and literature review

2025-04-26T08:25:50+0530

Urethral myoma is an uncommon benign tumor of mesenchymal origin. Establishing the diagnosis can be challenging due to its similarity to other periurethral masses. We report a case of a 36-year-old multiparous woman (P4A0) presenting with a painless mass protruding from the distal vaginal wall, surpassing the vaginal introitus for the past two years. Physical examination revealed a round, solid mass measuring 9.4 x 4 x 4 cm emerging from the vagina. A trans perineal scan indicated a leiomyoma in the anterior vaginal area. The mass was successfully excised via a vaginal approach in collaboration with a urologist. A Foley catheter was placed preoperatively, and the patient showed favorable recovery three weeks post-surgery. Histopathological analysis confirmed the diagnosis of leiomyoma. Urethral myoma accounts for approximately 5% of leiomyoma cases. Preoperative imaging and thorough clinical examination are essential for diagnosis. The preferred treatment is complete surgical excision via the vaginal route, followed by histological evaluation. While laparoscopic management has been reported in isolated cases, local recurrence remains rare. Close postoperative monitoring can help detect potential recurrences at an early stage. This case highlights the rarity of urethral leiomyoma and its successful management through surgical intervention.

Distal pancreatectomy with preserved spleen for benign serous cystadenoma of the pancreas

2025-04-26T08:27:43+0530

Pancreatic serous cystadenoma is a benign tumor of the pancreas that can be effectively managed using the Kimura surgical technique. This method involves resecting the distal portion of the pancreas while preserving the spleen and its associated vessels. The aim of this study was to evaluate the application of the Kimura technique in two different surgical approaches—laparotomy and laparoscopy—for the treatment of pancreatic serous cystadenomas. Specifically, the study assessed the feasibility, surgical outcomes, and postoperative prognosis associated with each approach. A case review was conducted involving two patients who underwent surgery at the Department of Organ and Tissue Transplantation, Plastic, and Endocrine Surgery at Grodno Clinical Hospital. The study focused on distal pancreatectomy and its surgical variants, paying special attention to the patients' clinical presentations, symptoms, and imaging findings (CT and MRI). Both patients had uneventful postoperative recoveries without complications such as pancreatic fistula, gastric stasis, or splenic infarction. The findings suggest that the Kimura technique is a safe and effective method for managing benign serous cystadenomas of the pancreas. Favorable outcomes with both surgical approaches highlight the importance of a patient-specific strategy, taking into account factors such as lesion size, anatomical location, splenic vessel involvement, and the surgeon’s expertise to optimize surgical results. Furthermore, spleen preservation using the Kimura technique helps maintain immune function and reduces the risk of postoperative complications, including severe infections and splenic infarction.

Post-extraction vertical guided bone regeneration with a titanium-reinforced polytetrafluoroethylene membrane

2025-04-06T07:39:41+0530

Tooth loss can lead to resorption of the alveolar bone, affecting soft tissue support and altering the facial profile. The long-term success of dental implants depends on adequate bone dimensions, so guided bone regeneration (GBR) is crucial to increase bone volume prior to implant placement. GBR is a technique that promotes new bone formation in bone defects to create adequate support for dental implants. It uses a combination of autologous bone and xenograft to optimize the graft's osteogenic and osteoconductive properties. However, its main limitation is the bone's maturation time, which is usually between 6 and 9 months. A 58-year-old patient with tooth loss due to severe bone destruction required GBR for dental implant placement. The combination of the physical barrier of d-PTFE (polytetrafluoroethylene) and the structural strength of titanium provides a favorable environment for bone regeneration, but it is crucial to consider the potential complications associated with these membranes, such as soft tissue injury and membrane exposure.

Non-operative management in tracheal injuries: a feasible approach

2025-04-26T08:27:37+0530

Tracheal injuries secondary to penetrating chest trauma are rare, and the non-operative management of isolated injuries, few successful cases of non-operative management are recorded. A 20-year-old male patient presented after sustaining a penetrating injury to his chest. On clinical evaluation and diagnostic imaging, he had an isolated perforated tracheal injury. Extensive surgical emphysema, bilateral pneumothoraces and a positive finding of tracheal injury on bronchoscopy clinically evidenced it. The patient was managed conservatively in the intensive care unit, endotracheal intubation was placed below the injury and subsequently, associated clinical signs improved; he was extubated and discharged home with no further complications noted. Isolated tracheal injury secondary to trauma is a rare finding. The treatment depends on the size, location and resolution of surgical emphysema and pneumothorax. In the absence of these, surgical management is preferred. Non-operative management for tracheal injuries is favoured in iatrogenic injuries. Isolated tracheal injuries secondary to trauma can be managed non-operatively. With close monitoring in high-care settings and a good understanding of the disease process make successful management of tracheal injuries possible. Conservative management saves both the patient and the health system the burden of undergoing surgical repair.

Delayed diagnosis and surgical management of gastric perforation: a case report

2025-04-26T08:25:47+0530

Gastric perforation is a life-threatening emergency requiring prompt diagnosis and intervention. However, in resource-limited settings, delayed diagnosis and referral can worsen outcomes. This report presents a case of gastric perforation initially misdiagnosed as perforated appendicitis, leading to delayed treatment and increased morbidity. A 56-year-old male presented with severe, diffuse abdominal pain for one day, accompanied by the inability to pass stool and urine. The patient had a history of chronic knee pain and frequent NSAID and corticosteroid use. He was initially misdiagnosed at a rural hospital due to the unavailability of imaging and referred to a primary hospital with X-ray facilities after a two-day delay. On arrival, he showed signs of sepsis and peritonitis. Abdominal X-ray revealed free air under the diaphragm, confirming gastric perforation. Emergency laparotomy showed a 1×1 cm gastric perforation with extensive peritoneal contamination and omental inflammation. Primary closure with omental patch repair was performed, followed by peritoneal lavage. The patient was managed in the intensive care unit (ICU) for three days before transferring to the general ward. He was discharged after ten days with weekly follow-ups for one month. This case highlights the challenges of diagnosing gastric perforation in resource-limited settings and emphasizes the need for improved access to imaging and timely surgical intervention. Delayed diagnosis increases morbidity, underscoring the importance of efficient referral systems and early detection.

Toxic megacolon: a rare presentation of complicated diverticular disease

2025-04-19T06:30:06+0530

Toxic megacolon is a life-threatening complication most commonly associated with inflammatory bowel disease (IBD) or Clostridioides difficile infection. Its occurrence secondary to complicated diverticular disease is exceedingly rare. We present the case of a 56-year-old woman who developed toxic megacolon in the context of sigmoid diverticular disease. She initially received intravenous antibiotics for Hinchey IB diverticulitis and was discharged on oral therapy. Four days later, she returned with abdominal distension, severe leukocytosis, and radiographic evidence of colonic dilatation and pneumatosis. Emergency surgery revealed a perforated stenotic sigmoid tumor with ischemic changes, and a subtotal colectomy was performed. Histopathological analysis confirmed ischemic colitis with features of toxic megacolon. The patient had an uneventful recovery and was discharged on postoperative day seven. Although toxic megacolon is classically linked to IBD and C. difficile, clinicians must be aware of rare etiologies such as complicated diverticular disease. Prompt recognition and early surgical intervention are crucial for favorable outcomes in atypical presentations.

Obstructive Meckel’s diverticulum in a renal transplant recipient: a case report and intraoperative enteroscopy findings

2025-04-26T08:25:32+0530

Meckel’s diverticulum, the most common congenital anomaly of the gastrointestinal tract, is often asymptomatic but may lead to bleeding, obstruction, or inflammation. In renal transplant recipients, immunosuppression and overlapping symptoms can obscure diagnosis. We present a 37-year-old male renal transplant recipient with chronic obscure gastrointestinal bleeding, anemia, and diarrhea. His complex medical history included end-stage renal disease due to vesicoureteral reflux, multiple immunosuppressive therapies, and prior transplant rejection episodes. Initial endoscopic studies revealed nonspecific findings. Capsule endoscopy identified a submucosal lesion suggestive of Meckel’s diverticulum, and imaging showed mural thickening and graft atrophy. Surgical exploration with intraoperative enteroscopy confirmed a 2.5 cm Meckel’s diverticulum 50 cm from the ileocecal valve, alongside lymphangiectasias and arteriovenous malformations. Segmental small bowel resection with side-to-side enteroenteric anastomosis was performed. The patient recovered uneventfully. Histopathology demonstrated chronic inflammation and recent hemorrhage, with no evidence of malignancy. Meckel’s diverticulum, though rare in adults, should be considered in transplant recipients presenting with obscure gastrointestinal bleeding. Capsule endoscopy and intraoperative enteroscopy proved invaluable for diagnosis. Surgical resection remains the treatment of choice in symptomatic cases. Multidisciplinary management is essential in immunosuppressed patients with complex gastrointestinal symptoms.

Surgical management of hemorrhagic pancreatic pseudocyst with splenic artery rupture and submucous hematoma of gastric wall development

2025-04-26T08:25:40+0530

Hemorrhagic pancreatic pseudocyst is a rare but life-threatening complication of chronic pancreatitis due to the erosion of vascular vessels by leakage of pancreatic enzymes. This case report aims to highlight the diagnostic challenges, investigation methods, and management strategies for hemorrhagic pancreatic pseudocysts while emphasizing the importance of a multidisciplinary approach. 47-year-old male presented with chronic pancreatitis presented with severe abdominal pain and gastrointestinal bleeding. Investigations included ultrasonography, gastrography with barium swallow study, endoscopy, CT and MRI, which revealed a hemorrhagic pseudocyst eroding the gastric mucosa. Celiacography identified splenic artery rupture, leading to initial management through endovascular embolization using nitinol spirals. However, recurrent bleeding necessitated surgical intervention. Laparotomy revealed a massive hemorrhagic pancreatic pseudocyst invading the gastric mucosa and the patient underwent an en-bloc resection of the proximal part of the stomach with hemorrhagic pseudocyst, and distal resection of pancreas with splenectomy followed by esophagogastrostomy. After proper surgical intervention, patient showed improvement. Post-operative complications including subdiaphragmatic abscess and pleural effusion were managed with surgical drainage and thoracocentesis and antibiotics. The patient gradually improved, and was discharged in a satisfactory condition. This case highlights the importance of early diagnosis through advanced imaging studies and timely intervention using radiological, endovascular and surgical techniques. Although embolization provides a temporary hemostasis, definite surgical intervention is required in cases of vascular destruction and pseudo cyst ruptures invading the surrounding tissues.

Ileo-colic intussusception in an adolescent secondary to high-grade B-cell (Burkitt’s) lymphoma: a case report and literature review

2025-04-26T08:25:48+0530

Intussusception in older children and adolescents is relatively uncommon and is frequently associated with a pathological lead point. High-grade B-cell lymphomas (e.g., Burkitt lymphoma) may involve the abdomen and precipitate intussusception. A 16-year-old male presented with a two-week history of intermittent upper abdominal pain, melena, and symptomatic anemia. Contrast-enhanced computed tomography (CECT) demonstrated ileo-colic intussusception. Exploratory laparotomy revealed a polypoidal mass in the ascending colon acting as the lead point, necessitating a right hemicolectomy. Histopathological and immunohistochemical analyses confirmed high-grade B-cell lymphoma consistent with Burkitt lymphoma. The patient’s postoperative course was uneventful, and he was referred for chemotherapy. This case underscores the importance of considering Burkitt lymphoma in adolescent patients with intussusception. Prompt surgical intervention, definitive histopathological confirmation, and timely initiation of chemotherapy are critical to optimizing patient outcomes.

Inferior epigastric artery aneurysm: a rarest complication of laparoscopic cholecystectomy

2025-04-26T08:27:46+0530

Case is an uncommon rare incidental finding of an inferior epigastric artery aneurysm (IEAA) following a routine laparoscopic cholecystectomy performed for symptomatic gallstones. The vascular anomaly with idiopathic thrombocytopenic purpura (ITP) was identified postoperatively, underscoring the critical need for heightened vigilance during surgical procedures to prevent unintended vascular injuries. The case emphasizes the importance of meticulous surgical technique and the potential value of preoperative imaging in identifying such anomalies, particularly in patients considered high-risk.

Eosinophilic colitis necessitating surgery: a rare case report

2025-04-26T08:27:45+0530

Eosinophilic colitis (EC) is a rare heterogenous inflammatory disorder with a wide range of symptoms that can mimic a variety of pathologies. We report a rare case of EC presenting as recurrent intestinal obstruction. A 45-year gentleman presented with recurrent episodes of colicky abdominal pain whose blood investigations revealed eosinophilia and high absolute eosinophilic count. Abdominal radiograph and USG abdomen and pelvis were suggestive of intestinal obstruction. Computerised tomography and colonoscopy revealed ascending colon stricture, and colonoscopy-guided biopsy suggested chronic nonspecific colitis. Laparotomy revealed an obstructive lesion of the ascending colon with no regional lymphadenopathy. A right radical hemicolectomy was performed, and the histopathological examination revealed EC. The patient had an uneventful postoperative recovery and was started on medical therapy with albendazole, levocetirizine, montelukast and diethylcarbamazine. The patient has been on regular follow-up and is doing well.

A rare case of giant adrenocortical carcinoma: a case report

2025-04-26T08:27:44+0530

Adrenocortical tumors are rare, and when large, they are often referred to as incidentalomas if detected during evaluation for unrelated symptoms. These tumors may be nonfunctional or have subtle clinical presentations, posing diagnostic and management challenges. A 50-year-old male presented with a seven-day history of dull, aching pain in the right hypochondrium, associated with a sensation of fullness in the right upper abdomen. Physical examination revealed a palpable mass in the right hypochondrium. Based on clinical evaluation, mass was suspected to be an adrenocortical malignancy. Contrast-enhanced computed tomography (CECT) identified a well-circumscribed, heterogeneous mass measuring 11×9×10 cm arising from the right adrenal gland. Hormonal workup demonstrated no functional activity, and the mass was considered an incidentaloma. The patient underwent open surgical excision of the tumor. Intraoperative findings revealed a well-encapsulated mass with no invasion of surrounding structures. Histopathological evaluation confirmed an adrenocortical carcinoma (Weiss score >3). Postoperative recovery was uneventful, and follow-up imaging at six months showed no signs of recurrence or metastasis. This case highlights the importance of evaluating incidentalomas, particularly large adrenal masses, for their potential clinical significance. Timely surgical intervention and histopathological confirmation are essential for ensuring favourable outcomes in such cases.

Importance of parathyroid hormone assessment in a known case of ulcerative colitis and recurrent pancreatitis

2025-04-26T08:25:57+0530

Gastrointestinal diseases like acute pancreatitis, ulcerative colitis, peptic ulcer may be associated with hyperparathyroidism which may be primary or secondary. These conditions associated with parathyroid adenoma is rare in the literature globally. Here we present a 43 years old female patient who was treated for ulcerative colitis and probably drug induced pancreatitis as initial impression in other health care facility but without any relief. When consulted at our health facility, she was systematically and rationally investigated for hyperparathyroidism and was diagnosed to have parathyroid adenoma. She was operated and now reported to have relieved of her symptoms. This case report thus demonstrates importance of investigating patients of ulcerative colitis with pancreatitis for hyperparathyroidism.

Miraculous recovery of perioperative acute uniocular loss of vision following spine surgery in prone position

2025-04-26T08:25:56+0530

An 18 years old female came to emergency with low back pain radiating to left lower limb for 8 months. The patient had no comorbidities as such and was hemodynamically stable with HR-72/min, BP-120/60 mmHg, Spo2-98% in room air, RBS-125 mg/dl. Patient was diagnosed with L5-S1 PIVD with Lumbar Canal Stenosis and was planned for L5-S1 instrumented spinal Stabilization with L5 laminectomy and discectomy under general anaesthesia. Preoperative status of the patient was stable. Perioperatively patient had uniocular left sided complete loss of vision for 3 days following which gradual improvement of vision to normal restoration of vision achieved after 4 months along with a diagnosis of left optic neuritis with severe retino-optic nerve pathway dysfunction.

A rare case of Peutz Jeghers syndrome associated with gastric adenocarcinoma and multiple intestinal polyps

2025-04-26T08:25:43+0530

Peutz-Jeghers syndrome (PJS) is a rare hereditary disease, inherited as autosomal dominant fashion (variable penetrance). It is characterized by hyperpigmentation over oral cavity and lips and gastrointestinal hamartomatous polyps. It has incidence rate between 1 in 50,000 and 1 in 200,000 people and prevalence of 1 in 100,000 people. Mucocutaneous pigmentations are most common clinical features in these patients. PJS patients have increased risk of gastrointestinal (more commonly) and extra intestinal malignancies. Incidence rate of gastric malignancy in PJS is around 5%. We presented a rare complication of PJS in terms of gastric adenocarcinoma. A 24 year old female presented with left lower abdominal pain on and off since one year. She had nausea, multiple episodes of gastric vomiting and obstipation since two days. On examination, hyperpigmented patches were present over both lips, had tachycardia. Abdomen was distended and tender. Abdominal ultrasound showed possibility of intussusception and CECT abdomen confirmed long segmental intussusception involving jejunal loops with lead point being polyp/hamartoma and presence of hamartoma/polyp in stomach and jejunum. Patient underwent Exploratory Laparotomy. Jejuno-jejunal intussusception was found. Intussusception could be reduced three big sessile polyps were found in it. Resection with jejuno-jejunal anastomosis was done. Postoperative course was uneventful. Upper GI scopy was done which showed multiple polyps in stomach, one large ulcerated polyp, biopsy from that polyp showed moderately differentiated adenocarcinoma. As the development of malignancies in PJS hamartomas is rare, periodic surveillance in patients and their family members is of utmost importance.

Twisted ovarian dermoid cyst with sigmoid colon volvulus: a rare cause of closed-loop obstruction

2025-04-26T08:25:51+0530

Ovarian dermoid cysts (mature cystic teratomas) are common benign ovarian tumors, but they rarely cause intestinal obstruction. We present an extremely rare case of a large twisted left ovarian dermoid cyst with an edematous pedicle, around which the sigmoid colon had looped, leading to a closed-loop obstruction, rarely seen in young adults, which can be a life-threatening condition, if remains untreated. A 34-year-old female presented with left lower abdominal pain since three days, associated with obstipation and multiple episodes of non-bilious vomiting. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a large left ovarian dermoid cyst with a twisted pedicle, causing sigmoid colon entrapment and luminal narrowing. She underwent an emergency exploratory laparotomy with resection of the redundant sigmoid colon and side-to-side colocolic anastomosis alongwith left oophorectomy. The patient had an uneventful recovery and was discharged on post-operative day 6 with soft diet and a healthy wound. This case highlights a rare but significant complication of ovarian dermoid cysts leading to intestinal obstruction.

Recurrent non-parasitic hepatic cyst with jaundice: a case report

2025-04-26T08:25:49+0530

The prevalence of simple hepatic cyst is 5-10% worldwide and usually does not require surgical intervention unless the patient becomes symptomatic. After laparoscopic surgical treatment there is a high chance of recurrence. Recurrence have been treated on individual basis by different centers either by laparoscopy or open cystectomy. A case of recurrent simple cyst of liver with obstructive jaundice in a 42-year-old lady treated by open cystectomy is presented.

Rare case presentation of intestinal intussusception due to leiomyosarcoma

2025-04-26T08:25:45+0530

Intussusception is defined as one segment of bowel telescopes into an adjacent bowel segment, which can cause obstruction and even intestinal ischemia. Multiple complications such as intestinal obstruction, intestinal necrosis, and sepsis can occur as result if not treated early. Intussusception is much more common in the pediatric age group and rare in adults.in children it presents with the classic triad of cramping abdominal pain, bloody diarrhea, and a palpable tender mass. In children intussusception mostly likely occurs due to benign causes, whereas in adults cause of intussusception are more likely carcinomas, polyps, diverticulum, strictures, benign neoplasms, or postoperative condition. Most useful diagnostic tools are ultrasonography and computed tomography. We operated a case of adult intussusception due to leiomyosarcoma of small intestine which is even rare. on imaging, ileo-ileal intussusception with dilated proximal bowel loops were found. Exploratory laparotomy done in which large hard polypoidal mass causing ileo-ileal intussusception was found for which ileo-ileal resection & anastomosis done with normal bowel margin of 10 cm on both sides. Patient’s post operative period was uneventful on histopathology, high grade leiomyosarcoma was detected.no clinical or radiological evidence of metastasis found.

A wandering mystery: freely mobile ectopic pleomorphic adenoma clinically mimicking cervical lymphadenopathy

2025-04-26T08:25:39+0530

Ectopic pleomorphic adenoma is a rare entity. It usually originates from heterotopic salivary gland tissue. During an excision via surgery, the tumor ought to be excised completely with an intact capsule. We present a case of ectopic pleomorphic adenoma of the parotid gland in the neck. It was in the right jugulo-diagastric region and freely mobile. Cervical lymphadenopathy was the first clinical diagnosis. But, on investigations, it turned out to be pleomorphic adenoma. This case emphasizes that ectopic pleomorphic adenoma can be a differential diagnosis of neck swellings and needs meticulous surgical excision to prevent recurrence and malignant change.

Pelvic ectopic kidney with malrotation: a rare case report of renal cell carcinoma

2025-04-26T08:25:55+0530

The incidence of renal cell carcinoma in a pelvic kidney is rare and has only been reported in a very small number of cases. We report a 42 years old female patient presented with haematuria. CT scan showed large heterogeneous soft tissue mass arising from a right interpolar region of pelvic kidney with saccular aneurysm and peripheral hpoenhancing lesion. Histopathology after radical nephroureterectomy showed grade II clear-cell renal carcinoma. Renal cell carcinoma of ectopic kidney is a rare disease. Even though the presentation might be atypical and challenging, the treatment strategy is still the same as for tumours of orthotopic kidneys.

Valentino’s syndrome: a curious case of perforated peptic ulcer mimicking acute appendicular perforation, a case report and comprehensive literature review

2025-04-26T08:25:42+0530

Valentino’s syndrome is an uncommon presentation of perforated peptic ulcer disease where the contents of the stomach and duodenum can trickle through the right paracolic gutter and imitate the classic signs of acute appendicitis. This atypical presentation poses a significant diagnostic challenge, especially in older patients with several health issues. We describe the case of a 74-year-old lady having a history of uncontrolled diabetes, hypertension, hypothyroidism, and allergic airway disease. She presented with a sudden onset of mid-abdominal pain that soon localized to the right lower quadrant, accompanied by gradual distention of abdomen, nausea, and a single episode of bilious vomiting. The initial imagining was not confirmatory and only suggested a hollow viscus perforation, the findings pointing towards a probable appendicular perforation. An emergency laparotomy revealed a normal appendix and caecum, with further exploration uncovering a partially sealed 2×2 cm partially sealed pre-pyloric perforation. A modified Graham patch repair was performed, and a feeding jejunostomy was placed to support her recovery given her frail condition. Surgical findings were contrary to the findings noted on the cross-sectional imaging and led to a revision of diagnosis surprisingly from an anticipated appendicular perforation to a perforated peptic ulcer. After a thorough peritoneal lavage, the prepyloric perforation was repaired using a modified Graham’s technique, with supportive measures in the form of a feeding jejunostomy that contributed to her gradual recovery. Histopathological analysis confirmed chronic inflammation and the patient’s postoperative course was steady and uneventful. This case highlights the importance of considering Valentino’s syndrome in elderly patients presenting with right lower quadrant pain. A careful and comprehensive diagnostic approach, aided by modern imaging and thorough surgical exploration, is essential for achieving the best outcomes in these challenging cases.

Surgical and endoscopic approaches to achalasia: what does the evidence say

2025-04-26T08:25:35+0530

Achalasia is a rare primary esophageal motility disorder characterized by failure of the lower esophageal sphincter (LES) to relax and absence of normal peristalsis in the esophagus. Patients typically present with progressive dysphagia to both solids and liquids, regurgitation, chest pain, and weight loss. Diagnosis is confirmed by high-resolution manometry demonstrating incomplete LES relaxation and aperistalsis, with supportive findings on barium esophagram (e.g. “bird’s beak” narrowing) and endoscopy to exclude pseudo achalasia. Achalasia is subdivided into three manometric subtypes (I–III) based on esophageal pressure patterns, which have prognostic significance. Treatment is directed at relieving the distal esophageal obstruction, with options including pneumatic balloon dilation, laparoscopic Heller myotomy (LHM) with partial fundoplication, and peroral endoscopic myotomy (POEM). Botulinum toxin injection is reserved for high-risk patients. Current evidence from guidelines and recent studies indicates that LHM and pneumatic dilation have comparable efficacy in appropriate candidates, and POEM offers similar symptomatic relief to LHM. Manometric subtype guides therapy—type II achalasia responds best to any therapy, whereas type III often benefits from a tailored myotomy approach. The addition of fundoplication to Heller myotomy significantly reduces post-treatment reflux without compromising achalasia symptom control. In pediatric achalasia, Heller myotomy yields superior long-term outcomes compared to dilations. Robotic-assisted Heller myotomy is an emerging technique showing comparable efficacy to LHM with a potential reduction in perforation risk. An individualized, patient-centered approach - considering achalasia subtype, patient age/comorbidity, and available expertise is essential to optimize outcomes. This review synthesizes the current evidence on achalasia management, highlighting the role of Heller myotomy relative to other therapies in light of recent clinical guidelines and studies.

Burns within the South African context

2025-04-26T08:25:54+0530

Burn injuries are a major cause of morbidity and mortality worldwide, with significant physical and psychological sequelae. The application of trauma resuscitation principles can substantially reduce the impact of these injuries. In South Africa, their incidence is closely linked to socioeconomic factors and their management requires a coordinated multidisciplinary approach.

GLP-1 medications versus surgery and balloon: evaluating cost-benefit in weight loss

2025-04-26T08:25:29+0530

This narrative review compares three prominent interventions-GLP-1 receptor agonists (e.g., semaglutide), laparoscopic sleeve gastrectomy (LSG), and intragastric balloon therapy-regarding their clinical efficacy and cost-effectiveness. Drawing on recent meta-analyses, professional guidelines, and economic modeling studies from 2023-2025, we synthesize key findings related to weight loss outcomes, comorbidity resolution, and long-term value. Bariatric surgery, particularly LSG, achieves the most substantial and durable weight loss (~20-30% of total body weight) and offers superior long-term benefits, including diabetes remission and reduced cardiovascular risk. Despite high initial costs, it is consistently found to be cost-effective or cost-saving over time, particularly in patients with diabetes. GLP-1 receptor agonists produce meaningful weight loss (~10-15%) and metabolic improvement but are associated with significant ongoing costs and potential weight regain after discontinuation, limiting long-term cost-effectiveness. Intragastric balloon therapy is less invasive and lower in immediate cost, with moderate efficacy (~10-15% weight loss), but typically results in temporary benefits and limited insurance coverage. As a standalone therapy, its cost-effectiveness is inferior to surgery, though modeling suggests economic value when used as a pre-surgical adjunct. Overall, LSG emerges as the most cost-effective intervention in severe obesity, while GLP-1 therapy’s value depends heavily on duration and pricing. Intragastric balloons may be viable for specific subpopulations or preparatory contexts. Tailoring intervention selection based on both clinical and economic parameters is essential for sustainable obesity management. Further research is warranted to refine cost-benefit assessments as new therapies and pricing models evolve.

A review to elucidate the role and scope of topical ozenoxacin in routine surgical practice in India

2025-04-26T08:25:28+0530

Superficial skin infections are a prevalent and are a significant challenge in surgical practice, particularly in India, where high surgical volumes and a high prevalence of comorbidities elevate the risk of infection. The use of topical antibiotics is a widely known strategy for preventing and managing superficial skin infections, yet the rise of antibiotic resistance demands innovative solutions. Based on the clinical evidence, epidemiology of superficial skin infections in surgical practice, risk factors, and panel discussion, this expert opinion aims to guide clinicians to optimize the use of ozenoxacin in surgical practice. The role of ozenoxacin, a novel fluoroquinolone, has been explored as an effective topical antibiotic for the treatment of superficial skin infection seen in surgical practice such as cellulitis, erysipelas, impetigo, ecthyma, folliculitis, furuncles, carbuncles, abscesses, and infections related to minor trauma. The article highlights ozenoxacin’ s mechanism of action, its broader antimicrobial coverage against gram-positive pathogens, and its potential advantages over older topical antibiotics.

Age and off-pump coronary artery bypass grafting: assessing surgical outcomes in elderly patients - a single-center perspective study

2025-04-05T08:35:09+0530

Background: Coronary artery disease (CAD) remains a major global burden, increasingly affecting the elderly and requiring effective interventions like coronary artery bypass grafting (CABG). Off-pump CABG (OPCABG) has gained popularity as a technique that avoids cardiopulmonary bypass, reducing perioperative complications such as stroke and inflammatory responses. The impact of advanced age on OPCABG outcomes remains a critical area of investigation.

Methods: This comparative cross-sectional study was conducted in the Department of Cardiac Surgery at Bangladesh Medical University from January to December 2024, including 100 patients undergoing OPCABG, divided into two groups: patients younger than 65 years (n=50) and those older than 65 years (n=50).

Results: Data analysis revealed significant differences in post-operative outcomes, with elderly patients experiencing prolonged ventilation time (449.6±31.5 min versus 303.1±35.4 min, p<0.05), increased postoperative bleeding (450.6±81.3 ml versus 316.4±69.3 ml, p<0.05), and higher serum creatinine levels on the first postoperative day (1.9±0.2 mg/dl versus 1.5±0.3 mg/dl, p<0.05). Psychosis was more prevalent in the older cohort (4 versus 1 case, p=0.02), along with higher rates of wound infections after the fifth postoperative day (9 versus 2 cases, p=0.03) and respiratory tract infections in the ICU (8 versus 1 case, p=0.01).

Conclusions: Despite similar preoperative profiles, elderly patients faced more complications, highlighting the influence of age-related physiological changes on post-operative recovery. These findings highlight the need for optimized ventilation, strict infection control, and personalized postoperative care in elderly OPCABG patients.

Normative macular thickness measurements in healthy Saudi paediatric population using optical coherence tomography

2025-04-16T06:45:56+0530

Background: The purpose of the study was to establish normative data for macular thickness in a healthy Saudi pediatric population using Cirrus HD- optical coherence tomography (OCT) and to analyze the effects of age and gender on macular thickness.

Methods: A cross-sectional study was conducted on 350 eyes of 175 Saudi children aged 6–18 years. Participants underwent a comprehensive ophthalmic examination, including vision assessment, refraction, fundus examination, intraocular pressure measurement, and macular thickness measurement using Cirrus HD-OCT. Macular thickness was measured in different quadrants following the early treatment diabetic retinopathy study (ETDRS) map and analyzed by age and gender.

Results: The mean macular thickness was 281.3±12 µm, and the mean spherical equivalent refraction was -0.31±1.75 diopters (D) (range: -2.50 to +2.25 D). The parafoveal area was the thickest, followed by the perifoveal area and the central subfield (CSF) thickness (p<0.001). The nasal quadrant of the macula was the thickest, followed by the superior, inferior, and temporal quadrants in both the parafoveal and perifoveal regions. No statistically significant differences were observed between genders or age groups.

Conclusions: This study provides normative data for macular thickness in Saudi children, which will aid in the early diagnosis and monitoring of macular disorders in this population. The findings suggest that gender and age have no significant impact on macular thickness measurements in pediatric patients.

Systemic inflammatory response syndrome in ureteroscopy: frequency, risk factors, and implications for prevention

2025-04-26T08:27:51+0530

Background: Systemic inflammatory response syndrome (SIRS) is a preventable cause of morbidity and mortality in patients undergoing ureteroscopy for urinary stone treatment. Multiple factors, including diabetes, hypertension, positive urine cultures, prophylactic antibiotics, and procedure duration, may influence SIRS risk, but their individual roles remain unclear.

Methods: A descriptive, retrospective, and prospective cross-sectional study was conducted at Hospital General Dr. Manuel Gea González from January 2021 to December 2024. Inclusion criteria encompassed patients aged ≥18 years undergoing ureteroscopy. Data were collected on comorbidities, stone characteristics, procedural details, and outcomes. Statistical analyses were performed using logistic regression to identify risk factors. Ethical approval was obtained.

Results: Among 351 patients, 60 (17.09%) developed SIRS. Factors associated with higher SIRS rates included flexible ureteroscopy (73.33%), ureteral access sheath use (50%), postoperative stents (60%), and preoperative positive urine cultures (33.33%). Patients with harder stones (≥1175 HU) experienced longer operative times (≥75 minutes).

Conclusions: Flexible ureteroscopy, ureteral access sheaths, postoperative stents, and positive urine cultures are significant risk factors for SIRS.

The importance of re-look urethrocystoscopy after fulguration of posterior urethral valve

2025-04-26T08:27:46+0530

Background: Endoscopic fulguration is the gold-standard treatment for posterior urethral valve (PUV). However, there is no consensus on detecting residual valves post-fulguration. Some urologists advocate re-look urethrocystoscopy (UC), while others recommend voiding cystourethrograms (VCUG). This study evaluates the significance of re-look UC after initial PUV fulguration.

Methods: This observational study involved 28 patients undergoing re-look UC post-fulguration due to persistent symptoms, elevated serum creatinine, or abnormalities in uroflowmetry and ultrasonography (e.g., high post-void residual (PVR) or hydroureteronephrosis). Continuous data were analyzed using the Wilcoxon signed-rank test and categorical data with Fischer’s exact test, with p<0.05 deemed significant.

Results: The median age for re-look UC was 7 years. Symptoms included weak urinary stream (92.9%), straining (75%), dribbling (71.4%), and others. Hydroureteronephrosis was noted in 92.9% of cases, and 50% had elevated serum creatinine. Residual valves were detected in 21.4% of patients three months after initial fulguration. Residual PUV was associated with a higher median age of 10 years (p=0.045). No significant associations were found between residual PUV and hydroureteronephrosis, PVR, or serum creatinine levels.

Conclusions: Re-look UC is crucial for detecting residual valves, enhancing clinical outcomes, and improving long-term bladder function. Integrating re-look UC into PUV management protocols is recommended to ensure comprehensive patient care.

Retro-prospective review of abscess epidemiology and its management in Western subdivisional hospitals in Fiji

2025-04-26T08:25:53+0530

Background: Abscesses, localized collections of pus resulting from bacterial infections, pose significant challenges to patient care. They are categorized into internal and cutaneous abscesses, with internal abscesses being more severe and harder to diagnose. Limited data exists on the epidemiology and management of abscesses in Fiji, particularly in subdivisional hospitals. This study aims to investigate the prevalence, anatomical distribution, demographic trends, and etiological factors of abscesses in subdivisional hospitals in Fiji’s Western division. Additionally, it seeks to analyze management strategies and outcomes to inform improvements in clinical practice.

Methods: A retrospective study was conducted from January 2020 to September 2022, analyzing patient data from four subdivisional hospitals-Rakiraki, Tavua, Nadi, and Sigatoka. The study utilized both qualitative and quantitative methods, with MBBS students collecting data under medical supervision. Statistical analyses were performed to assess demographic trends, anatomical sites, and microbiological findings.

Results: A total of 1,160 abscess cases were recorded, with Sigatoka hospital reporting the highest number (588 cases). Pediatric patients (ages 0-20) were the most affected, with a male predominance. The most common anatomical sites included the scalp, abdomen, head and neck, limbs, and gluteal region. S. aureus was the predominant pathogen, followed by S. pyogenes and E. histolytica. Management strategies involved incision and drainage (I and D), antibiotic therapy, and wound care, with variations based on abscess location and severity.

Conclusions: The study highlights a high prevalence of abscesses in pediatric and male populations in Fiji’s Western division. The identification of bacterial and parasitic pathogens underscores the need for targeted antibiotic and antiparasitic treatments. Findings emphasize the importance of public health interventions, improved hygiene practices, enhanced diagnostic capabilities, and antibiotic stewardship programs to optimize patient outcomes and reduce abscess-related morbidity in the region.

A comparative study on condition of hypertensive and non-hypertensive patients with dental implant success and survival: 15 years follow ups

2025-04-26T08:27:42+0530

Background: The study evaluates the success and survival of dental implants in hypertensive and non-hypertensive patients over a 15-year follow-up period. Hypertension may affect osseointegration and implant longevity, necessitating careful assessment of its impact on implant success.

Methods: This comparative study was conducted at Banasree Dental and Implant Center and German Dental and Implant Center, Dhaka, Bangladesh. A total of 109 patients were initially selected, but 19 were excluded due to loss to follow-up. Finally, 90 patients (67 females, 23 males, 45 in each group) were included, receiving a total of 257 implants (135 implants in maxilla and 122 implants in mandible), including guided bone regeneration (GBR) and sinus elevation. Participants aged 35 to 70 years underwent implant surgeries in 2009, with follow-ups until 2024.

Results: Marginal bone loss ranged from 0.5 mm to 2.0 mm, which is within the normal limit. All implants (100%) remained functional, with no significant difference in outcomes between hypertensive and non-hypertensive groups. This suggests that well-integrated implants can achieve long-term survival even in uncontrolled hypertensive patients.

Conclusions: With careful planning, proper blood pressure management, and close collaboration between healthcare providers, dental implants can be a durable and successful tooth replacement option for hypertensive patients. Ensuring optimal preoperative, intraoperative, and postoperative care is crucial for long-term implant stability, regardless of hypertension status.

Efficacy of local infiltration tramadol (transversus abdominis plane block technique) versus preemptive intravenous tramadol on postoperative pain after open appendectomy: a prospective randomized controlled trial

2025-04-26T08:27:38+0530

Background: Acute postoperative pain, if mismanaged, leads to increased morbidity and mortality. Effective perioperative analgesia is crucial to prevent persistent pain. In abdominal surgeries, endogenous opioids are released, and tramadol, a weak synthetic opioid, has demonstrated effective analgesic properties. Recent studies suggest tramadol's mechanism involves blocking voltage-dependent sodium channels, which increases extracellular calcium and affects peripheral nerves. This suggests tramadol has both systemic and local anesthetic effects.

Methods: A prospective, randomized, double-blind study was conducted on 32 patients (ages 18–60) diagnosed with acute appendicitis who underwent open appendectomy under general anesthesia. Participants were randomly assigned to two groups: group 1 received normal saline with tramadol infiltration for transversus abdominis plane (TAP) block (n=16), and group 2 received preemptive intravenous tramadol with TAP normal saline infiltration (n=16). Pain was assessed using the visual analogue scale (VAS) at various postoperative intervals. Opioid consumption was monitored through patient-controlled analgesia (PCA), and intraoperative data, complications, and hospital stay were recorded.

Results: Demographic data were similar between groups. The primary outcome showed a significant reduction in postoperative pain (VAS score) at 0 hours (p=0.031) for the tramadol TAP group, with a 1-point reduction in pain over 24 hours compared to the intravenous group. Secondary outcomes indicated reduced opioid consumption, with no significant differences in complications (nausea/vomiting, infection, hospital stay).

Conclusions: Local tramadol combined with TAP block is an effective alternative for postoperative pain relief after open appendectomy, reducing opioid consumption without additional complications.

Clinical and surgical outcome of hemi thyroidectomy in low-risk papillary carcinoma thyroid

2025-04-26T08:27:40+0530

Background: Hemi thyroidectomy involves removing one lobe of the thyroid gland and is often considered for patients with low-risk papillary carcinoma of the thyroid. The surgical outcome generally includes a reduced risk of complications and a shorter recovery time comparing total thyroidectomy. This study aimed to assess the clinical and surgical outcomes of hemi thyroidectomy in individuals with low-risk papillary thyroid carcinoma.

Methods: This cross-sectional study was conducted in the department of ENT & Head Neck Surgery, Combined Military Hospital (CMH), Dhaka Cantonment, Dhaka, Bangladesh from 26 March 2021 to 21 July 2023. In this study, 67 patients with low-risk papillary carcinoma of the thyroid (PCT) who had undergone hemi-thyroidectomy were purposively selected. The preoperative ultrasound, FNAC and post-thyroidectomy histopathology report for all participants were documented. The data were processed & analyzed.

Results: Female patients contributed the majority at 67.2%, and 52% belonged to 31-40 yeas age group. Clinical outcomes showed that 93% of patients achieved symptom relief, while 88% were surgically cured, with a 12% recurrence rate. Complications included transient recurrent laryngeal nerve issues in 3%, permanent recurrent laryngeal nerve problems in 1.5%, transient hypothyroidism in 3%, permanent hypothyroidism in 1.5%, and hematoma in 1.5%.

Conclusion: Females are predominantly prone to low-risk papillary thyroid carcinoma. Both clinical and surgical outcomes of hemi thyroidectomy for this condition are satisfactory, making it an effective and safe treatment method.

Tuberculosis in anal fistula: incidence, clinical insights, and diagnostic challenges

2025-04-26T08:27:35+0530

Background: Tuberculosis (TB) is a rare but significant cause of anal fistula, often leading to diagnostic delays and suboptimal treatment. This study aimed to assess the incidence, clinical characteristics, and diagnostic challenges of TB in anal fistula cases.

Methods: A prospective observational study was conducted from July 2023 to December 2024 at six hospitals in Bangladesh. A total of 85 patients with anal fistula underwent clinical evaluation, histopathological examination, and microbiological testing for TB. Fistulas were classified using the Parks and American gastroenterological association (AGA) systems. Demographic, clinical, and diagnostic data were analyzed using SPSS Version 25.

Results: Among 85 patients, the mean age was 38.6 years, with a male predominance (80.0%). Inter sphincteric (48.2%) and low trans sphincteric (24.7%) fistulas were the most common types. Histopathology confirmed TB in 3.5% (3/85) of cases. All TB-positive cases presented with chronic non-healing fistulas, unhealthy granulation tissue, and were initially misdiagnosed. Simple fistulas accounted for 64.7% of cases, yet TB was identified in both simple and complex fistulas.

Conclusions: TB should be considered in chronic or recurrent anal fistulas, especially in endemic regions. Routine histopathological examination is crucial for timely diagnosis. A combination of surgical intervention and anti-tubercular therapy (ATT) leads to favorable outcomes. Increased awareness among clinicians can help reduce diagnostic delays and improve patient management.

Calcification of ureteral stents: a determinant factor in renal function deterioration in patients with urolithiasis

2025-04-26T08:27:50+0530

Background: Ureteral stents play a crucial role in managing urinary tract obstructions, significantly advancing urological care. However, complications such as stent calcification present significant challenges.
Methods: This retrospective case-control study included 72 patients with ureteral stents placed for urolithiasis between 2020 and 2023. Patients were divided into two groups: calcified stents (n=36) and non-calcified stents (n=36). Data on demographics, comorbidities, stent duration, and renal function parameters were collected. Statistical analyses included Mann-Whitney, Fisher, and Chi-squared tests, with odds ratios (OR) calculated for associations (p<0.05). Ethical approval was obtained from the hospital’s ethics committee.
Results: Calcified stents were strongly associated with chronic kidney disease (CKD) (OR=2.667, 95% CI: 1.093–6.507) and renal function deterioration (OR=2.200, 95% CI: 0.804–6.018). Prolonged stent durations (>3 months) significantly increased calcification risk (OR=4.375, 95% CI: 2.322–8.243), while durations <3 months were protective (OR=0.156, 95% CI: 0.062–0.396). CKD prevalence was significantly higher in the calcified group (38.9%) compared to controls (11.1%) (p=0.006).
Conclusions: Stent calcification is associated with CKD and renal function decline. Timely removal (<3 months) is critical. Further research with larger cohorts is necessary to confirm these findings and guide preventive strategies.

A comparative study between hydrocolloid dressing and conventional vaseline gauze dressing in healing of donor site wound in split skin graft

2025-04-26T08:25:41+0530

Background: One of the frequently performed procedures by plastic surgeons, and general surgeons is skin graft. Pain in the donor region is a typical patient complaint. Paraffin dressing usually covers the area of the skin graft donor location. Split-skin grafting is commonly used by surgeons to treat skin abnormalities in the event of ulcers, deep burns and subsequent trauma. Epidermis harvesting and upper 1/3rd of dermis resulting in a wound called donor site wound (DSW) are needed for the technique of split-skin graft harvesting. These wounds pose a sort of burden to patients during the procedure and after the wound healing process. These injuries tend to cause immense discomfort, are at risk of infection, and may cause scratching of the patient (pruritus) and cosmetic inconvenience. Care and management of local donor site wound (DSW) should aim to create an environment that promotes early epithelialization for the patient with shortened hospital stay period with minimal pain and discomfort. This study was done to evaluate effectiveness of hydrocolloid dressing in comparison to paraffin gauze dressing in healing of split skin graft donor site wound, and in comparing the parameters like pain, pruritis, requirement of analgesics of donor site wound.

Methods: The study was done on 50 patients, 25 as study group who received effectiveness of hydrocolloid dressing and 25 as paraffin gauze dressing.

Results: Statistics proved that study group (hydrocolloid dressing) had lesser pain than control group (paraffin gauze dressing).

Conclusions: The hydrocolloid dressing on skin graft donor area reduces pain in post-operative period.

A study on preoperative clinico-radiological factors in predicting intraoperative difficulties in laparoscopic cholecystectomy

2025-04-26T08:27:53+0530

Background: Gallstones, or cholelithiasis, are common conditions causing patients to seek surgery. They can result from chronic or acute disorders in the biliary, pancreatic, gastrointestinal, and hepatic systems. The main pathways for gallstone formation are excessive bilirubin, cholesterol supersaturation, and impaired gall bladder contractility. Surgeons need to establish criteria for difficult laparoscopic cholecystectomy (LC) and conversion, but there's no consensus among them.

Methods: Observational analytical prospective cohort study, conducted in general surgery, People’s hospital, Bhopal from November 2022 to February 2024, patients diagnosed with cholelithiasis scheduled for LC in the study area during the study period.

Results: LC is the gold standard treatment for symptomatic cholelithiasis. Preoperative prediction of conversion risk is crucial for planning surgery. Predicting difficult LC allows experienced surgeons to be present during surgery, preventing complications. Early decision-making can prevent unnecessary surgery prolongation. Despite attempts to develop scoring systems for difficult LC, they are complex, difficult to use in daily practice, and often cannot be applied preoperatively.

Conclusions: LC is a common surgery for symptomatic cholecystectomy. A detailed clinical assessment and preoperative ultrasound are important to identify potential challenges and complications. Factors like recurrent acute cholecystitis, pancreatitis, chronic liver disease, and past hospitalizations can predict difficulties. Intraoperative issues may include bile spillage and bleeding. Difficult cases may require conversion to open surgery, extending operation time and hospital stays.

Precision cuts time-comparative outcomes of laser hemorrhoidoplasty and open hemorrhoidectomy

2025-04-26T08:27:52+0530

Background: Hemorrhoidal disease, one of the most common anorectal disorders and significantly affects individuals’ quality of life and poses a considerable health burden globally. Persistent or advanced-grade hemorrhoids often require procedural interventions such as traditional surgical approaches but these are associated with significant risks and complications. Recent developments, including minimally invasive techniques like laser hemorrhoidoplasty, are transforming the treatment landscape.

Methods: This research was a comparative, prospective study. It involved patients who were diagnosed to have grade II and III haemorrhoids with persistent symptoms. The patients were split into two groups: group 1, which underwent laser hemorrhoidoplasty, and group 2, which received open surgical haemorrhoidectomy and the mean age, duration of the surgery and antibiotic used were compared.

Results: A total of 44 patients were included in the study. Group 1 consisted of 23 participants and group 2 consisted of 21 participants. The mean age between the two groups varied from 21 to 73 years and the mean difference was found to be 0.67. The mean duration of surgery in group 1 was found to be 30.87±14.11 whereas in group 2 it was found to be 96.43±48.09. The mean antibiotics used in group 1 was found to be 4.91±1.12 and in group 2 was found to be 7.81±2.84.

Conclusions: Laser hemorrhoidoplasty is a safe, effective, and minimally invasive alternative to open hemorrhoidectomy for the management of symptomatic hemorrhoidal disease when compared to the duration of surgery, hospital stay and the perioperative antibiotic used.

A comparative study between single antibiotic prophylaxis and double antibiotic prophylaxis for reduction in incidence of surgical site infection in patients undergoing mesh hernioplasty

2025-04-26T08:27:48+0530

Background: This study aims to evaluate and compare the effect of single antibiotic prophylaxis and double antibiotic prophylaxis for reducing incidence of surgical site infection (SSI) in patients undergoing mesh hernioplasty.

Methods: It is a prospective study conducted at general surgery inpatient department, Rama medical college hospital and research centre, Hapur, U.P. from December 2022-March 2024. Intervention was surgery mesh hernioplasty. Injection ceftriaxone 1 gm (third generation cephalosporin) in single antibiotic group and injection ceftriaxone 1 gm (third generation cephalosporin) + injection amikacin 500 mg (Aminoglycoside) in double antibiotic group were given. Patients of either gender between 14-80 years of age with primary, unilateral or bilateral inguinal hernia, femoral hernia, umbilical hernia, ventral hernia or incisional hernia who are planned to undergo mesh hernioplasty were included and patients with diabetes mellitus, on steroid therapy, cigarette smokers, immunocompromised status like HIV, malignancy and abnormal KFT/RFT were excluded. Single and double antibiotic group were divided.

Results: The incidence of SSI in both groups was noted. The incidence of SSI in single antibiotic group (28%) was higher than the incidence of SSI in double antibiotic group (12%). No patient underwent mesh removal and no significant difference in terms of post-operative complications was observed in the results of both groups.

Conclusions: Double antibiotic prophylaxis was more effective than single antibiotic prophylaxis in decreasing the incidence of SSI in patients who undergo mesh hernioplasty by 16% as per the study.

Feasibility and safety of difficult laparoscopic cholecystectomy without using salvage procedures: a tertiary center experience

2025-04-26T08:25:46+0530

Background: Difficult laparoscopic cholecystectomy is associated with an increased risk of serious complications and a higher conversion rate. Iatrogenic injuries and conversion rates during laparoscopic cholecystectomy are still high which can be reduced with a surgeon's experience, special techniques, and intraoperative investigations. The present study aims to determine the outcomes of performing laparoscopic total cholecystectomy rather than salvage procedures.

Methods: A retrospective analysis of 100 patients who underwent difficult laparoscopic cholecystectomy between March 2023 and March 2024 was considered for this study. Inclusion criteria were abnormal anatomy, Mirizzi syndrome, Frozen Calot’s triangle, gangrenous gallbladder, and perforated gallbladder. Statistical analysis was done utilizing statistical package for the social sciences (SPSS) version 21.0, with a significance level of p<0.05 deemed significant.

Results: Current results show that the mean age was 58 years (18-89 years) with male predominance (68%). Three major categories of difficulty were identified which include: difficult dissection of the Calot's triangle in 42% of cases, difficulty in grasping and retracting the gallbladder (GB) in 45% of cases, and abnormal anatomy in 13% of cases. In 97% of patients, cholecystectomy was performed within the first 48 hours of admission. Among the total number of patients, 42% had phlegmonous, 12% had gangrenous cholecystitis and 5% had a subhepatic abscess. Total cholecystectomy was carried out in all patients without any damage control measures or conversion to open surgery and mortality was found to be 0%. Over a follow-up of 8 months, patients were performing well with no complications.

Conclusions: Difficult laparoscopic cholecystectomy can be completed without conversion to open surgery or switch to salvage procedures. The utmost importance is to achieve a critical view of safety (CVS).

Observational study to predict gut gangrene from raised serum C reactive protein levels in intestinal obstruction cases

2025-04-26T08:25:44+0530

Background: Intestinal obstruction can progress to bowel gangrene, increasing morbidity and mortality. Early diagnosis and decision taking for intervention remains challenging. This study evaluated serum C-reactive protein (CRP) as a predictive marker for gangrene in intestinal obstruction.

Methods: A prospective observational study was conducted on 110 patients with surgically managed intestinal obstruction at SMS Hospital, Jaipur. Serum CRP levels at admission were recorded and correlated with intraoperative findings. Statistical analysis included ROC curve for determining predictive value.

Results: Bowel gangrene was found in 30% of cases. Mean CRP levels were significantly higher in gangrene cases (121 mg/l) vs. non-gangrene (12 mg/l) (p<0.001). A CRP cut-off of 43.05 mg/l showed 93.9% sensitivity and 96.1% specificity. Delays >48 hours from symptom onset to surgery significantly increased gangrene risk (p=0.008).

Conclusions: Serum CRP is a valuable, accessible biomarker for early detection of gut gangrene in intestinal obstruction, aiding timely surgical intervention. Further studies with serial CRP measurements are recommended.

Development of a predictive scoring system for identifying difficult laparoscopic cholecystectomy cases based on preoperative factors

2025-04-26T08:25:37+0530

Background: Laparoscopic cholecystectomy (LC) is the preferred treatment for gallstone disease. However, difficult cases often require conversion to open surgery and are associated with higher complications. A standardized scoring system can aid in predicting difficult LC cases, enabling better preoperative planning and patient counseling. This study aims to develop and validate a scoring system based on key preoperative factors to predict difficult LC cases.

Methods: This prospective study was conducted at a tertiary healthcare center in India, analyzing 80 patients who underwent LC. Based on previously identified risk factors-including patient-related, biochemical, imaging, and intraoperative variables-a scoring system was developed. Each factor was assigned a weighted score based on its impact on surgical difficulty. The scoring model was validated by assessing correlation with surgical outcomes.

Results: Patients were stratified into three risk categories: low (<5 points), moderate (5-9 points), and high (≥10 points). Among patients with high scores, 80% required conversion to open surgery, 60% developed postoperative complications, and their hospital stay was significantly prolonged (p<0.05). In contrast, low-score patients had no conversions and minimal complications. The scoring system demonstrated strong predictive capability (AUC=0.87, p<0.001).

Conclusions: This predictive scoring system effectively identifies difficult LC cases. Its application can optimize surgical planning, minimize adverse outcomes, and improve patient selection for early open surgery.

Optimizing outcomes in ulnar nerve injuries: nerve grafting after primary neurorrhaphy

2025-04-26T08:27:41+0530

This case series rigorously assesses the efficacy of primary neurorrhaphy followed by secondary nerve grafting in five patients with ulnar nerve injuries, utilizing the quick disabilities of the arm, shoulder, and hand (QuickDASH) score as a standardized measure of functional outcomes. Treated between 2019 and 2023, these patients underwent initial neurorrhaphy followed by nerve transfer. Functional assessments were conducted preoperatively, post-neurorrhaphy, and post-nerve transfer using the QuickDASH questionnaire. The mean preoperative QuickDASH score was 43.00 (standard deviation [SD]=7.34), improving to 36.20 (SD=6.54) after neurorrhaphy (mean difference=-6.8, p<0.01), and further to 24.20 (SD=2.59) after nerve transfer (mean difference=-12, p<0.01). Paired t-tests substantiated statistically significant enhancements in functional activity at each intervention stage (p<0.01). These results indicate that integrating primary neurorrhaphy with secondary nerve transfer effectively restores nerve function in acute ulnar nerve lacerations. This study underscores the potential of these combined surgical strategies to optimize outcomes in complex peripheral nerve injuries, though larger-scale investigations are warranted to confirm these findings.

Colonic complications in acute pancreatitis: management experience from a single institution

2025-04-26T08:25:53+0530

Colonic complications secondary to acute pancreatitis (AP) are rare. Management of these pathologies is inconsistent and non-standardized because of their rarity. A retrospective review was performed for patients admitted to our health network with colonic complications secondary to AP from 1st January 2009 to 31st December 2023. 13 patients were admitted at Monash Health between January 2009 and December 2023 for a colonic complication secondary to AP. One had a bowel obstruction secondary to retroperitoneal compression, four had pancreatic-colonic fistulas, three had colonic infarction, two presented with colonic perforation while three presented with obstructive colonic strictures. The most common aetiology was gallstone pancreatitis (n=4). Initial management for colonic fistulas and strictures were commonly with a diverting loop ileostomy, while perforations/necrosis required emergent colectomies with or without diverting stomas. Colonic fistulas in AP can be managed safely with a diverting loop ileostomy to delay or avoid the need for a major resection during the acute phase. However, emergency colonic resection should be performed in the case of colonic perforation or necrosis and is associated with worse outcomes.