International Surgery Journal

Frey procedure in pediatric chronic calcific pancreatitis: a single-centre case series

Waliullah Siddiqui — 2026-10-27

Chronic pancreatitis in children is an uncommon but debilitating disorder characterized by recurrent abdominal pain, pancreatic ductal abnormalities, calcification, and progressive loss of pancreatic function. Although medical and endoscopic therapies are useful in selected patients, persistent pain, recurrent pancreatitis, ductal obstruction, pancreatic calculi, and impaired quality of life may necessitate surgical intervention. The Frey procedure, combining pancreatic head coring with longitudinal pancreaticojejunostomy, provides pancreatic ductal decompression while preserving pancreatic tissue and function. Published pediatric experience remains limited. The aim of the study is to describe the clinical presentation, indications, operative findings, technical challenges, postoperative complications, and follow-up outcomes of children with chronic pancreatitis managed with the Frey procedure. A single-centre retrospective case series of six pediatric patients with chronic pancreatitis who underwent surgical management with the Frey procedure. Clinical records were reviewed for age, etiology, previous endoscopic interventions, imaging findings, indications for surgery, operative findings, postoperative complications, pain, quality of life, and follow-up outcomes. Particular attention was given to pancreatic duct morphology and technical challenges encountered during surgery. The patients ranged from 6 years 4 months to 13 years of age. Etiologies included idiopathic disease and pancreas divisum. Several patients had chronic calcific pancreatitis with pancreatic ductal calculi and ductal dilatation. Recurrent pancreatic-type abdominal pain was the principal indication for surgery, and some patients had previously undergone ERCP and pancreatic duct stenting. Imaging demonstrated pancreatic atrophy, calcification, ductal dilatation, pancreatic calculi, and pseudocyst formation in individual cases. One child had a non-dilated pancreatic duct measuring less than 2 mm with splenic vein thrombosis and left-sided portal hypertension, creating a major technical challenge. Postoperative complications included pancreatic fistula in one patient and transient blood-stained drain output in another. One patient developed a lower common bile duct stricture with jaundice three years after surgery, which was managed with PTBD following failed ERCP. At six years of follow-up, this patient remained asymptomatic. Follow-up in the other patients demonstrated improvement in pain and quality of life. The Frey procedure appears to be a feasible organ-preserving surgical option for carefully selected children with chronic pancreatitis and debilitating pain, particularly those with calcific disease, ductal obstruction, pancreatic calculi, or failure of endoscopic management. The series also highlights the technical challenges encountered in young children with an atrophic or minimally dilated pancreatic duct and associated portal hypertension. Larger multicentre studies with standardized assessment of pain, pancreatic function, quality of life, and long-term outcomes are required.

Penetrating neck injuries: experience at a zonal hospital: a case series

Pallavi Gupta — 2026-10-27

Penetrating neck injuries (PNI) are potentially life-threatening due to the high density of vital structures within a small anatomical area. Prompt evaluation and management are crucial for favorable outcomes. Objectives were to describe three cases of PNI with varied mechanisms, clinical presentations, management strategies and outcomes. Three patients presenting with PNI over a 6-month period were reviewed retrospectively. The study conducted at Department of ENT and Head and neck Surgery. All patients with PNI requiring surgical or conservative management are included, Blunt neck trauma is excluded. All patients survived. Early airway control, vascular assessment and appropriate surgical exploration were key determinants of outcome. A structured protocol based on principles of ATLS, hemodynamic stability and anatomical zone involvement ensures optimal management of PNI.

Clinical practice of obstetric anesthesia: neuraxial techniques, general anesthesia and maternal safety

Adela A. Córdova Fernandez — 2026-10-16

Obstetric anesthesia is a specialized field that integrates labor analgesia, anesthesia for cesarean delivery, and emergency peripartum care. Contemporary practice favors neuraxial techniques because they provide effective analgesia, avoid airway manipulation, and are associated with lower maternal morbidity and mortality compared with general anesthesia in many obstetric settings. Epidural analgesia remains the standard method for labor pain relief and can be titrated continuously while preserving maternal participation and minimizing dense motor block. Spinal anesthesia is commonly used for elective cesarean delivery because of its rapid onset, reliability, and dense surgical block, whereas combined spinal-epidural techniques provide both rapid onset and catheter-based flexibility. General anesthesia remains essential for selected emergencies, particularly Category 1 cesarean delivery when fetal or maternal compromise prevents timely regional anesthesia, but it carries higher risks of failed intubation, aspiration, awareness, and neonatal drug exposure. Safe obstetric anesthesia requires individualized technique selection, anticipation of maternal comorbidities, preparation for hemorrhage and failed airway, appropriate vasopressor use, and multidisciplinary crisis response. This review summarizes the clinical practice of obstetric anesthesia, emphasizing the rationale for neuraxial preference, the persistent role of general anesthesia, and practical considerations for maternal and neonatal safety.

Lymph node biopsy in resource-limited breast cancer systems: a scoping review of non-nuclear mapping, implementation and outcomes

Hridhay Somera — 2026-10-27

This study aimed to map non-nuclear sentinel lymph node biopsy techniques for breast cancer in resource-limited systems and synthesise implementation requirements and outcomes. Scoping review following Joanna Briggs Institute guidance and PRISMA-ScR. Setting: Services meeting a service-level definition of resource limitation; low- or middle-income country location alone was insufficient. Information sources: PubMed, Europe PMC and backward citation searching. Subjects: Clinical studies, implementation reports, surveys, reviews and guidelines on axillary staging. Outcome measures: Identification, false-negative performance, morbidity, axillary dissection avoided, cost, barriers and training. The merged database exports contained 2,301 records; 1,252 unique records were screened and 36 evidence sources included. Methylene blue (MB) programmes reported 85.7%–100% identification, with a 13% false-negative rate in one meta-analysis. Fluorescein plus MB achieved 82%–100% identification with false-negative rates of 6.3%–8.7%. Indocyanine green series achieved 95.7%–100% identification but required near-infrared equipment. Gentian violet achieved 97.5% identification in a small cohort. Ethiopian programmes achieved 100% identification; one avoided axillary dissection in 80%. North African data showed less lymphoedema after sentinel biopsy than dissection (3.8% versus 23.0%). Constraints were nuclear medicine, pathology, supply, training and follow-up. Non-nuclear sentinel node biopsy appears feasible in resource-limited services when introduced as a governed pathway rather than dye substitution. MB was the lowest-cost/lowest-infrastructure option identified; fluorescein plus MB adds redundancy, while indocyanine green suits services able to support reusable imaging. Evidence is insufficient to establish oncological equivalence. Prospective implementation studies with audited recurrence, morbidity and cost are required.

Beyond glycemic control: ocular effects of GLP-1 receptor agonists across medical and surgical ophthalmology

Alexa Crystal González Herrera — 2026-10-27

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have become a cornerstone in the management of type 2 diabetes mellitus and obesity because of their proven metabolic and cardiovascular benefits. As their clinical use continues to expand, increasing attention has been directed toward their potential ophthalmic effects. This narrative review summarizes the current evidence regarding the biological mechanisms, therapeutic potential, and ocular safety profile of GLP-1RAs across medical and surgical ophthalmology. Experimental studies demonstrate that GLP-1 receptors are expressed in multiple ocular tissues and that receptor activation exerts anti-inflammatory, antioxidant, vasculoprotective, and neuroprotective effects through modulation of oxidative stress, mitochondrial homeostasis, and retinal cell survival. Clinically, evidence from cardiovascular outcome trials initially raised concern regarding diabetic retinopathy progression, particularly following the SUSTAIN-6 trial. However, subsequent randomized trials, observational studies, and recent systematic reviews have not demonstrated a consistent class-wide increase in diabetic retinopathy risk. Current evidence suggests that the reported retinal complications are more likely associated with advanced baseline retinal disease and rapid glycemic improvement than with direct retinal toxicity. Emerging data also indicate potential applications in glaucoma, retinal neuroprotection, age-related macular degeneration, and ocular surface disease, although these findings remain largely supported by preclinical or observational evidence. A possible association between semaglutide and nonarteritic anterior ischemic optic neuropathy has recently been reported, but available evidence is insufficient to establish causality. Overall, GLP-1RAs appear to maintain a favorable ocular safety profile while offering promising therapeutic opportunities beyond metabolic disease. Future prospective ophthalmology-specific studies are needed to clarify their long-term ocular effects, identify patients at increased risk of retinal complications, and determine whether their experimental neuroprotective properties translate into clinically meaningful benefits.

Focal therapy for prostate cancer: current evidence and controversies

Erick Alexander Jara Leon — 2026-10-27

Focal therapy is an organ-preserving strategy for selected patients with localized prostate cancer, aiming to eradicate clinically significant disease while preserving uninvolved prostate tissue. Advances in multiparametric magnetic resonance imaging, targeted biopsy, and ablative technologies have improved patient selection and treatment planning. Contemporary studies report encouraging short- and intermediate-term oncological control with relatively low rates of major urinary and sexual morbidity. However, the available evidence remains limited by heterogeneity in patient selection, ablative technologies, definitions of treatment failure, and follow-up protocols. The lack of mature comparative trials against radical prostatectomy or radiotherapy remains a major limitation to its adoption as standard treatment. Focal therapy is a promising option for carefully selected patients, particularly those with localized favorable intermediate-risk disease. Nevertheless, current evidence does not establish long-term oncological equivalence with radical treatments. Standardization of patient selection, treatment delivery, and surveillance, together with adequately powered comparative studies and long-term follow-up, is required to define its definitive role in prostate cancer management.

Abul Qasim al-Zahrawi and his surgical work: a comprehensive review with unani instruments and clinical evidence

Mohd Danish Mohd Nasim Ansari — 2026-10-27

Abul Qasim al-Zahrawi (936–1013 CE), widely known as Albucasis, is regarded as the founder of operative surgery and a central authority in Ilm ul-Jarahat within Unani medicine. His encyclopedic treatise Kitab al-Tasrif li-man ‘ajiza ‘an al-ta’lif, particularly its surgical section, represents one of the earliest systematic and illustrated accounts of surgical techniques, instrumentation, and wound management. The Indian Urdu translations of this work have preserved its authenticity and ensured its continued relevance. This review article synthesizes classical knowledge from Kitab al-Tasrif with Indian Unani literature, incorporating authentic clinical statements, standardized Unani terminology, and detailed descriptions of surgical instruments (Aalat-e-Jarahat) and their applications. Al-Zahrawi’s contributions encompass cauterization, suturing, wound management, lithotomy, orthopedic procedures, obstetric interventions, and the design and application of specialized surgical instruments. His systematic approach to operative procedures and emphasis on anatomical knowledge, precision, appropriate instrumentation, and postoperative care demonstrate the sophistication of medieval Islamic surgical practice. His work continues to represent an important historical foundation for the development of surgery and remains relevant to the teaching and preservation of Unani surgical knowledge.

Surgical training in the era of artificial intelligence and large language models: a narrative review from the perspective of a surgical resident

Ashwin Vinod — 2026-10-27

Artificial intelligence (AI) and large language models (LLMs) have entered surgical residency faster than the curricula, assessment systems and governance frameworks designed to accommodate them, yet most published appraisals adopt the standpoint of educators rather than that of the trainee, who is simultaneously the principal user and the principal subject of these tools. This narrative review, informed by the SANRA criteria, searched five databases from January 2015 to June 2026 and synthesises the evidence from the resident's perspective. Genuine educational value is supported in four domains: on-demand knowledge synthesis and examination preparation, intelligent tutoring and automated feedback in simulation, objective video- and kinematics-based skill assessment, and relief from administrative burden. Randomised trials show that AI tutoring improves machine-derived performance metrics but that gains are often not reproduced on blinded human ratings, and that AI combined with expert instruction outperforms AI alone. Against this stand substantial risks: hallucination and guideline drift, with accuracy falling sharply on current, guideline-specific content; the first real-world signal of clinical deskilling following routine AI exposure in a procedural specialty; cognitive offloading, with attendant mis-skilling and never-skilling during formative training; threats to assessment construct validity and to the apprenticeship relationship; breaches of confidentiality; algorithmic bias; and a widening divide between well-resourced and resource-constrained programmes. Surveys show substantial trainee uptake alongside negligible formal instruction. The governing principle for the trainee is sequence: independent reasoning and unassisted practice must precede augmentation. Training programmes should teach structured AI literacy, protect AI-free deliberate practice, and adopt verification-centred supervision.

Redefining operability after neoadjuvant therapy in pancreatic ductal adenocarcinoma: a biology-driven surgical framework

Supreet Kumar — 2026-10-27

Neoadjuvant therapy (NAT) has reshaped the management of pancreatic ductal adenocarcinoma (PDAC), improving systemic control and increasing margin-negative resection rates. However, it has also introduced complexity into surgical decision making. Post-treatment imaging, tumor markers, and pathologic findings frequently diverge, creating uncertainty regarding operability. Traditional anatomy-based frameworks are increasingly insufficient in the era of biologically driven therapy. The objective was to synthesize contemporary evidence and propose a practical, multidisciplinary framework for post-neoadjuvant surgical decision making in PDAC, particularly in the setting of discordant radiologic and biologic signals. A focused narrative review of PubMed-indexed literature (2015-2025) was conducted, emphasizing systematic reviews, prospective studies, and contemporary cohort analyses addressing response assessment, vascular resection, tumor regression grading, nodal downstaging, biomarker kinetics, and emerging technologies. Evidence was integrated into a structured tumor board–oriented decision framework. Post-NAT radiologic stability does not reliably indicate treatment failure, as therapy-induced fibrosis may mimic persistent vascular invasion. CA19-9 kinetics, staging laparoscopy, and patient physiologic reserve provide critical complementary information. Venous resection following NAT is oncologically justified in selected patients with favourable biology, whereas arterial resection requires stricter selection. Standardized pathology reporting, including tumor regression grading and nodal assessment, refines prognostication. Emerging tools such as circulating tumor DNA and radiomics show promise but require prospective validation. Post-neoadjuvant operability in PDAC demands integration of anatomy, biology, and patient resilience rather than reliance on a single modality. A structured, multidisciplinary framework enables biologically informed restraint or resection, ensuring that surgery is not merely technically feasible but oncologically justified.

Giant gallbladder mucocele with interparietal abdominal wall extension: a case report

Gabrielle L Matthews — 2026-10-27

Gallbladder mucocele (hydrops) is an uncommon consequence of prolonged cystic duct obstruction, usually caused by an impacted gallstone at the gallbladder neck or cystic duct. Giant gallbladder mucoceles are rare, and extension into the abdominal wall with interparietal displacement has seldom been described. This case is reported in accordance with the CARE (CAse REport) guidelines. A 73 year old woman presented with a four-week history of a progressively enlarging right upper quadrant mass associated with mild abdominal discomfort. She had no fever, jaundice, or biochemical evidence of biliary obstruction. Contrast-enhanced computed tomography demonstrated a markedly distended gallbladder measuring approximately 15×12×13 cm, with an impacted gallbladder-neck calculus and anterior extension into the abdominal wall between the rectus sheath layers. Open cholecystectomy was performed because of significant anatomical distortion and concern regarding iatrogenic rupture and safe biliary dissection. Intraoperatively, the gallbladder was massively distended, densely adherent to the abdominal wall, and displaced between the anterior and posterior rectus sheaths. Controlled decompression released approximately 800 mL of mucinous fluid, allowing improved operative exposure. Intraoperative cholangiography demonstrated normal biliary anatomy without choledocholithiasis. Histopathological examination confirmed chronic cholecystitis with obstruction-related gallbladder distension, Rokitansky–Aschoff sinus formation, fibrosis, and chronic inflammatory changes, without evidence of dysplasia or malignancy. This case describes an unusual presentation of giant gallbladder mucocele mimicking an abdominal wall mass. Cross-sectional imaging was essential for diagnosis and operative planning, while controlled decompression, intraoperative cholangiography, and open cholecystectomy facilitated safe management in the setting of severe anatomical distortion.

Inadvertent catheter placement into the innominate artery successfully repaired with perclose

Catherine Kilada — 2026-10-27

Inadvertent arterial catheterization during central venous access is an uncommon but potentially catastrophic complication, with reported incidence ranging from 0.1% to 1%, depending on technique and patient factors. Injuries involving non-compressible, large-caliber vessels such as the brachiocephalic (innominate) artery are particularly high risk due to the potential for hemorrhage, stroke, pseudoaneurysm formation, and mediastinal hematoma. Historically, management has favored open surgical repair, especially for supra-aortic trunk injuries; however, this approach carries significant morbidity in elderly and medically complex patients.¹ With advances in endovascular techniques, less invasive strategies including covered stent placement and percutaneous suture-mediated closure devices have emerged as viable alternatives. Recent literature supports the use of suture-mediated closure systems, such as Perclose, in select cases of iatrogenic arterial injury, demonstrating high technical success rates and low complication profiles when appropriate imaging, wire access, and procedural planning are employed.¹These approaches are particularly advantageous in anatomically challenging or surgically hostile fields. We present a case of inadvertent catheterization of the brachiocephalic artery during tunnelled infusion port placement, successfully managed with percutaneous suture-mediated closure. This case highlights the growing role of minimally invasive techniques in the management of central arterial injuries and underscores the importance of early recognition, detailed imaging evaluation, and multidisciplinary coordination. A review of the literature highlights growing evidence supporting endovascular approaches for inadvertent supra-aortic arterial cannulation. Reported success rates of suture-mediated closure devices range from 90–100% in select patients, with reduced morbidity compared to open repair.^1-7 This case demonstrates the feasibility, safety, and efficacy of percutaneous closure for innominate artery injury, reinforcing a paradigm shift toward minimally invasive management.

Rare cause of pneumoperitoneum: perforated appendicitis mimicking upper gastrointestinal perforation

Chua Ian Bin — 2026-10-27

Pneumoperitoneaum is seen in perforated hollow viscus but is a rare presentation in cases of perforated appendicitis. It accounts for 0-7% of patients with pneumoperitoneum. We report on a 24 year old male with epigastric pain for 4 days, demonstrating air under diaphragm on an erect chest X-ray. This case highlights that perforated appendicitis although rarely associated with pneumoperitoneum, must be considered in the differential diagnosis of patients presenting with acute abdomen.

Unrecognized horseshoe kidney precipitating a severe renal pelvis injury during routine laparoscopic cholecystectomy: a case report

Altakhineh M. A. — 2026-10-27

Horseshoe kidney (HSK) is a common congenital fusion anomaly characterized by lower renal positioning, malrotation, and aberrant ventrally displaced collecting systems. Iatrogenic urinary tract trauma during laparoscopic cholecystectomy is exceedingly rare, but distorted retroperitoneal anatomy can predispose patients to inadvertent injury.

A 25-year-old female presented on postoperative day 10 following an uneventful laparoscopic cholecystectomy with worsening lower abdominal pain, gross hematuria with blood clots, and an acute hemoglobin drop from 14.0 g/dl to 8.0 g/dl requiring two units of packed red blood cells. Immediate postoperative hematuria had been initially confounded with ongoing menses. Multiphase computed tomography (CT) urography and intraoperative fluoroscopy revealed an unsuspected horseshoe kidney with a grade IV renal injury and active urinary extravasation originating from the right moiety. The patient was managed conservatively with retrograde double-J ureteral stenting, bed rest, and close clinical observation. Hemostasis and resolution of the extravasation were achieved without requiring open or minimally invasive surgical re-exploration. The stent was subsequently removed with complete clinical recovery. Postoperative gross hematuria following routine laparoscopic procedures demands prompt evaluation to exclude retroperitoneal injury. Even high-grade urinary extravasation secondary to congenital fusion anomalies can be managed successfully with timely endoscopic retrograde stenting and conservative monitoring.

Foreign body induced acute perforated appendicitis: an unusual case presentation from a tertiary care centre

Amir Mohamed — 2026-10-27

Foreign body-induced appendicitis is an uncommon cause of acute appendicitis and may rarely result in perforation and localized peritonitis. Diagnosis can be challenging when there is no definite history of foreign body ingestion. We present a case of acute perforated appendicitis secondary to an impacted appendiceal foreign body in an adult patient. Clinical evaluation, laboratory investigations, contrast-enhanced computed tomography (CT), operative findings, and postoperative outcome were assessed. A 45-year-old male presented with a 2-day history of abdominal pain that localized to the right iliac fossa, associated with low-grade fever, nausea, vomiting, and anorexia. Examination revealed right iliac fossa tenderness, guarding, and rebound tenderness, with positive McBurney's and Rovsing's signs. Leukocytosis with neutrophilic predominance was present, and the Alvarado score was 8/10. CT demonstrated an inflamed appendix containing a hyperdense linear foreign body with focal appendiceal wall disruption, suggestive of perforation. Emergency appendectomy revealed a perforated appendix with localized peritonitis and an impacted foreign body within the appendiceal lumen. The foreign body and appendix were removed, and postoperative recovery was uneventful. Foreign body-induced perforated appendicitis is a rare but important cause of complicated appendicitis. CT is valuable for identifying an intraluminal foreign body and associated complications. Early surgical intervention with appendectomy and foreign body removal is effective when perforation or localized peritonitis is present.

Diagnosis of accessory liver lobe torsion on diagnostic laparoscopy: an important differential in the absence of imaging findings

Andy Liang — 2026-10-27

Accessory liver lobe (ALL) torsion is a rare differential for the acute abdomen that is usually first considered with positive imaging findings. We present a case of accessory liver torsion as a cause for an acute abdomen without findings on ultrasound. A 9-year-old female presented with 3 days of right sided abdominal pain. Her vitals were within normal limits, and the patient demonstrated voluntary guarding over the right lower quadrant and right flank on exam. Bloods showed a C-reactive protein of 25.6, however other bloods including a full blood count, kidney and liver function tests were unremarkable. An abdominal ultrasound was performed which showed reactive right iliac fossa lymph nodes and probe tenderness. The patient’s pain escalated and became generalised prompting a diagnostic laparoscopy which revealed a pedunculated dark red 5×6×1 cm mass on the posterior surface of the liver. This was resected via diathermy. Histology showed haemorrhagic necrosis with associated granulation tissue consistent with infarction. Post operatively, the patient developed a port site wound infection that was drained and treated with oral antibiotics. The patient is pain-free 2 months post operatively. It is important to consider torsion of the ALL as a differential diagnosis for the acute abdomen, even in the absence of definitive imaging findings.

A transtibial amputation following femoral artery injury: application of military trauma protocols in civilian care – a case report

Ahmed Ali Shabhay — 2026-10-27

Surgical management of vascular injuries remains a daunting challenge to practicing clinicians. Timely and appropriate management is critical. We present a case of a 20 -year-old man who sustained a penetrating vascular injury that led to a transtibial amputation of his left lower limb due to distal vascular occlusion. Inappropriate and untimely management of vascular injuries can lead to limb and life loss. Military protocols adopted during battlefield care have contributed to the development of new guidelines in civilian settings. Due to increasing violence, crime rates, and contemporary threats such as improvised explosive devices associated with terrorist attacks in urban settings, civilian medical personnel have started to encounter high-energy blast injuries in urban medical centers that mimic war injuries. Timely and appropriate management is critical in preventing limb and life loss. It is the author’s opinion that vascular injuries should be managed by trained vascular specialists.

A durable limb salvage and functional recovery after prolonged prostaglandin E1 therapy following femoro-popliteal bypass graft thrombosis: a one-year follow-up case report

Shoaeb Imtiaz Alam — 2026-10-27

Infrainguinal bypass graft thrombosis can cause recurrent limb ischemia, tissue loss, and major amputation. A 65-year-old man with diabetes, hypertension, and previous cigarette smoking developed complete thrombosis of a Dacron femoropopliteal bypass graft six months after surgery. Pharmacogenetic testing identified a CYP2C19 intermediate-metabolizer phenotype associated with reduced clopidogrel responsiveness. Clopidogrel was discontinued, while aspirin and rivaroxaban were continued, and intravenous prostaglandin E1 (PGE1; alprostadil) therapy was initiated. Following three previously reported cycles, he completed six total cycles, each administered over three consecutive days at approximately four-week intervals. At one-year follow-up after treatment completion, he remained free of ischemic pain, ulceration, gangrene, and tissue loss, avoiding major amputation and repeat revascularization. He could walk more than 200 m and had Rutherford category 0 status. Follow-up computed tomography angiography demonstrated collateral vessels from the deep femoral circulation. This case highlights sustained limb preservation following prolonged PGE1 therapy despite graft thrombosis.

Benign multicystic peritoneal mesothelioma as a rare disease in an incidental imaging finding in a middle-aged woman: case report and literature review

Patrícia Bárbara — 2026-10-27

Benign multicystic peritoneal mesothelioma (BMPM) is a rare, benign cystic neoplasm arising from the peritoneum, most frequently diagnosed in premenopausal women. Fewer than 200 cases have been reported worldwide. Risk factors include endometriosis and pelvic inflammatory disease in women, and prior abdominal surgery in both sexes. Due to its rarity and lack of specific clinical presentation, preoperative diagnosis is challenging, with most cases discovered incidentally. Diagnosis is confirmed through surgical sampling and histopathological analysis. Several treatment strategies have been proposed, with cytoreductive surgery being the standard approach. Long-term follow-up is essential due to the high recurrence rate and the rare possibility of malignant transformation.

Superinfected giant renal hydatid cyst with magnetic resonance imaging and intraoperative correlation

Salma Tabati — 2026-10-27

Renal hydatid disease is rare and can mimic a complex renal cyst, abscess, or cystic neoplasm. Preprocedural recognition is essential because inadvertent puncture may cause leakage, dissemination, allergic complications, or infection. A 45-year-old Moroccan man presented with progressive abdominal enlargement and left-sided heaviness. Initial ultrasonography elsewhere showed a giant septated left renal lesion interpreted as a Bosniak II cyst, which subsequently underwent percutaneous puncture. Repeat ultrasonography demonstrated daughter vesicles. Magnetic resonance imaging revealed a 29×28×30 cm left renal cyst with heterogeneous T1- and T2-weighted signal, daughter vesicles, detached membranes, a peripheral low-T2 rim, mild wall enhancement, small gas foci, and heterogeneous diffusion restriction. Surgery demonstrated daughter vesicles and hydatid membranes with purulent material. Histopathology confirmed cystic echinococcosis. Daughter vesicles, detached membranes, and a low-T2 pericyst identify the hydatid origin of a complex renal cyst even when gas, wall enhancement, and restricted diffusion indicate superinfection. Hydatid disease should be considered before puncture or drainage of an atypical renal cyst in endemic regions.

Recurrent basal cell carcinoma of the nasal tip: from dermatological assessment to resection and reconstruction with a local flap

Diana E. Gutiérrez Gómez — 2026-10-14

Basal cell carcinoma (BCC) is the most common cutaneous malignancy, and the nasal tip is among the highest-risk sites for recurrence because of its complex three-dimensional anatomy and limited local tissue laxity. Tumor persistence after resection with positive margins mandates oncologic re-excision and individualized reconstructive planning. A 62-year-old woman with Fitzpatrick skin type II and a history of nasal-tip BCC excision with positive surgical margins presented with a 2.5 cm pearly, slow-growing neoformation arising over the previous scar, with a dermoscopic pattern consistent with recurrence. She was referred to plastic and reconstructive surgery, where a paramedian forehead flap was initially planned. Intraoperatively, after resection of a 2.8 × 2.2 cm defect, the surgical team opted instead for a local Rieger-type (rotation-advancement) flap with extension, achieving a tension-free, single-stage closure without the need for a regional flap. Definitive histopathology reported an infiltrative BCC with tumor-free margins. This case highlights the importance of coordinated care between dermatology and plastic surgery in managing recurrent nasal-tip BCC, and the value of intraoperative reassessment of the reconstructive plan according to the reconstructive-ladder principle, favoring the least complex technique capable of achieving a functional and aesthetically satisfactory result.

The treatment challenges of an exceedingly rare diagnosis of rectal small cell neuroendocrine carcinoma: a case report

Lithira R. Walisinghe — 2026-10-27

Small cell neuroendocrine carcinoma (SCNEC) of the rectum is a rare, aggressive malignancy with limited evidence guiding management. We report a case of T4N1b rectal SCNEC in a female presenting with severe proctalgia. Imaging and endoscopy identified a near-obstructing rectal mass, with histology confirming SCNEC. Staging demonstrated locoregional disease without distant metastases. Initial management with platinum-based chemotherapy, etoposide, and radiotherapy achieved partial response; however, persistent disease abutting the posterior vaginal wall necessitated abdominoperineal resection (APR) with partial vaginectomy. Histology revealed poor treatment response and close margins, indicating high recurrence risk. She underwent close surveillance, ultimately progressing to metastatic disease 8 months later, and underwent further adjuvant chemotherapy and immunotherapy. She was eventually palliated with continued deterioration secondary to febrile neutropaenia and myelodysplastic syndrome, ultimately passing away a further 2 months later. This case highlights the aggressive nature of rectal SCNEC, uncertainty surrounding optimal management, and the need for flexible, multidisciplinary approaches. Further research is required to establish evidence-based disease specific treatment algorithms for a diagnosis that is void of such definitive guidelines and treatment strategies which are largely extrapolated.

Rapunzel syndrome (Trichobezoar) revisited from Gadchiroli: a case report and review of literature

Prasad Y. Bansod — 2026-10-05

Trichobezoar, a concretion of swallowed hair within the gastrointestinal tract, is a rare condition that predominantly affects young females with trichotillomania and trichophagia; extension of the mass beyond the pylorus into the small intestine is termed Rapunzel syndrome. We present a 28-year-old married woman from Gadchiroli district, Maharashtra, with a one-year history of progressive epigastric heaviness and one month of worsening burning abdominal pain, early satiety and significant weight loss. She firmly denied hair-eating behavior, although her husband reported prolonged unusual irritability. Examination revealed a smooth, firm, well-defined 10×8 cm epigastric mass. Upper gastrointestinal endoscopy showed a large mass of matted hair occupying the stomach, and contrast-enhanced computed tomography (CECT) of the abdomen demonstrated a laminated, mixed-density intraluminal lesion without pyloric extension. She underwent elective open anterior gastrotomy with en-bloc removal of the trichobezoar, and examination of the entire small bowel excluded distal fragments. Recovery was uneventful. On psychiatric evaluation before discharge, she admitted to pulling and eating her own hair for about three years, and trichotillomania with trichophagia was diagnosed. Habit reversal therapy, cognitive-behavioral therapy and sertraline were initiated; at nine months her weight was well maintained, although adherence to psychiatric care was poor. Trichobezoar should be considered in any young woman presenting with an epigastric mass, irrespective of whether she admits to hair-eating. Endoscopy and CECT establish the diagnosis, and open anterior gastrotomy remains a safe, reproducible treatment for large lesions in resource-limited settings. Postoperative psychiatric care is the cornerstone of relapse prevention.

Stone-induced spontaneous pancreatico-gastric fistula in chronic calcific pancreatitis presenting with upper gastrointestinal bleeding: a rare case report

Dinesh K. Bhuria — 2026-10-27

Pancreatico-gastric fistula is a rare sequela of chronic calcific pancreatitis and only infrequently presents with upper gastrointestinal bleeding, often posing a diagnostic challenge. We describe a 63-year-old male with alcohol-related chronic calcific pancreatitis who presented with hematemesis and melena. Cross-sectional imaging demonstrated a subepithelial gastric lesion closely resembling a gastrointestinal stromal tumor, along with obliteration of the fat planes between the stomach and pancreas. A large calcified calculus was identified within the main pancreatic duct, lying in close proximity to the posterior gastric wall. Endoscopic ultrasound findings further favored a neoplastic etiology. However, surgical exploration revealed a spontaneous pancreatico-gastric fistula resulting from direct erosion of the impacted ductal stone into the stomach. The patient underwent wide local excision of the involved gastric segment along with a Frey’s procedure. Postoperatively, he had a biochemical leak, formerly classified as grade A postoperative pancreatic fistula, and had an uneventful recovery. This case illustrates an unusual pathogenic mechanism of fistula formation, where pressure-induced erosion by a pancreatic duct calculus mimicked a gastric neoplasm and presented with upper gastrointestinal bleeding.

Male breast cancer masquerading as a chronic chest wall ulcer

Pooja P. Patel — 2026-10-27

Male breast cancer is rare and may present with atypical local findings, resulting in delayed or incorrect initial diagnostic consideration. A large ulcerative lesion involving the male chest wall may mimic a primary cutaneous malignancy or chronic inflammatory/infective ulcer. A 49-year-old man presented with a large ulceroproliferative lesion involving the left anterior chest wall and nipple–areolar region. The lesion measured approximately 23×75×62 mm³ on imaging and was associated with left axillary lymphadenopathy. Ultrasonography demonstrated a heterogeneous hypoechoic vascular mass, while contrast-enhanced CT showed an ulcerated soft-tissue lesion involving the skin and abutting/involving the underlying pectoral musculature. Core biopsy showed poorly differentiated carcinoma. Immunohistochemistry demonstrated CK7 positivity, strong GATA3 positivity, diffuse strong estrogen receptor and progesterone receptor expression (Allred score 8/8 for both), and HER2 negativity, supporting mammary origin. The patient underwent wide local excision with left axillary lymph node dissection and reconstruction with a latissimus dorsi myocutaneous flap. Final pathology showed a 10×7×2 cm³ infiltrative invasive breast carcinoma involving skin and skeletal muscle, with lymphovascular and perineural invasion, clear margins, and metastases in 3 of 10 axillary lymph nodes with extranodal extension. Male breast carcinoma should be considered in the differential diagnosis of persistent or fungating ulcers involving the nipple–areolar or anterior chest wall region. Correlation of clinical findings, imaging, histopathology and immunohistochemistry is essential for establishing the primary site and guiding treatment.

An unusual presentation of acute gallbladder perforation: a case report from a tertiary care-centre in Visakhapatnam, India

Amir Mohamed — 2026-10-27

Gallbladder perforation is an uncommon but potentially life-threatening complication of acute cholecystitis. Clinical presentation may be atypical, particularly in elderly patients, making early diagnosis challenging. We report an unusual case of free perforation of a gangrenous gallbladder with a relatively stable clinical presentation. A case of an 85 year old female presenting with acute abdominal pain was evaluated clinically and radiologically. Laboratory investigations and contrast-enhanced computed tomography (CT) were performed, followed by operative assessment and postoperative follow-up. An 85-year-old woman presented with three days of progressively worsening generalized abdominal pain associated with diarrhea and chills. Examination revealed epigastric and right hypochondrial tenderness with a positive Murphy's sign. CT demonstrated an irregularly enhancing gallbladder with multiple wall defects, extensive inflammatory changes, and free intraperitoneal fluid, suggestive of perforated gangrenous cholecystitis. Laparoscopy revealed approximately 1 litre of free bile and a gangrenous gallbladder with perforation involving the fundus and body. Laparoscopic cholecystectomy, peritoneal lavage, and drain placement were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Histopathology revealed acute on chronic cholecystitis. Free gallbladder perforation may present atypically despite severe underlying pathology. CT is valuable for diagnosis, and laparoscopic cholecystectomy with adequate peritoneal lavage can provide effective treatment in appropriately selected patients.

A tissue-saving strategy for removing giant breast fibroadenoma using the modified Swiss roll method: theoretical foundations – a case report

Pooja Bajaj — 2026-10-27

It may be difficult to remove giant fibroadenomas (5 cm or more) using conventional techniques. Large lesions can distort breast shape, and in young women the cosmetic effect of the incision and the preservation of breast contour are important considerations. The Modified Swiss-roll procedure allows removal of a large, mobile, encapsulated tumour through a relatively small circumareolar incision while minimizing manipulation of the surrounding breast tissue. This case describes a 19 year old woman with a rapidly enlarging right breast mass diagnosed as a giant fibroadenoma. The tumour was carefully mobilized and delivered through a small circumareolar incision using a modified Swiss-roll manoeuvre, with initial fixation using 2-0 Vicryl sutures and minimal tissue handling.

Successful treatment of recurrent anal fistula in a patient with hepatitis B using Kshar Sutra: a case report

Prasad Bapat — 2026-10-27

The ideal treatment for fistula‑in‑ano remains elusive, despite several treatments being described. The treatment of fistula‑in‑ano is a tightrope walk between preserving continence and preventing recurrence. A 49-year-old male patient was suffering from fistula‑in‑ano for 9 years. The patient was positive for HBsAg (Australia antigen). Kshara Sutra thread was used for the treatment. No internal medication was given for wound healing or infection control. There were no complications such as infection, severe pain, severe bleeding, and incontinence after the procedure. The patient was completely cured and is disease-free for 33 months. Kshara Sutra is an effective treatment with no complications and complete healing.

Transvaginal ultra-low anterior resection for low rectal gastrointestinal stromal tumor after neoadjuvant imatinib: a case report

Gokul Vasu — 2026-10-27

Rectal gastrointestinal stromal tumors (GISTs) are uncommon and their low pelvic location makes complete resection with preservation of the anal sphincter technically challenging. Neoadjuvant imatinib may facilitate organ-preserving surgery. We report a transvaginal ultra-low anterior resection for a low anterior rectal GIST in a woman. A 45-year-old woman presented with bleeding per rectum. Digital rectal examination revealed an anterior rectal wall lesion with distal lesion extending to approximately 4 cm from the anal verge. Colonoscopy showed an ulcerated submucosal growth at the anorectal junction. Biopsy demonstrated a GIST positive for CD117 and DOG1, with a reported mitotic index of 3/50 high-power fields. After 6 months of imatinib 400 mg daily, imaging demonstrated approximately 50% reduction in tumor dimensions. Pre-operative MRI showed a well-defined exophytic T2 hyperintense lesion 5×4×3 cm in anterior wall of mid and lower rectum projecting into recto-vaginal space. Lowermost point of contact is 2,5 cm from anal verge, displacing the cervix and vagina anteriorly with preserved fat planes. Anal canal and sphincter complex appear uninvolved. Pelvic side walls appear free. At operation, a 5×4×3 cm circumscribed submucosal distal rectal tumor was identified, with a partly exophytic component impinging on the vagina. Following abdominal mobilization and proximal rectal transection, the posterior vaginal wall was incised and the distal rectum was transected with a reported 1-cm distal margin. The specimen was retrieved transvaginally and a coloanal anastomosis was constructed using interrupted 2-0 Vicryl sutures. The vaginal mucosa was closed with 2-0 Vicryl and a diverting ileostomy was created. Final histopathology showed spindle-cell GIST, mitotic index of 3/50 high-power fields with free proximal and distal margins and reported pT3N0 stage. The patient continued postoperative imatinib. A rectovaginal fistula developed at 6 months, was surgically repaired and healed. Ileostomy closure was performed 2 months later. At 14 months of follow-up, she remained well with unremarkable bowel and bladder function. In carefully selected women with a low anterior rectal GIST, a transvaginal route can provide direct access to the distal rectum and may facilitate sphincter-preserving resection. Further experience and longer follow-up are required to establish its oncological and functional outcomes.

Jeep driver’s disease of the penis: ultrasound-guided management of a penile pilonidal sinus: a case report and review of the literature

Sonya Amin — 2026-10-27

Pilonidal sinus is a chronic inflammatory condition resulting from the subcutaneous trapping of hair, most commonly in the sacrococcygeal region. Penile involvement is exceptionally rare and, because the presentation is non-specific and it is frequently mistaken for a penile abscess or for malignancy. Diagnosis in the published literature has been almost invariably retrospective, following excision and histopathological examination. We report a 25-year-old uncircumcised, morbidly obese man who presented with pain and swelling over the left preputial area of five to seven days duration, resistant to oral antibiotics and analgesics, with pus discharging through a small sinus at the coronal sulcus. Ultrasonography demonstrated a subcutaneous collection containing a linear echogenic focus consistent with a hair shaft. He underwent emergency drainage of pus, division of synechiae, removal of the hair shaft from the sinus tract under intraoperative sonographic control and a dorsal slit of the preputial skin; a confirmatory scan before closure excluded residual collection or retained foreign material. His postoperative course was complicated by a fixed drug reaction, which settled on withdrawal of the offending drugs and a short course of steroids, and prepucioplasty was planned electively in view of recurrent balanoposthitis. A review identified 34 previously reported patients, which has been summarized. The causative hair can be demonstrated on imaging and its clearance was confirmed intraoperatively; thus the diagnosis may be established before histopathology and the extent of surgery required may be reduced.

External fecal fistula secondary to ileal perforation in an incarcerated incisional hernia: a rare case report

Juhi Singhal — 2026-10-27

Incisional hernia is a common complication following abdominal surgery, with an incidence of 10–20% after laparotomy. Although most incisional hernias remain reducible, long-standing hernias may become incarcerated and, rarely, result in bowel perforation with overlying skin necrosis and external fecal fistula formation. We report the case of a 35-year-old woman with a long-standing incisional hernia following a lower segment caesarean section performed six years earlier. She presented with abdominal pain, localized edema, skin necrosis, and fecal discharge from the anterior abdominal wall. Emergency exploratory laparotomy revealed incarcerated ileal loops with a 0.5×0.5 cm perforation located approximately 40 cm proximal to the ileocecal junction and associated fecal contamination. Debridement, diversion loop ileostomy, and source control were performed. Following serial wound debridement, daily papain-urea dressings, clinical resolution of sepsis, and two consecutive sterile wound cultures, a planned second-stage abdominal wall reconstruction with polypropylene mesh was successfully undertaken. The postoperative course was uneventful, and the patient is currently awaiting elective ileostomy closure following nutritional optimization. This case highlights the importance of early recognition, prompt source control, and individualized staged abdominal wall reconstruction in managing this rare and life-threatening complication.

Contained perforation of Meckel’s diverticulum presenting as small bowel obstruction secondary to omental band in an adult: a case report

Shatakshi Dutt — 2026-10-27

Meckel’s diverticulum is usually asymptomatic, but may rarely present with obstruction or perforation. An omental band simultaneously containing a perforated Meckel’s diverticulum and causing small bowel obstruction is exceptionally uncommon. A 28-year-old man presented with obstipation, abdominal distension and vomiting. Imaging suggested small-bowel obstruction without evidence of perforation. Following clinical deterioration, emergency laparotomy revealed an omental band forming a narrow aperture through which an ileal loop was passing. A Meckel’s diverticulum, located 30 cm proximal to the ileocaecal junction, was perforated at its tip, which was embedded within the inflamed omental band, limiting peritoneal contamination. Segmental ileal resection with primary anastomosis and proximal loop ileostomy was performed. Histopathology confirmed perforated Meckel’s diverticulum with transmural inflammation and omentitis. The patient recovered uneventfully and underwent successful ileostomy reversal after three months. An omental band may simultaneously cause mechanical obstruction and contain Meckel’s diverticular perforation. Contained perforation should therefore be considered despite absence of generalized peritonitis.

Appendiceal signet ring cell carcinoma masquerading as acute appendicitis: a case report

M. Praveen Kumar — 2026-10-27

Appendiceal signet ring cell carcinoma (ASRCC) is a rare and aggressive malignancy of the appendix. It often presents with nonspecific symptoms resembling acute appendicitis, making early diagnosis challenging. Prompt recognition and appropriate management are essential to improve outcomes. A 28-year-old gentleman presented with pain in the right lower abdomen for 2 weeks, associated with low-grade fever. Abdominal examination revealed tenderness and guarding in the right lower quadrant. Computed tomography (CT) of the abdomen revealed a retrocaecal appendix with severe acute appendicitis, appendicular tip perforation, and a peri-appendicular collection. The patient underwent laparoscopic drainage of the abscess with appendectomy. Histopathological examination of the specimen revealed signet ring cell carcinoma of the appendix. Further staging evaluation was performed, following which the patient underwent cytoreductive surgery comprising right hemicolectomy and regional lymphadenectomy, along with hyperthermic intraperitoneal chemotherapy (HIPEC). Histopathological examination established the diagnosis of appendiceal signet ring cell carcinoma following an initial presentation as perforated acute appendicitis. The patient subsequently underwent definitive oncological management with cytoreductive surgery and HIPEC. A comprehensive review of the available literature was also undertaken, focusing on the clinical presentation, histopathological characteristics, proposed pathogenesis, treatment strategies, and prognosis of ASRCC. Appendiceal signet ring cell carcinoma is an uncommon but highly aggressive malignancy that may mimic acute appendicitis, particularly in cases presenting with perforation or peri-appendicular abscess. Histopathological examination of appendectomy specimens is crucial for detecting unexpected malignancy. Early diagnosis, appropriate staging, and timely multidisciplinary oncological management, including cytoreductive surgery and HIPEC in selected patients, may improve clinical outcomes.

A typical presentation of ankylosing spondylitis with acute anterior uveitis and cutaneous rash: a case report

Amir Mohamed — 2026-10-27

Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthropathy predominantly affecting the axial skeleton. Extra-articular manifestations such as acute anterior uveitis may precede prominent musculoskeletal symptoms, making early diagnosis challenging. We report an atypical presentation of AS initially dominated by cutaneous and ocular manifestations. A case of a 24-year-old male presenting with cutaneous rash, acute ocular symptoms, and subsequent musculoskeletal manifestations was evaluated through clinical assessment, immunological investigations, and magnetic resonance imaging (MRI). The patient initially presented with generalized rash, eye redness, pain, photophobia, and blurred vision and was diagnosed with anterior uveitis. Seven days later, he developed left foot pain and swelling, low backache, and neck pain. Detailed history revealed intermittent inflammatory back pain for four months and a maternal family history of ankylosing spondylitis. Rheumatoid factor, anti-CCP antibodies, and ANA were negative, while HLA-B27 was positive. MRI demonstrated sacroiliitis, along with subtle marrow edema and minimal joint effusions in the left foot. Based on the clinical, laboratory, family history, and imaging findings, ankylosing spondylitis with extra-articular manifestations was diagnosed. Treatment with naproxen, sulfasalazine, exercise, physiotherapy, and subsequently tofacitinib resulted in improvement of back pain and foot swelling, with complete resolution of the rash and anterior uveitis. Acute anterior uveitis and cutaneous manifestations may precede characteristic axial symptoms in ankylosing spondylitis. Recognition of this association and appropriate use of HLA-B27 testing and MRI can facilitate early diagnosis and treatment.

Probiotic-postbiotic crosstalk in the gut microbiome: emerging mechanisms in colorectal homeostasis and cancer prevention – a systematic review

Swati Mishra — 2026-10-27

The gut microbiome is increasingly recognized as a critical determinant of gastrointestinal health and disease, and interactions between probiotic microorganisms and their bioactive metabolites, known as postbiotics, play a fundamental role in maintaining colorectal homeostasis. Recent evidence suggests that disruption of these interactions contributes to colorectal carcinogenesis, while restoration of microbial balance may provide novel preventive and therapeutic opportunities. This systematic review aimed to evaluate the role of probiotic-postbiotic interactions in colorectal homeostasis and their potential implications in colorectal cancer prevention through published literature from 2020 to 2025. A structured search of peer-reviewed literature was conducted using PubMed, Scopus, and Web of Science, and studies examining gut microbiota composition, probiotic supplementation, postbiotic metabolites, and colorectal disease outcomes were included. Data were systematically extracted and synthesized to evaluate associations between microbial diversity, functional metabolites, inflammatory pathways, and colorectal pathology. The reviewed literature consistently demonstrated that probiotic genera such as Lactobacillus and Bifidobacterium enhance the production of beneficial postbiotics, particularly short-chain fatty acids including butyrate, acetate, and propionate. These metabolites were associated with improved epithelial barrier function, suppression of inflammatory signaling pathways, modulation of host immunity, and inhibition of tumorigenic processes. A balanced gut microbiome was associated with a reduced incidence of colorectal adenomas and carcinomas, whereas dysbiosis was linked to chronic inflammation, epithelial dysfunction, and increased cancer risk. Overall, probiotic–postbiotic crosstalk represents a critical mechanistic pathway in colorectal homeostasis and cancer prevention, supporting the development of microbiome-targeted interventions aimed at reducing colorectal cancer burden, although further prospective clinical and mechanistic studies are warranted.

Splenectomy, indications and outcomes: a 12-year experience in a community hospital

Jordan Stone — 2026-10-27

Background: Splenectomy volume has declined as improved imaging, nonoperative management of blunt trauma, and novel medical therapies such as rituximab and thrombopoietin receptor agonists have narrowed its indications, making elective splenectomy uncommon and raising concern about maintaining operative proficiency.

Methods: We conducted a single-center retrospective chart review at Flushing Hospital Medical Center in Queens, NY of patients who underwent splenectomy between October 2012 and March 2025. Eligible patients were identified by institutional record review using diagnostic codes and confirmed by chart review. Inclusion criteria were patients 18 years and older who underwent splenectomy for any indication. Patients under the age of 18 or who required transfer to another institution were excluded. Data collection included patient demographics, medications, splenectomy indication, emergent versus elective, surgical approach (laparoscopic, robotic, or open), length of stay (LOS), morbidity, and in-hospital mortality. Descriptive statistics were calculated; chi-square tests with Bonferroni correction and Fisher's exact test assessed categorical relationships, and Pearson's correlations assessed continuous variables. IRB approval was obtained.

Results: Twenty-two patients were included (mean age 59.2±18.7 years; 54.5% male; 63.6% Hispanic), with hypertension (45.5%) and diabetes (22.7%) the most prevalent comorbidities; 50% were on steroids and approximately one-third on immunosuppressive therapy or chemotherapy. Most cases were elective (90.9%) and open (68.2%), with robotic (18.2%) and laparoscopic (9.1%) approaches less common. Immune thrombocytopenic purpura and neoplasm were the leading indications (40.9% each), while 9.1% (n=2) were urgent or emergent for massive splenomegaly. Postoperative bleeding occurred in 22.7% (n=5/22), mean LOS was 8.4±7.3 days, readmission rate was 27.3%, and there was no mortality. Surgical indication was significantly associated with complication type (p<0.03), and average volume was 2 cases per year.

Conclusions: Splenectomy has become a rare elective operation but remains highly effective and often life-saving; community and teaching surgical services should deliberately maintain minimally invasive splenectomy skills, recognizing that outcomes vary by indication.

Clinicopathological profile and surgical outcome of choledochal cysts: a prospective observational study from Bangladesh

Mahmud Hasan — 2026-10-27

Background: Choledochal cysts are uncommon congenital abnormalities of the biliary tract characterized by cystic dilatation of the extrahepatic and/or intrahepatic bile ducts. This study evaluated the clinicopathological characteristics, diagnostic profile, cyst morphology and surgical outcomes of patients with choledochal cysts treated at a tertiary surgical center in Bangladesh.

Methods: This prospective observational study was conducted in the Department of Surgery, Bangladesh Medical University, Dhaka, from January 2013 to December 2014. Forty-two patients with choledochal cysts were included. Demographic characteristics, clinical presentation, associated hepatobiliary conditions, laboratory findings, imaging investigations, Todani classification, operative procedures, histopathological findings and postoperative complications were evaluated. Descriptive statistical analysis was performed.

Results: Among 42 patients, 27 (64.3%) were female and 15 (35.7%) were male. Thirty-two patients (76.2%) were older than 20 years. Abdominal pain was the most frequent presenting symptom, occurring in 34 (81.0%) patients, followed by jaundice in 19 (45.2%). Todani type I was the predominant cyst type, identified in 20 (47.6%) patients, followed by type IV in 13 (31.0%). Type II, III and V cysts were present in 3 (7.1%), 1 (2.4%) and 5 (11.9%) patients, respectively. Ultrasonography was performed in all patients, while MRCP was performed in 38 (90.5%). Complete cyst excision was achieved in 34 (81.0%) patients, with Roux-en-Y hepaticojejunostomy being the predominant reconstructive procedure. Seven patients (16.7%) developed postoperative complications. One postoperative death occurred.

Conclusions: Choledochal cysts in this series predominantly affected females and were frequently diagnosed during adulthood. Todani type I was the commonest anatomical subtype. Ultrasonography followed by MRCP provided the principal diagnostic pathway. Complete cyst excision with biliary reconstruction was the predominant definitive treatment. Early diagnosis and appropriate anatomical delineation may facilitate definitive surgery and reduce complications associated with delayed presentation.

Postoperative chronic groin pain after open inguinal hernioplasty – a hospital-based assessment of prevalence and severity

Amir Mohamed — 2026-10-27

Background: Chronic postoperative inguinal pain, or inguinodynia, is an important long-term complication following inguinal hernia repair and may adversely affect daily activities and quality of life. This study assessed its prevalence and severity following open inguinal hernioplasty.

Methods: A prospective observational study was conducted among adult patients undergoing open inguinal hernioplasty at King George Hospital, Visakhapatnam, during 2025-2026. A total of 164 patients were included by consecutive sampling. Demographic and clinical data were collected through medical records and postoperative follow-up interviews. Chronic inguinal pain and pain intensity were assessed using the visual analogue scale.

Results: Among 164 patients, males constituted 85.4% and females 14.6%. The most common age group was 45-54 years (29.9%). Chronic postoperative inguinal pain was reported in 28 patients, giving a prevalence of 17.1%. Among patients with inguinodynia, moderate pain was most frequently reported (42.9%), followed by mild pain (32.1%), severe pain (14.3%), and very severe pain (10.7%). NSAID use was reported by 21 patients (12.8%).

Conclusions: Chronic postoperative inguinal pain occurred in 17.1% of patients following open inguinal hernioplasty. Most symptomatic patients experienced mild to moderate pain, although severe pain occurred in a smaller proportion. Structured postoperative surveillance may facilitate early recognition and appropriate management of persistent inguinodynia.

Reverse dorsal metacarpal artery flap to cover skin and soft tissue defects over fingers proximal to distal interphalangeal joint

Nurun Nahar Happy — 2026-10-27

Background: Finger injuries with soft-tissue loss and exposure of tendons, joints, or bones require stable and durable vascularized flap coverage to preserve hand function. The aim of the study was to evaluate the clinical outcomes of reverse dorsal metacarpal artery flap reconstruction for covering skin and soft-tissue defects of the fingers proximal to the distal interphalangeal joint.

Methods: This descriptive observational study was conducted at the Department of Plastic Surgery and 100-Bed Burn Unit, Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh, from February 2016 to January 2017. 50 (fifty) patients were included with finger skin and soft-tissue defects proximal to the distal interphalangeal joints. Reconstruction was done by Reverse dorsal metacarpal artery flap. Flap survival, donor-site morbidity, and joint function were assessed. Data were analyzed using SPSS after obtaining informed consent.

Results: Among 50 patients, most were male (42, 84.0%) and aged 25-35 years (27, 54.0%). Index-finger defects (24, 48.0%) and electric burns (31, 62.0%) predominated. Complete flap survival occurred in 39 patients (78.0%), with no donor-site morbidity in 43 (86.0%). Full MCP and PIP movement was achieved in 39 (78.0%) and 45 (90.0%) patients, respectively.

Conclusions: The reverse dorsal metacarpal artery flap is a simple, reliable, single-stage option for skin and soft-tissue reconstruction of fingers proximal to the distal interphalangeal joint, with minimal donor-site morbidity and early functional recovery.

Transanal hemorrhoidal dearterialization for hemorrhoid treatment at International Medical Center, Jeddah: a retrospective analysis of patient outcome

Rakan W. Mal — 2026-10-27

Background: The objective is to evaluate the clinical outcomes of THD with and without mucopexy in patients with symptomatic hemorrhoidal disease.

Methods: Retrospective cohort study of 105 patients who underwent THD at a tertiary care center in Jeddah between January 2020 and December 2024. Data were extracted from electronic medical records including patient demographics, operative details, and postoperative outcomes. Primary outcomes included recurrence rates, complications, pain scores, operative time, and hospital stay. Outcomes were compared between THD alone (n=28) and THD with mucopexy (n=33) using chi-square, t-test, and Mann-Whitney U tests. Statistical significance was set at p<0.05.

Results: Median age was 42 years (IQR 32-52) with 58% being males. Recurrence occurred in 13% of THD alone patients versus 33% of THD with mucopexy patients (p=0.233). Postoperative complications were 7.4% (THD alone) versus 19% (THD with mucopexy), p=0.3. Median pain scores were 3/10 in both groups (p=0.694). Operative time was 42 minutes in both groups (p=0.4). Recurrence rates by grade: Grade II 17%, Grade III 43%, Grade IV 9%.

Conclusions: THD appears safe with favorable pain control and low complication rates. No significant differences were observed between THD alone and THD with mucopexy. However, short follow-up duration and substantial missing data limit definitive conclusions regarding long-term efficacy.

C-reactive protein as an early marker of anastomotic leak after elective intestinal transit restoration surgery: a retrospective study in Hidalgo, Mexico

Abraham Romero Mendoza — 2026-10-27

Background: Anastomotic leak is one of the most serious complications of intestinal surgery, and its early diagnosis remains difficult in hospitals with limited access to imaging. This study evaluated whether a serum C-reactive protein (CRP) concentration above 135 mg/l on postoperative day 3 is associated with anastomotic leak after elective intestinal transit restoration surgery.

Methods: This observational, retrospective study reviewed the clinical and laboratory records of adults who underwent elective intestinal transit restoration at the Dra. Columba Rivera Osorio General Hospital, Pachuca, Hidalgo, Mexico, between January 2021 and January 2024. CRP on postoperative day 3 was dichotomised at 135 mg/L and cross-tabulated against anastomotic leak. Association was tested with the Chi-square test (α=0.05) and its strength with Cramér’s V.

Results: Of 50 records reviewed, 36 patients were included. Anastomotic leak occurred in 6 patients (16.7%) and CRP exceeded 135 mg/l in 10 (27.8%). All six patients with a leak had CRP above the cut-off, and no leak occurred among the 26 patients below it. The association was significant (χ²=18.72, p<0.001) and strong (Cramér’s V=0.72); sensitivity was 100%, specificity 86.7%, positive predictive value 60% and negative predictive value 100%. Type of anastomosis, anastomotic site and underlying diagnosis were not associated with leak.

Conclusions: A CRP above 135 mg/l on postoperative day 3 was strongly associated with anastomotic leak. As a low-cost, widely available test, CRP may serve as an early warning and rule-out tool in resource-limited hospitals, complementing clinical assessment and imaging. Larger prospective studies should validate this cut-off.

Postoperative surveillance of port site infection in laparoscopic cholecystectomy: identification of pathogens and antibiotic resistance trends in tertiary care hospitals of Peshawar

Izaz Ahmad Khan — 2026-10-27

Background: Port-site infection (PSI) is a frequent but poorly defined post-laparoscopic cholecystectomy (LC) complication, the most common surgical procedure for the treatment of symptomatic cholelithiasis. Increasing antimicrobial resistance of the causative organisms poses a risk to postoperative outcomes, especially in resource-limited areas where there is limited local pathogen and resistance data.

Methods: The study was conducted in the tertiary care hospitals of Peshawar, Khyber Pakhtunkhwa, Pakistan for six months (May–November 2025) using a cross-sectional study design. A purposive sampling method was used to recruit 95 patients aged ≥18 years who developed PSI within 7 days after LC, excluding patients with pre-existing infections or immunocompromising conditions. Patients were followed up at 48 hours, 1 week and 2 weeks after surgery. Microbiological culture and sensitivity were done on wound swabs of suspected infections. The data were analyzed by chi-square test, Mann-Whitney U test and Kruskal-Wallis test in SPSS-25.

Results: The mean patient age was 50.5±18.1 years (51 male, 44 female). PSI occurred in 85 patients (89.5%). The most common isolates were Staphylococcus aureus (36.5%), E. coli (27.1%), Klebsiella pneumoniae (21.2%), Pseudomonas aeruginosa (10.6%) and Proteus mirabilis (4.7%). High sensitivity was observed for levofloxacin, meropenem, vancomycin, linezolid and imipenem, and the highest resistance was observed for clindamycin (85.9%). There was no significant association between PSI and gender (p=0.210) or bile spillage (p=0.083). Patients with infection were significantly more likely to be hospitalized for longer than non-infected patients (median 6 days vs 2 days, p<0.001), and Klebsiella and Pseudomonas infections were associated with the longest hospital stay and the highest rates of persistent infection and re-intervention.

Conclusions: Gram-positive and gram-negative organisms make significant contributions to PSI following LC, and have different resistance patterns and clinical outcomes. To minimize morbidity, targeted antibiotic stewardship based on local resistance data is crucial.

Evaluation of the role of serum and 24-hour urinary fetuin-A levels in patients with urolithiasis

Ritvij R. Patankar — 2026-10-27

Background: Urolithiasis is a common urinary tract disorder with a substantial risk of recurrence. Fetuin-A (α2-Heremans-Schmid glycoprotein) is a systemic inhibitor of ectopic calcification and may influence urinary crystal formation. This study compared serum and 24-hour urinary fetuin-A concentrations in patients with urolithiasis and controls and examined their relationship with stone radiopacity and composition.

Methods: This prospective case-control study included 40 patients with urolithiasis and 40 controls matched for age, sex, and weight. Serum and 24-hour urine fetuin-A concentrations were measured using an ELISA. Stone radiopacity and chemical composition were assessed. Continuous variables were compared using independent-samples t-tests, with p < 0.05 considered statistically significant.

Results: Mean serum fetuin-A concentrations were lower in patients with urolithiasis than in controls (35.06 ± 12.90 vs 41.31 ± 8.89 ng/mL; p = 0.0137). Mean 24-hour urinary fetuin-A concentrations were also lower (26.42 ± 10.15 vs 36.90 ± 18.31 ng/mL; p = 0.0022). Neither serum nor urinary fetuin-A differed significantly between patients with radiolucent and radio-opaque stones. Calcium oxalate, including mixed calcium oxalate-containing stones, was present in 31 of 40 cases (77.5%).

Conclusion: Patients with urolithiasis had lower serum and urinary fetuin-A concentrations than controls. These findings demonstrate an association but do not establish causality. Larger studies are needed to determine whether fetuin-A has a role in stone formation or recurrence.

Clinical utility of the clinical abdominal scoring system in predicting the need for laparotomy following blunt abdominal trauma

Ruchi Choudhary — 2026-10-27

Background: Blunt abdominal trauma (BAT) remains a major cause of morbidity and mortality in emergency surgical practice. Early identification of patients requiring laparotomy is essential to reduce complications and improve outcomes. The objective of this study was to evaluate the Clinical Abdominal Scoring System (CASS) in predicting the necessity of laparotomy and clinical outcomes in patients with blunt abdominal trauma.

Methods: This prospective observational study was conducted in the Department of General Surgery, Pt. B.D. Sharma PGIMS, Rohtak, from May 2024 to May 2025. A total of 70 patients with blunt abdominal trauma were included. Clinical parameters including pulse rate, systolic blood pressure, Glasgow Coma Scale, abdominal findings, and time of presentation were used to calculate the CASS score. Radiological investigations including eFAST, X-ray abdomen, and contrast-enhanced CT were performed. Patients were managed conservatively or surgically based on clinical findings and scoring.

Results: The mean age of patients was 27.60±13.69 years, with male predominance (82.85%). Road traffic accidents were the most common mechanism of injury (81.42%). Conservative management was successful in 78.57% of patients, whereas 21.42% required surgery. Patients requiring surgical intervention had significantly higher mean CASS scores compared to conservatively managed patients (12.40±0.63 vs. 7.84±1.34, p<0.001). Mortality was significantly associated with higher CASS scores (12.50±0.71 vs. 8.71±2.19, p=0.017).

Conclusion: CASS is a simple, rapid, cost-effective, and reliable bedside scoring system that correlates significantly with operative requirement and clinical outcomes in blunt abdominal trauma patients.

Burned twice: the emotional toll of paediatric burns on caregivers

Peddi Manjunath — 2026-10-27

Background: Paediatric burn injuries significantly impact both the patients and their caregivers, with caregivers shouldering immense psychological and emotional burdens. While extensive research exists on the clinical outcomes of paediatric burns, the long-term effects on caregiver mental health and quality of life (QoL) remain underexplored.

Methods: An observational study was conducted with 100 caregivers of paediatric burn patients treated at a tertiary burn care centre. Participants were assessed at day zero, three months, and six months post-injury. Burn severity and total body surface area (TBSA) affected were documented. Hospital anxiety and depression scale (HADS), Infant dermatitis QoL index (IDQOL) and children’s dermatology life quality index (CDLQI) assessed the impact on caregiver and child QoL.

Results: At baseline, 52% of caregivers reported clinically significant anxiety and 47% reported depression. These levels decreased significantly by six months. QoL scores improved over time, with IDQOL scores decreasing from 17.5±4.2 at baseline to 7.6±3.2 at six months, and CDLQI scores declining from 18.3±4.7 to 9.1±3.8. Burn severity, measured by TBSA, was positively correlated with caregiver anxiety (r=0.62, p<0.01), indicating greater psychological distress for caregivers of children with more extensive burns.

Conclusions: Caregivers of paediatric burn patients face significant psychological and QoL challenges. These findings underscore the need for early and sustained psychological interventions, tailored support for caregivers of children with severe burns, and holistic burn care approaches that address both the physical and emotional well-being of patients and their caregivers.

Serial postoperative C-reactive protein for early prediction of anastomotic leakage after colorectal surgery: a prospective observational study

M. Abdul Jabbar — 2026-10-27

Background: Anastomotic leakage is a potentially life-threatening complication after colorectal surgery. Because clinical manifestations may be delayed or nonspecific, an accessible biochemical marker may facilitate earlier recognition and investigation. This study evaluated the association between serial postoperative serum C-reactive protein (CRP) levels and anastomotic leakage after colorectal surgery.

Methods: This prospective observational study was conducted in the Department of Colorectal Surgery, Shaheed Suhrawardy Medical College and Hospital, Dhaka, from July 2023 to June 2024. Forty patients undergoing colorectal surgery with anastomosis were included. Serum CRP was measured serially during the postoperative period, and patients were monitored clinically for anastomotic leakage, confirmed by clinical, radiological, endoscopic, or operative findings. Continuous variables were compared using the unpaired Student t test, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.

Results: The mean age was 43.1±12.1 years, and 26 (65.0%) patients were male. Diabetes mellitus and hypertension were present in 10 (25.0%) and 5 (12.5%) patients, respectively. Anastomotic leakage occurred in 3 (7.5%) patients. CRP did not differ significantly between leakage and non-leakage groups on postoperative day (POD) 1 but was significantly higher in the leakage group from POD 2 through POD 8. On POD 2, a CRP cutoff of 255.3 mg/L yielded an area under the ROC curve (AUC) of 0.934, with 100% sensitivity and 92.1% specificity. On POD 3, the AUC was 0.974, with 100% sensitivity and 94.7% specificity.

Conclusions: Serial postoperative CRP was associated with anastomotic leakage, with discriminatory performance evident from POD 2. CRP may complement clinical assessment in identifying patients requiring further evaluation. Larger multicentre studies are needed to validate these findings and establish generalizable thresholds.

A prospective study to compare laparoscopic appendicectomy versus open appendicectomy in acute appendicitis

Vikram Lalaso Patil — 2026-10-27

Background: Acute appendicitis is among the commonest surgical emergencies, and while laparoscopic appendicectomy (LA) has gained favour for its reported postoperative benefits, open appendicectomy (OA) remains widely practised, particularly in resource-constrained teaching hospitals. Comparative outcome data from such settings remain limited.

Methods: This prospective comparative study was conducted at a tertiary care teaching hospital over 18-24 months in 167 patients with confirmed acute appendicitis, of whom 44 underwent LA and 123 underwent OA based on clinical presentation and surgeon judgement. Operative duration, postoperative pain, time to oral intake, hospital stay, complications, recovery status, cosmetic outcome and sequelae were recorded and compared descriptively.

Results: Both groups were predominantly young adults. The LA group had a more balanced sex distribution than the OA group, which showed male predominance. Operative duration was similar between groups. LA patients resumed oral intake earlier and were discharged sooner than OA patients, and reported better cosmetic outcomes. Complication and recovery profiles were broadly comparable between the two groups; with scar pain the only sequela recorded at follow-up.

Conclusions: Both LA and OA were associated with acceptable postoperative outcomes in this cohort. LA was associated with earlier oral intake, shorter hospital stays and better cosmesis, while operative duration and recorded complication rates were broadly comparable between the two techniques.

Evaluating trauma management approaches and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a retrospective cohort study

V. M. K. Ayesha Reshma — 2026-10-27

Background: In settings with limited resources, hemodynamically unstable patients with severe multiple injuries continue to have a high mortality rate due to trauma, which is a major preventable cause of death globally. This study evaluated determinants of in-hospital mortality in this population.

Methods: This retrospective cohort study included 1000 hemodynamically unstable patients having an Injury Severity Score (ISS) of 16 or more, admitted to a tertiary care center in Tamil Nadu, India, between January 2024 and January 2026. Injury patterns, physiological parameters, trauma scores, management interventions, transfusion practices and outcomes were retrieved from hospital records. Independent predictors of in-hospital mortality were found using multivariable binary logistic regression, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) have been calculated.

Results: Mean age was 38.4 years and 77.6% were male. Road traffic accidents (63.5%) and blunt trauma (87.4%) predominated. In-hospital mortality was 35.0%, 24-hour mortality 11.4%, and exsanguination accounted for 7.0%. Independent predictors of death were higher ISS (AOR 1.12 per point; 95% CI 1.05 to 1.20), serum lactate above 6 mmol/L (AOR 3.84), Glasgow Coma Scale below 8 (AOR 3.12), delay to definitive haemostasis beyond 120 minutes (AOR 2.96), massive transfusion (AOR 1.58), mechanical ventilation (AOR 1.91) and vasopressor requirement (AOR 2.28). A ratio of 1:1 or higher between fresh frozen plasma and red blood cells was protective (AOR 0.42). Damage control surgery, interventional radiology and computed tomography before haemostasis were not independent predictors.

Conclusions: Injury severity, depth of shock, delayed haemostasis and unbalanced transfusion were the principal determinants of mortality. Early risk stratification, rapid hemorrhage control and balanced transfusion may improve survival.

Preoperative clinical and urodynamic factors influencing the short-term outcome of transurethral resection of the prostate for benign prostatic hyperplasia: a prospective observational study

Apoorva Saxena — 2026-10-27

Background. Although transurethral resection of the prostate remains the surgical mainstay for benign prostatic hyperplasia, a substantial minority of patients report an unsatisfactory result. This prospective observational study evaluated which preoperative clinical and urodynamic parameters influenced the short-term outcome of the procedure.

Methods. Thirty-five men with lower urinary tract symptoms due to benign prostatic hyperplasia, an International Prostate Symptom Score above 13, a maximum urinary flow rate below 15 mL/s and at least one absolute indication for surgery underwent monopolar transurethral resection of the prostate at a tertiary-care teaching hospital. Preoperative prostate volume, post-void residual urine, serum prostate-specific antigen, duration of catheterisation, uroflowmetry and multichannel urodynamics were recorded. The outcome at one month was graded by the International Prostate Symptom Score, the quality-of-life score and the maximum urinary flow rate, and was classified as effective or non-effective.

Results. The outcome was effective in 27 patients (77.1%) and non-effective in 8 (22.9%). A smaller prostate (43.3±8.4 versus 54.6±11.0 ml), catheterisation exceeding six weeks, a lower maximum detrusor pressure (30.0±19.2 versus 60.4±46.1 cm H₂O) and a lower bladder compliance (13.5±12.0 versus 37.7±29.7 ml/cm H₂O) were significantly associated with a non-effective outcome. Age, serum prostate-specific antigen, the presence of refractory retention and post-void residual urine showed no significant association.

Conclusions. A small prostate, prolonged preoperative catheterisation, a low detrusor pressure and poor bladder compliance predicted a less favourable short-term outcome. Preoperative urodynamic assessment is advisable in men with a small gland or prolonged retention, both to refine the indication for surgery and to counsel patients about the likely benefit.

Nigam’s modified Roeder’s knot with cutting seton has advantages over hybrid cutting seton in high and complex fistula-in-ano

Vinod Kumar Nigam — 2026-10-27

Background: Cutting seton is usually used in high or complex fistula-in-ano. Cutting seton with Nigam’s Modified Roeder’s Knot avoids rethreading and re-application of the cutting seton when becomes loose as the tightening is done in OPD during dressing without any pain or discomfort. While hybrid cutting seton of rubber or latex does not give the advantages of cutting seton with NMRK.

Methods: Cutting seton with NMRK is an easy method of seton application in high and complicated cases of fistula-in-ano. It avoids recurrence as well as anal incontinence which is common after surgery for high and complex fistula-in-ano.

Results: Cutting seton with NMRK is devoid of any post-operative serious complications. Recurrence and anal incontinence rate are minimal.

Conclusions: Cutting seton with NMRK is proved to be better with application of hybrid seton in cases of high and complex fistula-in-ano.

Morphometry and morphology of radial head: implications for prosthetic design and arthroplasty

Rimple Bansal — 2026-10-27

Background: Sufficient knowledge of various parameters of the radius head plays a cardinal role in various pathological conditions pertaining to radius be that reduction of fractures, designing its prosthesis, its knowledge is substantial in various such conditions. Current study was designed aiming to determine the morphometric & morphological parameters of adult human radii head in North Indian population.

Methods: 100 adult radii (50 from right and 50 from left) were studied.

Results: The mean weight of right radius bone was more on the left side while the mean values of total length of radius, medial length and lateral length were found to be more of right radii. The shape of radial head was found to be mostly circular. Strong significant correlation was found when total length of radius was compared with anteroposterior diameter of head (r=0.63, p=<0.05), transverse diameter of head (r= 0.66, p=<0.05) and head circumference of radius (r=0.62, p=<0.05). Very strong significant correlation between anteroposterior diameter and transverse diameter of radius head was seen (r= 0.84, p=<0.05).

Conclusions: Current study advocates the importance of alignment of the morphology and morphometry of the radius head while treating several conditions related to it.

Magnetic resonance imaging classification of perianal fistula and its surgical correlation: a prospective observational study

Partha Pratim Mandal — 2026-10-27

Background: Perianal fistula is a common anorectal disorder characterized by chronic infection and abnormal communication between the anal canal and perianal skin. Successful treatment depends on complete identification of the primary tract, secondary extensions, internal opening, and associated abscesses before surgery. Clinical examination alone often underestimates the complexity of disease, particularly in recurrent and complex fistulas. Magnetic Resonance Imaging (MRI) has emerged as the imaging modality of choice because of its excellent soft tissue contrast and multiplanar capability. The aim is to evaluate the MRI classification of perianal fistula according to anatomical type and MRI grading system and to correlate these findings with intraoperative observations.

Methods: A prospective observational study was conducted over 18 months at two surgical centers in West Bengal, India.

Results: The study included 50 patients with a mean age of 48.44±12.45 years. Males constituted 56% of the study population. Intersphincteric fistulas were the most common anatomical type (54%), followed by transsphincteric (20%), suprasphincteric (18%), and extrasphincteric (8%). Grade I fistulas represented 46% of all cases. MRI accurately demonstrated the primary tract in all patients and showed excellent agreement with operative findings regarding fistula classification and anatomical extent.

Conclusions: MRI provides accurate anatomical classification of perianal fistulas and correlates closely with operative findings. Routine preoperative MRI improves surgical planning, assists in identifying complex disease, and may reduce postoperative recurrence.

Patient and tumor characteristics in breast cancer undergoing indocyanine green-guided sentinel lymph node biopsy

Debasmita Pal — 2026-10-27

Background: Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in early-stage breast cancer. Conventional methods rely on radioisotopes and blue dye, which pose limitations including radiation exposure, allergic reactions, and the need for specialized nuclear medicine infrastructure. Indocyanine green (ICG) fluorescence-guided SLNB has emerged as a safe, non-radioactive alternative. This study assesses the feasibility, sentinel node yield, and tumor characteristics in patients undergoing ICG-guided SLNB at a tertiary care center in Southern India.

Methods: A retrospective review was conducted of 60 female patients with early-stage, clinically node-negative breast cancer treated between June 2024 and December 2025. All patients underwent ICG-guided SLNB using a near-infrared fluorescence camera without the addition of blue dye or radiotracer. Data collected included patient demographics, tumor location, histological subtype, receptor status (ER, HER2), and the number of sentinel lymph nodes retrieved.

Results: The mean patient age was 53±9.1 years, and 63.3% had a BMI ≥25 kg/m². Tumors were most frequently located in the upper outer quadrant (51.7%), and invasive ductal carcinoma was the predominant histology (90%). Estrogen receptor positivity was observed in 85% of cases, and 30% were HER2-positive. A mean of 2.5±1.2 sentinel lymph nodes (range 1-6) were successfully harvested using ICG alone. No adverse events related to the technique were noted.

Conclusions: ICG-guided SLNB is a feasible, safe, and resource-efficient surgical technique, particularly valuable in low-resource settings where access to nuclear medicine is limited.

Comparative assessment of early surgical recovery and functional outcomes following anterolateral thigh and radial forearm free flap reconstruction for oral soft-tissue defects in a tertiary care centre

Amir Mohamed — 2026-10-27

Background: Reconstruction of oral cavity soft-tissue defects following oncological resection is essential for restoration of oral function and minimization of donor-site morbidity. Anterolateral thigh free flap (ALTFF) and radial forearm free flap (RFFF) are commonly used reconstructive options. This study compared their early surgical and functional outcomes.

Methods: A prospective observational study was conducted in the Department of Plastic Surgery, King George Hospital, Visakhapatnam, from May 2025 to April 2026. Fifty patients requiring free-flap reconstruction of oral cavity defects were included. Twenty-eight patients underwent ALTFF reconstruction and 22 underwent RFFF reconstruction. Flap survival, defect and flap dimensions, donor-site complications, and postoperative mouth opening were assessed.

Results: The mean age was 54.64±8.89 years, and 60% of patients were female. ALTFF was used in 56% and RFFF in 44% of cases. Mean defect and flap surface areas were significantly greater with ALTFF than RFFF (61.53±19.51 vs 42.22±10.77 cm², p=0.0001; 138.62±42.26 vs. 74.46±15.89 cm², p<0.0001). Flap survival was 89.3% with ALTFF and 86.4% with RFFF. RFFF donor-site graft loss occurred in 40.9% of cases. Mean mouth opening improved from 4.15±1.15 cm preoperatively to 4.71±0.58 cm postoperatively.

Conclusions: Both ALTFF and RFFF provided satisfactory early surgical and functional outcomes. ALTFF facilitated reconstruction of larger defects with lower donor-site morbidity, while RFFF provided reliable reconstruction with acceptable functional outcomes. Flap selection should be individualized according to defect characteristics and tissue requirements.

Effect of aortic valve replacement on left ventricular systolic function, left ventricular mass index reduction and clinical outcome in early post-operative period in patients with aortic stenosis

Kazi Al-Hosne Jamil — 2026-10-27

Background: Aortic stenosis (AS) causes chronic left ventricular pressure overload, resulting in ventricular hypertrophy, remodeling and progressive impairment of ventricular function. Aortic valve replacement (AVR) relieves the pressure overload, but the extent of early ventricular recovery remains clinically important. This study evaluated early changes in left ventricular ejection fraction (LVEF), left ventricular mass (LVM), left ventricular mass index (LVMI), relative wall thickness (RWT), hemodynamic parameters and functional status following surgical AVR.

Methods: This prospective observational study included 40 adult patients with AS who underwent isolated surgical AVR at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh, from July 2017 to June 2018. Preoperative and early postoperative echocardiographic parameters were compared. Clinical outcomes included NYHA functional class, aortic valve pressure gradient, ICU stay and postoperative complications.

Results: The mean age was 39.23±12.41 years; 25 (62.5%) patients were male and 15 (37.5%) were female. Mean LVEF increased significantly from 46.30±7.07% preoperatively to 50.83±6.06% postoperatively (p=0.001). Mean LVM decreased from 407.92±157.05 g to 304.49±132.73 g (p=0.001), while LVMI decreased from 220.32±102.58 to 160.57±86.94 (p=0.001). The mean aortic valve pressure gradient decreased from 54.59±4.41 to 12.37±6.60 mmHg (p<0.0001). NYHA functional class improved from 2.83±0.38 to 1.07±0.25 (p<0.001). RWT decreased from 0.4738±0.074 to 0.4227±0.086 (p<0.003). One patient (2.5%) developed prosthesis-patient mismatch and one (2.5%) developed paravalvular leakage. Two deaths were reported during the study period.

Conclusions: Surgical AVR was associated with significant early improvement in left ventricular systolic function, regression of left ventricular mass and LVMI, reduction in transvalvular pressure gradient, and improvement in functional status within four weeks. These findings suggest that relief of aortic obstruction is associated with early favorable ventricular remodeling in patients with AS.