International Surgery Journal

Case series of retroperitoneal cyst: a clinical challenge and diagnostic dilemma

Prashanth Puvvada — 2024-09-25

Cyst in retroperitoneal region is a rare occurrence with reported incidence of 1 in 5750-2,50,000. They present incidentally in one third patients or with pain or sometimes clinical palpable painless mass. Their management remains a clinical dilemma. Here, we report five cases of retroperitoneal cyst which presented to our hospital between August 2022-February 2023 and summarize the clinical features, diagnosis, and their treatment. All patients presented to our outpatient department. All patients were female youngest 20 years and oldest 76 years of age. Two patients had pain abdomen with clinically palpable mass. Two patients had painless mass. One patient was detected incidentally. All the patients were evaluated with CECT and MRI pelvis wherever needed. Cyst excision was done laparoscopically in 3 patients and by open laparotomy in 2 patients and histopathology report was followed post operatively. All patients were discharged without any complications. Retroperitoneal cyst is uncommon pathology of abdomen. Their presentation is quite vague. Imaging is the key in diagnosis. It poses a great clinical challenge in the management of such patients due to suspected malignancy. Our study shows that these cysts can be managed with simple excision irrespective of size after evaluation and laparoscopic approach is better where feasible.

Endoscopic management of Boerhaave syndrome: a comprehensive review of techniques, outcomes and future directions

Sayra Karelia Rivera Nájera — 2024-09-25

Boerhaave syndrome, characterized by spontaneous esophageal rupture, presents a critical condition requiring prompt diagnosis and intervention to reduce morbidity and mortality. Traditionally managed with surgical intervention, advancements in endoscopic techniques have emerged as viable alternatives, offering less invasive options with promising outcomes. This article provides a thorough review of the endoscopic management of Boerhaave syndrome, detailing the indications, techniques, and outcomes associated with various endoscopic approaches. We examine the role of esophageal stenting, clipping, and tissue sealants, alongside adjunctive therapies. Furthermore, we discuss patient selection criteria, procedural considerations, and potential complications. Our review highlights the evolving landscape of Boerhaave syndrome management, underscoring the importance of multidisciplinary collaboration and the need for further research to optimize patient outcomes.

Time to revisit the enigma of mastalgia management

Arun Kumar Singh — 2024-09-25

Mastalgia (breast pain) also known as mastodynia, is one of the most common causes of breast issues for which a female visits a medical practitioner. It is divided into cyclical mastalgia, which is associated with menstruation, or can be noncyclical mastalgia which can present premenopausal or postmenopausal. The incidence of breast cancer associated with mastalgia is extremely low and reassurance plays a major role in the treatment of patients. Hormonal changes have been associated with the pathogenesis of cyclical mastalgia. Outdated treatment modalities are still being followed even though newer and more effective treatment options have been established. Objective assessment of breast pain should be done with the visual analog scale. Non-pharmacological therapy should be encouraged in every patient of mastalgia such as counseling and reassurance, sports bra, yoga, and relaxation therapy. Tamoxifen and ormeloxifene are now the drug of choice in severe mastalgia and care should be taken to counsel the patients about use and common and detrimental side effects. The available treatment modalities and their directions to use are discussed in this review.

Small bowel adenocarcinoma of the jejunum

Rita Monteiro — 2024-09-25

Jejunal adenocarcinoma is an unusual type of gastrointestinal malignancy. The symptoms are vague, such as abdominal pain, nausea, vomiting, and, in some cases, weight loss. Due to this vague presentation as well as lack of definitive imaging techniques, diagnosis tends to be delayed and patients typically present at later stages. We present a case of a patient who presented with acute onset abdominal pain. Imaging revealed the presence of a suspicious lesion of the jejunum, with a 3,6 extension. The patient underwent a laparoscopy segmental intestinal resection and omental lymph node resection. The lesion was a 3-cm mass at proximal jejunum. The jejunum adenocarcinoma is a rare neoplasm of the small bowel. The curative resection at the early stages is still the best treatment.

Ruptured mycotic abdominal aortic aneurysm in the setting of an adjacent perinephric abscess

Alexandar Schaal — 2024-09-25

Arterial aneurysms are most commonly present due to progressive vessel wall injury. They may then act as a nidus for bacterial seeding that can lead to the formation of a mycotic aneurysm in 2.5% of all abdominal aneurysms, which is associated with high mortality. Management of mycotic aortic aneurysm has been challenging always. Here we present a rare case of a ruptured mycotic aneurysm secondary to contiguous extension of a perinephric abscess. The patient required emergent surgery and underwent reconstruction of the aorta using a Dacron graft with a good 18 months outcome.

Stroke in gliomas: a case report and literature review

Ryan J. Green — 2024-09-06

A 60-year-old patient presented to the emergency department with sudden onset neurological symptoms suggestive of a cerebrovascular event. Initial diagnostic imaging revealed a complex clinical picture with an unclear diagnosis, with differentials including aneurysm, neoplasm, ischaemia accompanied by cerebral oedema. CT angiography revealed a small aneurysm, while subsequent MRI demonstrated findings consistent with diffuse multifocal glioma and areas of restricted diffusion, suggesting post-compressive ischaemia. This case highlights both the diagnostic challenges of using CT imaging for early suspected stroke and the importance of multimodal imaging when the clinical diagnosis is uncertain.

Presentation of a case of a dermoid cyst with a rare location

Noemí Porras Gazcón — 2024-09-13

Dermoid cysts are choristoma that accumulate normal embryonic tissue in abnormal locations, making up 3% to 5% of congenital orbit conditions. They are found in various parts of the body, including the head and neck, frontal, periorbital, scalp, cervical, and nasoethmoidal regions. Nasoethmoidal dermoid cysts can compromise deep structures and may extend intracranially, with a frequency of 1% to 45%. They are usually diagnosed in the first 3 years of life, but some may go undetected until adulthood. Two theories explain the origin of nasal dermoids: the cranial origin theory and the superficial inclusion theory. Nasal dermoids can be pale, flesh-colored, pearly, or erythematous and may be accompanied by congenital anomalies. Different diagnoses include epidermal cysts, gliomas, meningoencephaloceles, tumors of vascular origin, fibromas, neurofibromas, osteomas, and lipomas. Imaging evaluations are necessary for diagnosis, determining the degree of involvement of neighboring structures, rule out associated malformations, and establish potential intracranial extension. The only curative treatment for nasoethmoidal dermoid cysts is surgical removal, as untreated lesions can cause nasal deformities, recurrent infections, and intracranial extension.

Colorectal adenocarcinoma in pregnancy: intraoperative finding in a patient with intestinal obstruction

Carla M. Cruz R. — 2024-09-25

Colorectal cancer, a common malignancy with significant morbidity and mortality, is infrequently encountered during pregnancy. This rare overlap of conditions creates a formidable diagnostic. The therapeutic approach is equally complex, involving difficult decisions on whether to delay treatment until after delivery or to pursue immediate intervention, all while considering the impact on both maternal and fetal health. This case highlights the need for heightened awareness among clinicians, as well as the development of clear protocols to guide the management of colorectal cancer in pregnant patients. In the current case report we describe and document the incidental intraoperative findings of a colorectal adenocarcinoma in a 27-year-old patient with 20 weeks of pregnancy presenting with clinical symptoms of intestinal obstruction. We present the difficult diagnostic and therapeutic approach involving the decision on the treatment of an acute pathology as is intestinal obstruction. As well as to assess whether or not to start systemic oncological therapy and whether or not to end the pregnancy.

Giant adolescent tubular adenoma of the breast mimicking giant fibroadenoma: a case report

Shantel Chang — 2024-09-25

Tubular adenomas are a rare benign breast neoplasm, often clinically indistinguishable from fibroadenomas or phyllodes tumors. We present a case of the largest adolescent tubular adenoma reported in the literature, measuring 12.5 cm. Radiological evaluation and histopathological assessment of the core biopsy sample was consistent with a giant fibroadenoma. However, the final histopathological analysis of the excisional biopsy sample confirmed a tubular adenoma. This case highlights the clinical conundrum of reaching the definitive diagnosis in a patient with a tubular adenoma. A contemporary review of the clinical features, radiology, histopathology and management options for tubular adenoma of the breast was undertaken.

Well differentiated squamous cell carcinoma mimicking occipital lipoma

Ikenna Chimuanya Ohiaeri — 2024-09-25

Squamous cell carcinoma is the second most common cancer arising from keratinocytes which can present as benign lesions. We present a case of well differentiated carcinoma mimicking an occipital lipoma. A 39-year-old female presented with occipital swelling of 8 years duration with associated pain which on examination showed a firm, well-defined lobulated, mildly tender mass attached to the skin but not underlying structures. Ultrasound showed lipoma with degenerative changes and histology showed well differentiated squamous cell carcinoma. She subsequently had wide local excision. Our case is similar to other reports showing squamous cell carcinoma resembling benign conditions. There is therefore a need to have a high index of suspicion when evaluating benign lesions especially of the scalp.

Intestinal intussusception secondary to polyposis in Peutz-Jeghers syndrome

Daniela Vidal-Santiago — 2024-09-25

Peutz-Jeghers syndrome (PJS) is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation. We present a case of intestinal intussusception secondary to these polyps.

Splenic rupture post colonoscopy requiring splenectomy

Phi Nguyen — 2024-09-10

Colonoscopy is a safe procedure performed routinely worldwide. Splenic rupture is a rare complication of colonoscopy with less than 100 case reports since 1974. We report a case of splenic rupture post colonoscopy requiring splenectomy, with a focus on the analysis of risk, investigation and treatment. A 60-year-old patient underwent a colonoscopy with polypectomy after a positive faecal occult blood test. After 19 hours, the patient experienced abdominal pain and dizziness. A computed tomography showed a splenic rupture and abdominopelvic hemoperitoneum. An urgent splenectomy was successfully performed. Physicians should have greater awareness of the possibility of splenic rupture following coloscopy to avoid delay in diagnosis and treatment for this life-threatening complication.

Anorectal avulsion-an unusual anorectal trauma

Rita Monteiro — 2024-09-25

Anorectal avulsion is a rare trauma. In this type of lesion, the anus and the sphincter complex are pulled up by a tremendous compression of the pelvic floor. Frequently, this trauma is associated with other injured organs, like pelvic bones or urethra. We report a case of a young man who was admitted with a total anorectal avulsion associated with a pelvic fracture. A multidisciplinary treatment included external fixation of the broken pelvis, suprapubic cystostomy, sigmoid loop colostomy and reimplanting the anal complex in the original position with appropriate drainage. Anorectal injuries are uncommon and represent about less than 10% of rectal trauma, but anorectal avulsion is extremely rare. These cases often require a quick decision making and multidisciplinary approaches to reduce the possibilities of morbidity and mortality.

Retroperitoneal lymphangioma in a tertiary care hospital of North India

Saif M. Baig — 2024-09-18

Less than 200 cases of retroperitoneal lymphangiomas (RL), a rare type of benign cystic tumour of the lymphatic system that makes about 1% of all lymphangiomas, have been documented to date. Their rarity makes preoperative diagnosis challenging. 95% of lymphangiomas are found in the head, neck, and axilla where they are most frequently found. We are presenting a 30 years old woman, who presented to outpatient department (OPD) of general surgery with symptoms of recurrent left lumbar pain, radiating towards inguinal region for one month. The contrast computed tomography (CT) scan of abdomen and pelvis defined a large thin walled homogenous non enhancing hypodense cystic lesion in left side of abdomen in retroperitoneal location from left lobe of liver till pelvis on left side craniocaudally. The patient was planned for exploratory laparotomy. Midline laparotomy was performed. A cystic lymph-filled tumour was detected in the abdominal cavity adjacent to the bowel loops. Histologically the mass contained variable-sized cystic spaces lined by flattened endothelium consistent with lymphatic vessels, which on immunostaining were positive for CD31 and negative for Pan CK. The patient was discharged satisfactorily. In conclusion, retroperitoneal lymphangioma presents vaguely as abdominal pain or mass and grown to large sizes without causing any significant symptom. Tumour markers for the excised tissue are important for diagnosis. Laparotomy or laparoscopy are the two surgical excision methods used to treat retroperitoneal cystic lymphangioma and it responds well to excision.

Pedunculated lipoma of the breast

Ketan Vagholkar — 2024-09-25

Pedunculated lesions of the breast are usually benign conditions. They pose a clinical dilemma to the attending surgeon. Excision is the mainstay of treatment. A case of a pedunculated lipoma of the breast in a 52-year-old lady is presented. She underwent excision under general anesthesia. Histopathology revealed adult-type of adipocytes with no evidence of lipoblasts. There was no recurrence. Various types of pedunculated lesions of the breast, their diagnosis and management are discussed. Surgical excision is the mainstay of treatment. They have a low recurrence rate and are rarely malignant.

Pelvi-ureteric junction obstruction in a case of horseshoe kidneys with lower pole crossing vessels:a rare case and its management

Apoorva A. Kulkarni — 2024-09-25

Pelvi-ureteric junction obstruction is one of the most common urological conditions found in children. Horseshoe kidneys are a predisposing factor and to find a vascular anomaly causing the obstruction is rare. A 2-year-old girl with two episodes of culture-positive febrile urinary tract infections (UTI), was found to have right sided hydronephrosis. Renal scan revealed decreased functioning of right kidney with scars. A contrast CT scan showed a horseshoe kidney with pelvi-ureteric junction obstruction on right side with dilatation of renal pelvis. During laparoscopic pyeloplasty, lower pole crossing vessels were detected, not reported on CT scan. A dismembered pyeloplasty with transposition of uretero-pelvic anastomosis anterior to lower pole vessels was done. Anomalous vasculature of kidney should be kept in mind during surgery in such cases. A dismembered pyeloplasty along with transposition of anastomosis is necessary to prevent recurrence.

Submandibular gland pleomorphic adenoma masquerading as a multinodular goitre: a case report

Hardik M. Chaudhary — 2024-09-25

Tumors of the salivary gland comprise of a small percentage of all head and neck tumors, of which nearly 80% are benign. The submandibular gland tumors constitute only 5-10% of this group, of which pleomorphic adenoma is the commonest type. They can weigh several kilograms and grow to ludicrous sizes. If left untreated, they may result in facial deformity and airway compromise. We describe a case of a big pleomorphic adenoma arising from submandibular salivary gland that developed in a 65 years old female presenting as a swelling in right side of neck since 15 years. The dimensions of the lesion were roughly around 8×12×11 cm. During surgical examination, a solid mass that originated from the right submandibular gland was discovered to be linked to both the skin and the soft tissue beneath it. Pleomorphic adenoma was confirmed by histopathological examination. Review and discussion of the relevant literature was conducted. This article's emphasis is on the fact that, although the pleomorphic adenoma is a well-reported entity, they can attain very large sizes involving the neck region and can misrepresent itself leading to diagnostic dilemma due to many possible differential diagnoses of neck swellings.

Non-pancreatic retroperitoneal pseudocyst: a rare case report

Shankar Karuppusamy — 2024-09-25

A retroperitoneal pseudocyst is usually pancreatic in origin. Non-pancreatic retroperitoneal pseudocyst has a very low incidence, primarily benign and usually asymptomatic. The absence of epithelial lining in the cyst wall characterizes the pseudocyst. The absence of epithelial lining in the cyst wall characterizes the pseudocyst. Here, we report a case of a 53-year-old male patient who presented to OPD with mass per abdomen and lower abdomen pain. The computed tomography scan of the abdomen and pelvis revealed a retroperitoneal cyst abutting the right psoas muscle. The patient underwent an open excision of a retroperitoneal cyst. Histopathological examination of the specimen showed a non-pancreatic retroperitoneal pseudocyst. It is a rare case; very few cases have been reported in the literature. One such case is reported here.

A rare case of large femoral hematoma after femoral artery cannulation

Hemanshi K. Rathod — 2024-09-25

Femoral vessel cannulation is a commonly performed procedure in clinical practice. However, hematomas are a frequent complication of this procedure. Notably, hematoma formation is more likely to occur with femoral arterial cannulation compared to venous cannulation. If a hematoma does form, management can range from external compression to surgical intervention. In this report, we present a rare case of a large femoral hematoma without external skin cover, which is an unusual presentation of a common complication associated with femoral vessel cannulation. An elderly female presented with complaints of a raw area, pain, and blackening at the site of femoral artery cannulation for 10 days. She underwent coronary angioplasty and stenting 20 days prior. On examination, she exhibited a large hematoma over the right groin at the cannulation site without external skin covering. She underwent hematoma debridement with a gracilis muscle flap covering of the exposed femoral vessels. Early recognition and prompt evacuation of hematoma, assessment of femoral vessel breach and its management, as well as plastic reconstruction of exposed vessels, are vital for favorable outcomes.

Iatrogenic small bowel perforation during elective laparoscopic intraperitoneal onlay meshplasty leading to intraoperative change of plan: a case report with review of literature

Ravi Kalyanbhai Balar — 2024-09-25

Iatrogenic bowel injury during any surgery, be it open or laparoscopic; is associated with significant morbidity. Moreover, if the said injury occurs in a surgery in which a foreign material is planned to be implanted in the patient’s body as a prosthesis e.g., hernia surgery; the surgical team may have to deviate from its original plan of action. Even in the best of hands, iatrogenic bowel trauma can occur inspite of following best recommended practices. This usually occurs in the setting of dense adhesions of bowel to the parietes. Herein, we present one such case of a 72-year-old lady who was planned for laparoscopic incisional mesh hernioplasty, but had to be subjected to an intraoperative change in plan, due to an iatrogenic enterotomy.

Algorithm postmastectomy breast reconstruction secondary to breast cancer in a reference center in Mexico City

Esperanza Sánchez-Castrejón — 2024-09-25

Background: Postmastectomy breast reconstruction represents a challenge for the plastic surgeon. Contemporary techniques offer numerous options, the reconstructive procedure performed depends on the individual profile of each patient, but will also be influenced by the surgeon's preoperative analysis of their individualized risk profile.

Methods: Descriptive, longitudinal, and retrospective study. The reconstructed patients with breast cancer sequelae in the period from May 2023 to May 2024 were included. Based on the review of the literature and the experience of our center, a proposal for a breast reconstruction algorithm was formulated to standardize the ideal surgical treatment according to the case.

Results: 119 patients were reconstructed using the algorithm to decide the ideal surgical management. Breast reconstruction was performed in 3 stages: the first stage [1st BRS] (119 patients) consisted of a tissue expander, breast implant ± acellular dermal matrix or autologous pedicled flaps after the mastectomy; in the 2nd BRS (68 patients) the expander was replaced with an implant with or without contralateral symmetrization; and finally in the 3rd BRS (18 patients), the reconstruction of the nipple-areola complex ± neurotization, autologous fat transfer and scar remodeling was performed.

Conclusions: The algorithm proposed in this paper provides a guide for making decisions about ideal surgical management according to the clinical characteristics of each subgroup of patients to be reconstructed, improving results by making them reliable and predictable, which positively impacts patient's quality of life.

The role of subcutaneous drain in laparotomy patients

M. Mozammel Haque — 2024-09-25

Background: In surgical incision wounds, hematoma, serous fluid, and dead space increase the risk of infection because they provide a surface for microbial growth. Subcutaneous drain reduces dead space in the subcutaneous tissue plane, which prevents fluid from accumulating and seroma from forming by removing infectious content, residual effusion, and blood from the wound. This study attempts to determine the efficacy of subcutaneous drain in laparotomy in the management of surgical site infection (SSI).

Methods: This prospective study was conducted at the Department of Surgery in various hospitals in Cumilla, Bangladesh. This study includes 150 adult patients aged between 18 to 70 years. A closed subcutaneous suction drain was inserted before the skin was closed in 75 patients at random (drain group), whereas the rest of the 75 patients' subcutaneous suction drains were not kept (no-drain group).

Results: The association between comorbidities and SSI in both the drain and no-drain groups were significant, p value <0.001 respectively. SSI was mainly in the group with fewer surgery hours (72.4%). Patients with SSI also have longer hospital stays on average.

Conclusions: Patients with SSI have increased morbidity, and those undergoing major procedures are more likely to experience SSI afterwards. The presence of a subcutaneous closed suction drain contributes to reducing SSI.

Early surgical outcomes of children with mechanical intestinal obstruction at Moi teaching and referral hospital, Kenya

Ivy W. Agade — 2024-09-25

Background: Intestinal obstruction constitutes the largest proportion of abdominal surgical emergencies in the paediatric and adult patients in Sub-Saharan Africa, including Kenya. It is associated with high postoperative surgical complication and mortality rate in low resource healthcare systems.

Methods: A prospective mixed methods study with consecutive sampling procedure was carried out from September 2021 to June 2023. Pediatric patients from birth to 14 years, with mechanical intestinal obstruction were included in the study. Categorical data was analyzed in frequencies and percentages and continuous data was analyzed using measures of central tendency and measures of dispersion. Bivariate and multivariate associations between the dependent and independent variables were assessed with a p value of less than 0.05 being statistically significant.

Results: The final study population was 318 participants. Majority of participants were male with neonates comprising almost one third of participants. Classical symptoms were present in a majority of patients at initial presentation. Intussusception (34.6%) was the leading acquired aetiology of paediatric mechanical intestinal obstruction. Operative surgical management was in 94.6% of participants. Surgical complications were present in 61.1% of participants. The commonest surgical complication was surgical site infection in 16.9%. Overall mortality rate was 10.2% with 23.3% among neonates and 4.9% in older children. Referral status was statistically associated with mortality (p<0.001). Intestinal atresia had the highest case-specific mortality rate. Age, presence of comorbidity were factors associated to postoperative complications and mortality (p<0.05).

Conclusions: The overall mortality rate was 10.2%. A higher mortality was seen among neonates compared to older children.

Risk profile and thromboprophylaxis practices among patients undergoing laparotomy at Moi teaching and referral hospital

Njeri N. Dennis — 2024-09-25

Background: Venous thromboembolism (VTE) significantly causes hospital mortality worldwide, with abdominal surgery a risk factor. Venous thromboprophylaxis can reduce VTE risk, but has adverse effects. Local research on risk profile and practice helps individualize thromboprophylaxis and develop local protocols.

Methods: A prospective study was conducted at Moi teaching and referral hospital (MTRH) on adult laparotomy patients. The minimal sample size was 325 patients, using consecutive sampling. DVT was assessed using Well's score perioperatively, 2 weeks and 4 weeks postoperatively. A lower limb Doppler ultrasonography was performed on patients with a score of 2 or greater to rule out DVT.

Results: The mean age of study participants was 38 years, with a 1.5:1 male-to-female ratio. Infection in the abdomen was the main reason for laparotomy. All procedures were open, and 75.4% of individuals had high or moderate VTE risk. Within 72 hours, 82.7% of patients were mobilized. Chemoprophylaxis was limited to enoxaparin post-op. Enoxaparin duration was unstandardized, and MTRH VTE risk categorization chart use was not reported. 3% of individuals received chemoprophylaxis against ACCP guidelines and 12% received enoxaparin despite contraindications. Only 13% and 24% of intermediate and high-risk patients got chemoprophylaxis. No mechanical prophylaxis was used. Symptomatic DVT was 6.8%. Advanced age, Caprini score, and enoxaparin prescription increased symptomatic DVT risk.

Conclusions: Despite increased laparotomies for intra-abdominal infection and middle-aged patients, VTE is common in MTRH patients. Poor VTE risk stratification and MTRH protocol failure led to improper thromboprophylaxis. Prescribers should employ MTRH VTE regimen for proper prophylaxis. Providing prescribers with thromboprophylaxis choices to customize prescriptions.

A comparative analysis of the accuracy of cardiac surgery risk scores in tricuspid valve procedures undertaken in the Republic of Georgia

Yash Sailesh Kumar — 2024-09-25

Background: Tricuspid valve (TV) surgeries present significant challenges marked by elevated risk and mortality rates. Despite the application of established risk scores like ACEF-II, EuroSCORE-II, and Hannan EL et al's risk stratification (HRS), their accuracy in predicting mortality rates for these procedures in a third-world setting remains under-researched. This study sought to assess the predictive performance and overall accuracy of these risk scores in the context of TV surgeries performed in the Republic of Georgia.

Methods: A cohort of 63 patients who underwent TV procedures was retrospectively analyzed. ACEF-II, EuroSCORE-II, and HRS were applied and run through statistical analysis to assess their predictive capabilities.

Results: ACEF-II demonstrated an accuracy rate of 58.7%, an area under the curve (AUC) of 0.819, and an expected-to-observed mortality ratio of 0.16. EuroSCORE-II exhibited an accuracy rate of 61.9%, an AUC of 0.866, and an expected-to-observed mortality ratio of 0.17. The HRS demonstrated an accuracy rate of 65.1%, an AUC of 0.882, and an expected-to-observed mortality ratio of 0.35.

Conclusion: While the risk scores show promise, our study highlights their limitations in accurately predicting mortality rates of TV surgeries by underestimating them and emphasizes the need for refinement or the development of risk scores tailored specifically to TV procedures in third-world countries.

Observation of magnetic resonance imaging of pelvis and post operative findings in cases of rectal carcinoma

Tasmia Tanjum — 2024-09-25

Background: Colorectal carcinoma, the most common malignancy within the gastrointestinal tract, ranks second in cancer-related fatalities across Western Europe and the United States, with approximately one quarter of cases located in the rectum. The purpose of this study was to evaluate magnetic resonance imaging (MRI) findings and analyze postoperative outcomes in the pelvic region of patients diagnosed with rectal carcinoma. The aim of this study was to observe MRI findings and postoperative outcomes in the pelvic region of patients diagnosed with rectal carcinoma.

Methods: This cross-sectional study at Dhaka medical college hospital spanned 24 months from July 2021 to June 2023, involving 90 patients with provisional rectal carcinoma diagnoses. Patients underwent MRI using the Hitachi Echelon 1.5 T MR system™ for assessment of lesion site, tumor characteristics, lymph node involvement, and local organ status. Histopathological evaluation followed the WHO grading system and AJCC TNM classification, 8th edition. Statistical analysis was conducted using SPSS version 23.0 with significance set at p<0.05.

Results: In 90 patients with rectal carcinoma, common comorbidities included diabetes (30%) and hypertension (23.3%). MRI showed mid-rectal tumors (47.8%), mainly hypointense on T1WI (81.1%) and hyperintense on T2WI (96.7%). Tumor staging identified T2 in 36.7% and lymph node involvement (N0) in 50.0%. About 38.9% patients were found in T2 staging and 53.3% patients in N0 group identified by histopathology.

Conclusions: MRI findings in rectal carcinoma correlate well with histopathology, underscoring MRI's clinical utility and suggesting potential for enhancing diagnostic accuracy in future research.

Clinicopathological evaluation of the terminal end of the distal rectal pouch and fistula site in anorectal malformation

Renu Kushwaha — 2024-09-25

Background: The aim is to assess the clinicopathological evaluation of the terminal end of the distal rectal pouch and fistula site in anorectal malformation (ARM).

Methods: This study was conducted on patients who attended the surgery OPD and included 40 cases of ARMs over a 12-month period. All cases were admitted to the department of surgery at B. R. D. medical college, Gorakhpur, UP.

Results: Out of 40 cases studied 22 cases (55%) were female and 18 cases (45%). Out of total 40 cases, recto-bulbourethral fistula shown by 8 male patient (20%), recto-prostatic fistula shown by 8 male patient (20%), and recto-bladder neck fistula shown by 2 male patient (5%) out of total 18 male patient (45%) of total cases. Recto-vestibular fistula shown by 7 female patient (17.5%), ano-vestibular fistula by 11 male patient (27.5%), low rectovaginal fistula shown 3 female patient (7.5%), and no fistula shown by 1 female patient (2.5%) out of total 22 female patient (55%). In our study wound infection (5 cases) 12.5%, excoriation (5 cases) 12.5 %, constipation and bleeding (2 case) 5% were noted, no complication seen in 65% cases. All of them were treated conservatively followed by anal dilatation.

Conclusions: Histopathological variations in the distal rectal pouch and fistula site of ARMs have led to differing opinions on whether to preserve or excise the fistula site. Our study found that 45% of patients had a smooth muscle layer present in the histopathological examination.

Risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia

Shreya Bhardwaj — 2024-09-25

Background: Inguinal hernia occurs in 1 to 5% of the general population. The development of laparoscopic inguinal hernia repair techniques as an alternative to conventional open surgery has improved results such as less postoperative pain, shorter hospital stays, and faster recovery. This study was conducted to assess the risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia.

Method: A total of 200 patients who were scheduled to undergo TEP were enrolled. Complete demographic and clinical details of all the patients was obtained. A Performa was made and detailed intraoperative findings were evaluated. Baseline hemodynamic and biochemical profile was evaluated. Separate assessment of patients was done who were converted to open surgery. Comparison of patients was done among those with and without conversion. Various risk factors were evaluated which were responsible for conversion. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software.

Results: Mean age of the patients was 49.2 years. 60.5 percent of the patients were of rural residence. Mean BMI of the patients was 24.8 Kg/m2. Incidence of conversion was 6.5 percent. Geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear and previous hernia surgery history was found to be significant risk factors for conversion.

Conclusion: Laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia is an effective technique, but conversion to open surgery occurs in 6.5% of cases. Significant risk factors for conversion include geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear, and previous hernia surgery history. Identifying these risk factors can help optimize patient selection and improve outcomes for TEP repair.

A prospective study comparing intra-operative and postoperative complications in totally extra peritoneal repair vs extended totally extra peritoneal for inguinal hernia

Priyesh Aggarwal — 2024-09-25

Introduction: Inguinal hernia repair is one of the most common surgical procedures worldwide. Total extra peritoneal repair (TEP) and Extended-TEP (eTEP) are widely used minimally invasive methods. TEP involves creating a space in the preperitoneal plane without entering the abdominal cavity, whereas eTEP extends this approach, allowing for a broader operative field.This study compares the intra-operative and postoperative complications of TEP and eTEP, contributing to the optimisation of inguinal hernia management.

Methods: It is a prospective study. A total of 60 patients who underwent TEP and e-TEP for inguinal hernia, who fulfilled the inclusion criteria. Patients were randomised by simple random sampling technique and were divided into two groups of 30 each (group A-TEP and group B-eTEP). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test.

Result: The comparative analysis between TEP and eTEP procedures shows no significant differences in demographic parameters. However, eTEP demonstrates significantly shorter operative time and hospital stay, quicker return to work. Both procedures have similar rates of low intra-operative and postoperative complications, indicating comparable safety profiles.

Conclusion: Our study suggest that both techniques are associated with low complication rates and good patient outcomes, with eTEP showing potential advantages in terms of pain, recovery and wider access. These findings help to take better surgical decision, to make and helped optimize patient care in inguinal hernia management.

Comparative efficacy of autologous platelet rich plasma and conventional dressing in the management of chronic ulcers

Anuj Bishnoi — 2024-09-25

Background: Chronic ulcers pose a major global healthcare challenge. The use of platelet-rich plasma (PRP) for treating these wounds has garnered interest because of its potential healing benefits. Objective were to determine the effect of autologous PRP therapy on the percentage of surface area reduction/healing in chronic ulcers.

Methods: This randomized controlled trial was conducted at the department of general surgery of M.M. institute of medical sciences and research (M.M.I.M.S.R.) Mullana, Ambala from May 1, 2023, to April 30, 2024. Patients aged 18-80 years of either gender with chronic ulcers were enrolled. Patients were randomly allocated to the PRP group and control group. PRP group was administered autologous PRP once in two weeks for 6 weeks after debridement, while for the control group conventional saline dressings were done after debridement. Final assessment was done at 8 weeks.

Results: Of the 60 patients, the mean age was 53.90±11.23 years. There were 49 (82%) males and 11 (18%) females. At 8 weeks, the PRP group achieved 83.78% (SD=2.99) reduction in surface area of ulcers, whereas the control group had a 57.78% (SD=1.32) reduction in surface area of ulcers, with a p=0.0000 indicating a significant difference. The small sample size and 56-day follow-up period are insufficient to assess long-term treatment effects.

Conclusions: A better outcome of PRP was observed compared to conventional dressing in patients with chronic non-healing ulcers.

Correlation between radiological imaging and histopathological findings in patients with breast lump

Sweksha Sharma — 2024-09-25

Background: Breast cancer is the most common cancer among women globally and the second leading cause of cancer-related deaths, after lung cancer. Early detection via routine screening is crucial, as not all breast lumps are cancerous and benign lumps do not always progress to cancer. To improve diagnostic accuracy, a triple assessment approach is used, combining radiological imaging, pathological diagnosis, and clinical examination. Techniques such as mammography, ultrasonography, and fine needle aspiration cytology (FNAC) are key to this evaluation. This study assesses the breast imaging reporting and data system (BIRADS) scoring system’s diagnostic accuracy by comparing radiological techniques with histopathological findings.

Methods: The study involved 100 patients with breast lumps, categorised into three groups based on BIRADS scores: group A (BIRADS I-III), group B (BIRADS IV), and group C (BIRADS V). Data analysis using chi-square and student’s t tests were done.

Results: In our study we found that accuracy of BIRADS score: sensitivity: 88.9%, specificity: 89.5%, positive predictive value: 97.3%, negative predictive value: 65.4% and diagnostic accuracy: 81%.

Conclusions: The study demonstrated a high incidence of fibroadenoma (66%), others (3%) as benign cases and invasive ductal carcinoma (31%) malignant cases. The study highlights the importance of accurate diagnosis and targeted screening, especially in high-risk groups such as postmenopausal women and those with a family history of breast cancer. The findings affirm the high sensitivity and specificity of the BIRADS system as a valuable diagnostic tool.

Spectrum of exploratory laparotomy for acute abdomen in a central Gujarat tertiary care centre

Arpan J. Prajapati — 2024-09-25

Background: Exploratory laparotomy is one of commonest emergency surgeries performed in the world. Despite technological advance imaging, the fundamental technique of exploratory laparotomy has remained unchanged over years. Studies quantifying the spectrum of laparotomy in central Gujarat are lacking.

Methods: A retrospective study of 249 patients of emergency exploratory laparotomy for acute abdomen in SSG Hospital Baroda from May 2022 to May 2024 was done and data involving clinical presentation, imaging, operative findings and post- operative course were studied and analysed. The cases were divided into gastro-intestinal perforation, gastro-intestinal obstruction and miscellaneous cause.

Results: The most common cause of exploratory laparotomy in study was perforation peritonitis including 59 ileal, 16 jejunal, 49 pre-pyloric, 29 duodenal, 1 body of stomach, 17 appendicular and 8 colon. With post op major complications like burst-11%, leak-5%, pneumonia-5%, multi-organ failure-6.5% and ileus 5%, wound infection 18%. The overall mortality was 15%. Out of 58 cases of laparotomy for obstruction including adhesions (29.3%), obstructed inguinal hernia (12%), tuberculosis (32%), malignancy (13.8%), internal hernia (12.6%). The miscellaneous causes were ruptured liver abscess (9), rupture ectopic pregnancy (2), twisted ovarian tumour (1).

Conclusions: Acute abdomen remains a significant surgical problem. Peptic perforation remains a common cause of acute abdomen with high morbidity and mortality, despite improves medical management, though there is a declining trend in incidence, tuberculosis remains an important cause.