International Surgery Journal

Techniques with overview of sentinel lymph node biopsy in early breast cancer: a review

Muhammad Salman — 2026-04-16

The sentinel lymph node biopsy (SLNB) technique has been developed and validated in past three decades. It has been demonstrated to be feasible, accurate, and less morbid than axillary lymph node dissection (ALND), as a standard initial approach in patients with early-stage breast cancer. The techniques and management decision of SLNB in comparison with ALND was carried out by literature search from PubMed, Medline, Clinical key and clinical trials.com, ranging from 2010 to 2025. Despite variability in selection criteria and technique, sentinel lymph node is consistently identified in approximately 96 percent of patients predicting the status of remaining axillar lymph nodes in greater than 95 percent patients. Failure to map in a SLNB eligible patients or with three or more sentinel lymph nodes (SLN) positive should undergo ALND for staging and to maximize local control. There is no one size fits all SLNB technique, but the choice depends upon institutional resources, patient factors, logistics, surgeons experience. Multidisciplinary team approach with quality assurance and auditing to minimize false negative SLN rate (FNR) to achieve better patient outcome.

Reducing surgical site infections: mechanisms, risks and prevention

Ketan Vagholkar — 2026-04-06

Surgical site infections (SSIs) remain a leading cause of healthcare-associated infection with significant morbidity, mortality and cost. It is a surgeon’s nightmare. SSI risk is multifactorial, involving patient, procedure, perioperative management, microbial and institutional factors. Objectives were to synthesize current evidence on determinants of SSI, mechanisms linking risk factors to infection and evidence-based prevention strategies. Narrative synthesis of guidelines, randomized trials, systematic reviews and key observational studies. Patient comorbidities (diabetes, obesity, immunosuppression), colonization (S. aureus), nutritional status, smoking and age increase SSI risk. Procedure-related factors include contamination class, operative time, tissue handling, implants and emergency surgery. Perioperative management which includes timing and weight-based dosing of prophylactic antibiotics, antiseptic skin preparation (alcohol-based chlorhexidine superior in many settings), maintenance of normothermia, perioperative glycaemic control, hair clipping (not shaving) and sterile technique significantly affect SSI rates. Environmental and institutional factors (OR ventilation, sterilization practices, surveillance programs) and pathogen factors (biofilm formation, antimicrobial resistance) also drive SSI risk. Bundled, multimodal prevention programs such as targeted interventions (e.g., S. aureus decolonization for carriers) are effective in high-risk populations in reducing SSI rates. Reduction in SSI rates requires identification and optimization of modifiable patient and process risk factors, adherence to evidence-based perioperative practices and systems-level surveillance and stewardship.

Postoperative ileus after abdominal surgery: pathophysiology, prevention and contemporary management: a narrative review

Stephanie Johanna Chon Pineda — 2026-04-27

Postoperative ileus (POI) remains one of the most frequent complications following abdominal surgery, significantly contributing to delayed gastrointestinal recovery, prolonged hospitalization, and increased healthcare costs. Although a transient impairment of bowel motility is expected after surgical intervention, prolonged POI represents a pathologic state driven by complex perioperative mechanisms. To provide a focused narrative synthesis of the current evidence regarding the pathophysiology, epidemiology, risk factors, prevention strategies, and contemporary management of postoperative ileus in adult abdominal surgery. A targeted literature review was conducted using major biomedical databases, including PubMed/MEDLINE, Scopus, and Google Scholar. Emphasis was placed on high-impact studies published between 2000 and 2025, including randomized controlled trials, systematic and narrative reviews, and Enhanced Recovery After Surgery (ERAS) guidelines. Fifteen high-yield references were selected for narrative analysis based on clinical relevance and methodological robustness. POI is a multifactorial entity involving neurogenic inhibition, inflammatory activation, opioid-mediated dysmotility, and perioperative fluid disturbances that collectively impair coordinated gastrointestinal function. Identified risk factors include advanced age, open surgical approaches, prolonged operative time, and high perioperative opioid exposure. Preventive strategies centered on ERAS pathways — including minimally invasive surgery, opioid-sparing analgesia, early enteral nutrition, mobilization, and goal-directed fluid therapy — demonstrate consistent reductions in POI incidence and duration. Pharmacologic agents such as alvimopan provide adjunctive benefit, while non-pharmacologic measures, including sham feeding, further support gastrointestinal recovery. Effective mitigation of postoperative ileus relies on comprehensive, protocol-driven perioperative care rather than isolated therapeutic interventions. Continued refinement of ERAS implementation, alongside emerging predictive and pharmacologic strategies, will be essential to optimize postoperative recovery and surgical outcomes.

Mitigating hernia risk after abdominal surgery: a review article

Harini Krishnan — 2026-04-27

Incisional hernias are a frequent and costly complication following abdominal surgery, with a reported incidence ranging from 10% to 50%, depending on patient factors, surgical approach, and follow-up method. This narrative review consolidates contemporary evidence on prevention strategies, with a focus on operative techniques, prophylactic mesh augmentation, and perioperative optimisation. High-quality randomized trials and meta-analyses support the small-bite closure technique (5 mm bites with 5 mm spacing), continuous slowly absorbable monofilament sutures, and maintaining a suture-to-wound length ratio of at least 4:1. Prophylactic mesh placement in selected high-risk populations (retrorectus or pre-peritoneal planes) substantially reduces the incidence of incisional hernias. Modifiable risk factors, such as obesity, smoking, diabetes, malnutrition, and surgical site infection, should be optimized before elective surgery. Emerging resorbable synthetic meshes may provide temporary reinforcement and reduce long-term foreign-body complications. However, data on their long-term durability remain limited. Herein, we present an evidence-based algorithm and four summary tables to assist clinicians in risk stratification and tailored prevention. Implementation requires surgeon training, institutional pathways, and systems for long-term outcome monitoring to confirm durable benefits.

A review of literature and new comprehensive classification of “Mesh Repair Methods” (MRM classification) for abdominal wall hernias

Devenndra D. Sortey — 2026-04-27

The use of prosthetic mesh has brought a revolution in the history of the repair of abdominal wall hernia. Evidences suggest that using mesh for hernia repair significantly reduces recurrence. Every plane of abdominal musculature has been explored for mesh implantation. Various names have been used to describe each plane and different methods of implantation. But the terminologies used for various practices of mesh implantation are ambiguous and confusing. Inconsistent and confusing terminologies leads to difficulty in comparing and analyzing the literature. The aim of this review is to group various practices by identifying the basic method of utilizing various planes of abdominal wall musculature and bring them under some self-explanatory terminologies. Hernia-mesh implantation methods related articles were searched using Medline, PubMed and the Cochrane library during October 2024 to March 2025. 90 articles were shortlisted for this study. In our review of various available articles, we focused on identifying: abdominal plane utilized, number of planes utilized, number of sheets of mesh implanted, details of mode of implantation (open, endoscopic or hybrid), terminologies used for the planes, and overall name given for that concept. We tried to group various methods of mesh implantation according to above findings. This new comprehensive classification of “mesh repair methods” (MRM classification) is intended to be self-explanatory and its adoption would avoid ambiguity and improve comparison and communications for research studies of various practices of hernia mesh implantation.

Mesh choice in inguinal hernia repair: key evidence and practical considerations

Eduardo León-Madrigal — 2026-04-27

Inguinal hernia repair is one of the most commonly performed procedures in general surgery, with prosthetic mesh reinforcement widely recognized as the standard of care due to its ability to significantly reduce recurrence rates. However, the increasing diversity of available mesh products has introduced important considerations regarding optimal prosthetic selection. Beyond structural reinforcement, mesh characteristics have been shown to influence postoperative pain, foreign body sensation, functional recovery, and overall patient quality of life. This focused review summarizes key evidence surrounding mesh selection in contemporary inguinal hernia repair, emphasizing practical considerations relevant to daily surgical practice. Core variables analyzed include mesh weight, pore size, density, anatomical placement, and fixation strategies. Lightweight meshes have demonstrated favorable outcomes in terms of reduced chronic postoperative pain and improved abdominal wall flexibility, while maintaining acceptable recurrence rates in most primary repairs. Similarly, large-pore and low-density meshes appear to enhance tissue integration and reduce fibrotic response compared with microporous prostheses. Mesh positioning within anterior or posterior planes, as well as the choice between penetrating and atraumatic fixation methods, further influences postoperative outcomes. Techniques such as glue fixation or non-fixation in selected laparoscopic repairs may reduce pain without compromising stability. Ultimately, no single mesh type is universally superior. Prosthetic selection should be individualized based on patient characteristics, hernia complexity, surgical approach, and surgeon expertise. Continued innovation in biomaterials and fixation technologies, alongside standardized outcome reporting, will be essential to refine evidence-based mesh selection and optimize long-term results in inguinal hernia surgery.

Accuracy and efficiency of utilizing Microsoft Excel search functions and artificial intelligence for retrospective data analysis

Alec Kreilach — 2026-04-27

Background: Artificial intelligence (AI) has become integrated into many aspects of modern medicine, including medical research. Manual retrospective chart review has been regarded as an effective yet time-consuming and taxing process.

Methods: To identify an accurate yet faster process, a retrospective electronic chart analysis was performed comparing three modalities: Microsoft Excel search function and Microsoft CoPilot were compared against manual review in identifying appendiceal neoplasms in patients undergoing laparoscopic or open appendectomy from an extracted database. The time taken to identify key words establishing neoplastic processes and the number of words found were recorded for manual search, Microsoft Excel search function, and Microsoft CoPilot.

Results: The Microsoft Excel search function identified more terms than Microsoft CoPilot; however, it did not find all the instances found in manual search. The Microsoft Excel search function process took the least amount of time (2 minutes), and manual search took the most (2 hours 22 minutes). Although Microsoft CoPilot was the most dynamic tool, it was not as fast as the Microsoft Excel search function, nor as accurate as the other two modalities.

Conclusions: Although the Microsoft Excel search function had the best speed, it was a static tool that did not find every key word and could not extrapolate data. Based on this paper and other literature, AI has the potential to assist in retrospective chart analysis. However, the search function remains faster and much more accurate than AI at this time.

Association between preoperative C-reactive protein and atrial fibrillation after off-pump coronary artery bypass grafting

Kaushik Roy — 2026-04-27

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. This study aims to assess the association between preoperative C-reactive protein (CRP) levels and postoperative AF in Bangladeshi patients undergoing off-pump CABG.

Methods: This comparative, cross-sectional study was conducted at the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh, from July 2020 to June 2022, including 70 adult OPCAB patients divided by preoperative CRP levels (Group A: 0–<6 mg/l, Group B: 6–10 mg/l) to assess its association with postoperative atrial fibrillation. Standard preoperative evaluation, anesthesia, grafting and monitoring of intra- and postoperative events were performed, with data analyzed using SPSS-26 (p≤0.05).

Results: Among 70 patients undergoing off-pump CABG, baseline demographic, clinical, laboratory and operative variables were comparable between groups (all p>0.05). Group A had significantly shorter ICU stay (3.71±0.96 vs 3.75±0.91 days, p=0.010) and hospital stay (8.94±2.96 vs 10.91±2.81 days, p=0.006). Postoperative atrial fibrillation occurred more frequently in Group B (40.0%) than Group A (11.4%) (p=0.006). Multivariable analysis identified preoperative CRP (6–10 mg/dl) as the sole independent predictor of postoperative AF (OR 6.32, p=0.006).

Conclusions: Elevated preoperative CRP is an independent predictor of postoperative atrial fibrillation and prolonged ICU and hospital stay after off-pump CABG, highlighting its role in risk stratification and prevention.

Emergency abdominal surgery during a pandemic-related lockdown: a Vietnamese experience

Loc H. Tran — 2026-04-27

Background: The fourth wave of COVID-19 in Vietnam was associated with prolonged lockdown measures that may have influenced access to emergency surgical care. This study evaluated temporal changes in operative volume, prehospital presentation, disease severity, and early postoperative outcomes in common emergency abdominal conditions across distinct pandemic phases.

Methods: A retrospective study was conducted at a tertiary referral center, including adult patients undergoing surgery for appendicitis, cholecystitis, peptic ulcer perforation, and bowel obstruction during three periods: social distancing (June–September 2020), lockdown (June–September 2021), and post-lockdown (March–June 2022). Variables included demographic characteristics, prehospital symptom duration, disease severity graded by the American Association for the Surgery of Trauma (AAST) classification, and postoperative complications classified by Clavien–Dindo.

Results: A total of 1,251 patients were included. During lockdown, emergency operative volume decreased by approximately 50% compared with the social distancing period. Delayed presentation (>1 day) increased significantly in appendicitis and peptic ulcer perforation (p<0.01), accompanied by higher proportions of AAST Grade III–IV disease in both groups. No significant differences were observed in cholecystitis or bowel obstruction. Postoperative morbidity remained stable overall, except for an increase in moderate-to-severe complications in peptic ulcer perforation during lockdown (p=0.02). After lifting restrictions, operative volume, severity distribution, and early outcomes returned to pre-lockdown patterns.

Conclusions: During the lockdown period of Vietnam’s fourth COVID-19 wave, reductions in surgical volume and delayed presentation were observed in selected time-sensitive abdominal emergencies, accompanied by higher anatomic severity and morbidity in perforation cases. These patterns were not observed in the period following restoration of healthcare access.

Role of the Gastrografin test in adhesive small bowel obstruction in adults in Senegal

Mohamadou L. Gueye — 2026-04-27

Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, particularly in low-resource settings where delayed presentation and limited diagnostic resources complicate management. The Gastrografin test may help predict successful conservative treatment. This study evaluated its role in guiding the management of ASBO in adults in Senegal.

Methods: A prospective descriptive study with an analytical component was conducted in the Department of General Surgery at Aristide Le Dantec University Hospital in Dakar, Senegal, from December 2015 to December 2021. Adult patients diagnosed with ASBO without clinical or radiological signs of severity were included. All patients underwent a standardized Gastrografin test. The test was considered positive when contrast medium reached the right colon within 24 hours. Clinical outcomes, need for surgical intervention, length of hospital stay, and the diagnostic performance of the test were analyzed.

Results: Twenty-seven patients were included (16 men and 11 women), with a mean age of 39.7±17.3 years. Fourteen patients (51.9%) had a positive Gastrografin test, among whom 13 (48.1%) experienced resolution of obstruction without surgery. Fourteen patients (51.9%) required surgery due to a negative test (n=13) or recurrence after initial improvement (n=1). The specificity of the Gastrografin test was 92.9%. Patients with a positive test had a shorter mean hospital stay (4.76 vs. 5.33 days). No mortality occurred.

Conclusions: The Gastrografin test is a simple and accessible tool for the management of ASBO. It helps identify patients suitable for conservative treatment while guiding timely surgical intervention.

A comparative study between short term outcome of choledocholithotomy with and without T-tube

Saoda Islam — 2026-04-27

Background: Management of common bile duct is challenging especially closure of common bile duct (CBD) after removal of stones. The main aim of this study was to find out the outcome of choledocholithotomy with and without tube placement.

Methods: This descriptive observational type of study was conducted in the Department of Surgery Sher-E-Bangle Medical College Hospital, Barishal, Bangladesh from December, 2017 to November 2018. A total number of 50 patients were enrolled in the study. The patients were divided into two groups; each group included 25 patients. Group A consisted of the patients who had primary closure while group-B included the patients who had T-tube closure.

Results: The mean ages of group A and B were 43.75±2.76 (range: 29-63) years and 45.77±3.19 (range: 28-69) years respectively. Most of the patients were male in both groups (72% versus 80%). Diabetes mellitus was the major co-morbidity in both groups (32% versus 28%). Mean operating time significantly higher in open choledocholithotomy with T-tube insertion than open choledocholithotomy with primary closure (p=0.001). Additionally, mean hospital stay was also longer in T-tube insertion group rather than primary closure group which statistically the difference was significant (p=0.001). Wound infection (16% versus 36%) biliary fistula (4% versus 20%) subphrenic abscess (2% versus 0%), biliary leakage (4% versus 12%), jaundice % versus 8%) and retained stone (0% versus 4%) were the observed complications in primary closure group and t-tube closure group patients respectively. Postoperative complications were relatively higher in t-tube closure group though it was not statistically significant (p≥0.05).

Conclusions: Both primary closure of CBD and T-tube drainage after CBD exploration are equally good procedures for the treatment of uncomplicated choledocholithiasis. However, primary closure of CBD is having significantly lower operating time and less duration of stay at hospital.

Association of progesterone receptor status with histopathological grading in patients with intracranial meningioma

Pulak K. Biswas — 2026-04-27

Background: Intracranial meningioma is a common primary brain tumor. Although most are benign, recurrence and variable behavior remain concerns. While World Health Organization (WHO) histopathological grading is an established prognostic tool, it does not always accurately predict tumor behavior. Progesterone receptor (PR) expression may serve as an additional prognostic marker. Objective of the study was to assess the association between progesterone receptor status and histopathological grading in patients with intracranial meningioma.

Methods: This cross-sectional observational study was conducted in the Department of Neurosurgery, Bangladesh Medical University, Dhaka, Bangladesh from June 2018 to March 2020. A total of 35 patients with histologically confirmed intracranial meningioma were included. Clinical and radiological data were collected using a structured data sheet. Tumors were graded according to WHO classification. Progesterone receptor status was evaluated by immunohistochemistry and categorized based on percentage of nuclear positivity. Data were analyzed using statistical package for the social sciences (SPSS) version 22, and associations were tested using Fisher’s exact test. A p value <0.05 was considered statistically significant.

Results: Among 35 patients, 88.57% had WHO grade I and 11.43% had grade II meningioma. A significant association was found between PR status and histopathological grade (p=0.013). Lower PR expression was more common in grade II tumors. No significant association was observed between PR status and tumor size.

Conclusions: Progesterone receptor status is significantly associated with histopathological grading and may serve as an additional prognostic marker in intracranial meningioma.

Management of traumatic extradural haematoma at tertiary referral centre: a prospective study

Kankal Ashutosh Laxmanrao — 2026-04-27

Background: Extra dural haematoma (EDH) means collection of blood between skull and dura mater due to bleeding from extra-cerebral vessel which is a common complication of head injury, often fatal if not treated intime and can be managed by both conservatively and surgically, decision has made individually in each case depending on patient's age, hematoma size, location, patient's neurological status and course. Present study was done to study different ways of management of EDH and their prognostic outcomes and to predict outcome of conservative against surgical intervention at tertiary care centre.

Methods: Present prospective study was conducted in Surgery department at tertiary care centre for 2 years and 100 subjects included in study. Data was collected about wound mechanism, clinical features, occupation, Glassgow Coma score and thorough evaluation for evidence of traumatic sequelae. Data collected and entered in Microsoft excel, statistics were estimated by chi square test p<0.005 considered as significant. Ethical clearance was obtained.

Results: Out of 100 participants, 53% participants belong to age group 21-40 years with M:F ratio was 4.26:1.22% study participants students followed by drivers 17%. Most common mechanism of trauma was RTA (61%) and GCS score in range of 13-15 contributing 61%. The 88 study subjects managed conservatively whereas 12 cases were managed surgically. Mortality rate 8.33% in operative mode whereas 1.34% in conservative mode of management.

Conclusions: Present study concluded that when surgical treatment is indicated that time early surgical intervention is associated with the best prognosis. Many factors affect outcome of EDH surgery and most important is duration of time between incident/accident and operation in neurosurgical operation.

Timing of laparoscopic cholecystectomy following ERCP and its complications: an analytical cross-sectional study from Central India

Manasi Barve — 2026-04-27

Background: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy represents the standard treatment for patients with choledocholithiasis associated with gallstone disease.¹ However, the optimal timing of laparoscopic cholecystectomy after ERCP remains controversial.

Methods: The study included 50 patients who underwent ERCP followed by laparoscopic cholecystectomy. This is an analytical cross-sectional study was conducted in the Department of General Surgery at Government Medical College and General Hospital, Nagpur, over a period of two years from January 2023 to January 2025. Patients were divided into early (within 72 hours) and delayed (6-8 weeks) groups, each comprising 25 patients. The study was conducted after obtaining approval from the Institutional Ethics Committee, and all patients provided informed consent prior to inclusion. Demographic profile, operative time, conversion to open surgery, postoperative complications, recurrent hospital visits, and duration of hospital stay were analyzed descriptively.

Results: The mean age was 52.8 years with 22 females and 28 males. Mean operative time was shorter in the early group (1.4 hours) compared with the delayed group (2.1 hours). Conversion to open surgery occurred in one delayed-group patient. Postoperative complications were observed in three patients in each group, with one mortality in the early group. Recurrent hospital visits were higher in the delayed group (3.48 vs 1.92). Mean hospital stay was shorter in the early group.

Conclusions: Early laparoscopic cholecystectomy following ERCP appears safe and is associated with shorter operative time, fewer recurrent biliary admissions, and reduced hospital stay without increased complications. Early surgery should be preferred whenever feasible.

Assessment of donor site morbidity and functional outcome in anterior cruciate ligament reconstruction using peroneus longus autograft

Ibin Varghese — 2026-04-27

Background: Anterior cruciate ligament (ACL) reconstruction is commonly performed using hamstring tendon or bone–patellar tendon–bone autografts; however, donor site morbidity associated with these grafts has prompted the search for alternative autografts. The peroneus longus tendon (PLT) has emerged as a potential option due to its favorable biomechanical properties and adequate graft length and strength. Concerns remain regarding donor ankle morbidity following PLT harvest. Objective of the study was to assess donor site morbidity of the ankle and functional outcomes of the knee following arthroscopic ACL reconstruction using a peroneus longus tendon autograft.

Methods: This prospective observational study included 45 patients who underwent arthroscopic ACL reconstruction using an ipsilateral peroneus longus tendon autograft at a tertiary care center. Patients were followed up for a minimum of 12 months. Knee function and stability were assessed using the International Knee Documentation Committee (IKDC) score, anterior drawer test, Lachman test, and pivot shift test. Donor ankle morbidity was evaluated using the American orthopaedic foot and ankle society (AOFAS) score and muscle strength assessment of ankle eversion and first ray plantar flexion using the Medical Research Council (MRC) scale. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 20.0, with p<0.05 considered statistically significant.

Results: The majority of patients were aged 26–40 years (55.6%) and were male (68.9%). Sports-related injuries were the most common mechanism (60%). At 12 months follow-up, 93.3% of patients achieved excellent or good IKDC scores, with the mean IKDC score improving significantly from 60±2.2 preoperatively to 97.5±4.8 postoperatively (p<0.01). Objective knee stability was restored, with negative anterior drawer and Lachman tests in 95.6% and 93.3% of patients, respectively, and a negative pivot shift test in 100% of patients. Donor ankle function was preserved, with a mean AOFAS score of 98.4±3 at final follow-up. Grade V muscle strength was maintained in 91.1% of patients for ankle eversion and 95.6% for first ray plantar flexion, with no patient demonstrating strength ≤grade 3.

Conclusions: Arthroscopic ACL reconstruction using the peroneus longus tendon autograft provides excellent knee stability and functional outcomes with minimal donor ankle morbidity. The PLT autograft is a reliable and effective alternative to conventional autografts for ACL reconstruction.

The functional outcome of metacarpal fractures fixed with mini plates and screws

Abhijith Gopinathan — 2026-04-27

Background: Metacarpal fractures are common hand injuries that can significantly impair hand function if inadequately treated. Surgical fixation using mini plates and screws provides stable fixation and permits early mobilization, which may improve functional outcomes. However, evidence regarding procedure-specific functional outcomes remains variable.

Methods: This prospective observational study was conducted in the Department of Orthopaedics at Government Medical College, Kottayam, over a one-year period from 1st January 2025 to 31st January 2026. A total of 47 adult patients with metacarpal fractures requiring surgical intervention were included. All patients underwent open reduction and internal fixation using mini plates and screws. Functional outcome was assessed using the Total Active Flexion (TAF) score at 10 weeks, 3 months, and 6 months postoperatively. Pain was evaluated using the Visual Analogue Scale (VAS), and radiological union was assessed using serial X-rays. Statistical analysis was performed using SPSS version 26, with p<0.05 considered statistically significant.

Results: The mean age of patients was 34.6±9.9 years, with a male predominance (37;78.7%). Metacarpal shaft fractures were the most common injury (37;78.7%). Radiological union was achieved in all patients (47;100%) by 6 weeks. Functional outcomes improved significantly over time, with excellent TAF scores observed in 42 patients (89.4%) at 6 months (p<0.01). Postoperative pain reduced markedly, with 46 patients (97.9%) being pain free at 6 months (p<0.01).

Conclusions: Mini plate and screw fixation of metacarpal fractures provides reliable fracture union, excellent functional outcomes, and significant pain relief, making it an effective treatment option for unstable metacarpal fractures.

Intraoperative and postoperative complications in transabdominal preperitoneal versus totally extraperitoneal laparoscopic inguinal hernia repair: a prospective randomized controlled trial

Javed Ali Khan — 2026-04-27

Background: Laparoscopic inguinal hernia repair has gained widespread acceptance due to reduced postoperative pain, improved recovery, and favorable cosmetic outcomes. Among laparoscopic approaches, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair are the most commonly employed techniques. However, comparative evidence regarding intraoperative and postoperative complication profiles remains variable.

Methods: This prospective randomized controlled trial was conducted in the Department of General Surgery at Mahatma Gandhi Medical College and Hospital from April 2024 to September 2025. Sixty patients with inguinal hernia were randomized into TAPP (n=30) and TEP (n=30) groups. Postoperative pain was assessed using the visual analogue scale (VAS), and patients were followed for six months.

Results: The mean operative time was significantly shorter in the TAPP group (60.97±11.41 minutes) compared to the TEP group (69.37±11.25 minutes; p=0.006). Early postoperative pain at 6 and 12 hours was significantly lower in the TEP group (p<0.05). Incidence of edema, urinary retention, hematoma, chronic pain, and recovery outcomes were comparable.

Conclusions: Both TAPP and TEP are safe and effective laparoscopic techniques with comparable complication profiles. TAPP offers shorter operative time, whereas TEP provides reduced immediate postoperative pain. Long-term outcomes are equivalent.

A prospective study of P-POSSUM score in predicting morbidity and mortality in patients undergoing gastrointestinal surgeries

Vishwaja Vatnala — 2026-04-27

Background: The comparison of morbidity and mortality rates is an essential component of the surgical audit using severity scores, which helps in risk prediction, identification of patients with unexpected outcomes, and improving clinical decisions. The objective was to determine the accuracy of the Portsmouth-physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM score) in predicting the anticipated morbidity and mortality rate and to compare it with the actual morbidity and mortality rate in patients undergoing gastrointestinal surgeries in the Indian population.

Methods: This study was conducted over 02 years at Mamata General Hospital. It included 80 patients who were clinically suspected cases of gastrointestinal diseases and underwent both elective and emergency gastrointestinal surgeries. Diagnosis was based on history, thorough physical examination and routine investigations. Operative parameters like operative severity, number of procedures, blood loss, peritoneal soiling, presence of malignancy, and mode of surgery were recorded for each patient as per a predetermined proforma. Patients were followed-up for a period of 30 days post-surgery.

Results: The commonest age group of the study population was less than 60 years (45%) followed by 61 to 70 years (43.8%). The male-to-female ratio was 1.6:1. The majority of the cases were of gastrointestinal perforation (22.4%) and cholelithiasis (22.4%). Surgical site infections (SSIs) were the most commonly encountered postoperative complications (55.6%). Only 05 cases of mortality were encountered. Among physiological severity parameters, systolic blood pressure, pulse rate, haemoglobin level, total leucocyte count, serum urea, and serum sodium were significantly associated with morbidity and mortality. Among operative severity parameters, blood loss, peritoneal soiling and mode of surgery were significantly associated with morbidity and mortality.

Conclusions: The P-POSSUM scoring system is a useful tool for surgical risk stratification and helps in predicting morbidity and mortality in patients undergoing gastrointestinal surgeries.

Gender differences in early outcomes after coronary artery bypass surgery

Rajib Kumar Basak — 2026-04-27

Background: Gender differences in outcomes after coronary artery bypass graft (CABG) surgery remain a matter of clinical concern despite advances in surgical techniques and perioperative care. Early postoperative complications significantly influence morbidity, mortality, and healthcare utilization. Objectives were to evaluate gender differences in early postoperative outcomes following CABG surgery.

Methods: This comparative cross-sectional study was conducted at United Hospital and included 300 adult patients who underwent isolated CABG surgery. Patients were categorized into male (n=210) and female (n=90) groups. Demographic data, comorbidities, operative details, and early postoperative outcomes (during hospital stay or within 30 days) were collected. Data were analyzed using SPSS; continuous variables were compared by independent sample t-test, categorical variables by chi-square or Fisher’s exact test, and multivariate logistic regression was performed to determine independent predictors of early adverse outcomes.

Results: Female patients were significantly older and had a higher prevalence of hypertension and diabetes mellitus (p<0.05). Early postoperative mortality, stroke, acute kidney injury, and prolonged mechanical ventilation were significantly higher among females (p<0.05). Women also had longer ICU and total hospital stay. Multivariate analysis identified female gender as an independent predictor of early adverse outcomes.

Conclusions: Female patients were older and had more comorbidities, with significantly higher early complications and longer ICU and hospital stay. Multivariate analysis identified female gender as an independent predictor of early adverse outcomes.

Incidence, diagnosis and management of abdominal wall endometriomas: a retrospective study and literature review

Catherine Kilada — 2026-04-27

Abdominal wall endometriosis (AWE) is a rare extra pelvic manifestation of endometriosis, most commonly associated with prior cesarean section, and is frequently misdiagnosed due to nonspecific clinical features. This retrospective case study describes the presentation, diagnostic evaluation, and surgical outcomes of patients with abdominal wall and umbilical endometriosis at a single institution. Ten patients with pathologically confirmed endometriosis following surgical excision were identified. Eight cases involved the abdominal wall and two involved the umbilicus. All patients with abdominal wall lesions had a history of cesarean delivery, while neither patient with umbilical endometriosis had prior abdominal surgery. The most common presenting features were localized abdominal wall pain and a palpable mass, often with cyclical exacerbation. Magnetic resonance imaging and computed tomography were employed selectively for lesion characterization and operative planning. All patients underwent surgical excision with clear margins, resulting in significant postoperative symptom improvement and no immediate complications. Abdominal wall endometriosis should be considered in the differential diagnosis of abdominal wall masses, particularly in patients with a history of cesarean section and cyclical pain. Surgical excision remains the definitive treatment and is associated with excellent clinical outcomes.

The split stitch anchor: a technique to minimize suture material at wound ends

Joseph W. Duncumb — 2026-04-27

Non-absorbable suture material can cause local irritation, connective tissue reaction and adhesions. This can lead to infection such as a stitch abscess, which may necessitate further surgical intervention. We describe a split stitch anchor technique to minimise excess suture material at wound ends with the aim of reducing infection risk.

Excision of giant fibroadenoma of the right breast managed with skin-sparing mastectomy and immediate expander reconstruction: a case report

Akshay S. R. Babu — 2026-04-27

Giant fibroadenomas are uncommon benign breast tumours, typically defined as lesions larger than 5 cm or 500 g or occupying most of the breast volume. They may cause marked breast asymmetry, skin distortion, and psychosocial distress, and often mimic phyllodes tumours on clinical and radiological assessment. We report the case of a 33-year-old woman presenting with a progressively enlarging right breast mass. Imaging revealed a well-circumscribed, heterogeneous lesion measuring 21×17×17 cm (estimated maximal diameter 30 cm) consistent with a giant fibroadenoma. The patient underwent complete excision via a partial skin-sparing right mastectomy, including nipple–areola complex removal, followed by immediate expander implant reconstruction. The excised specimen weighed 5.3 kg, representing one of the largest fibroadenomas reported in the literature. Histopathological analysis confirmed a complex fibroadenoma without atypia or malignancy. Postoperative recovery was uneventful, with excellent cosmetic and functional outcomes and no evidence of recurrence on follow-up. This case highlights an extreme presentation of giant fibroadenoma successfully managed with complete excision and immediate oncoplastic reconstruction. Early recognition, detailed imaging evaluation, and multidisciplinary surgical planning are essential to distinguish giant fibroadenoma from phyllodes tumour and to achieve optimal oncological safety with satisfactory aesthetic results.

Parotid gland pleomorphic adenoma: case report and literature review

Maria Del Carmen Arrieta Barragan — 2026-04-22

Pleomorphic adenoma (PA) is the most prevalent benign tumor of the salivary glands, usually involving the parotid gland. Surgical treatment with segmental parotidectomy can be a secure, efficacious, nerve-protection route for superficial lobe lesions. observation can potentially provide an alternative to surgery considering that they may potentially face malignant transformation despite the risks associated with surgery as well as on the quality of life.

Frontonasal paramedian flap, a Marchac flap variation used for nasal tip reconstruction after basal cells carcinoma, a suitable option for large defects: case report

Luis F. Ochoa Meza — 2026-04-27

Basal cell carcinoma (BCC) is the most common cutaneous malignancy encountered in clinical practice. Lesions frequently arise on sun-exposed facial areas, with the nose being particularly vulnerable. Oncologic management is often straightforward but reconstruction of functionally and aesthetically sensitive regions such as the nasal tip tends to be more complex. We present the case of a 64-year-old woman with a long-standing lesion involving the nasal tip without major symptoms; however, she noticed bleeding, pruritus, pain on palpation, and a mild ulceration. On examination, the lesion demonstrated clinical features suspicious for malignancy. A diagnostic biopsy was therefore performed and showed a nodular BCC infiltrating the superficial and reticular dermis, with the lesion in contact with the lateral surgical margin. Given these findings, surgical management was indicated. The patient underwent wide local excision of the lesion under appropriate anesthesia. Intraoperative margin evaluation confirmed complete tumor removal with histologically clear margins. The resulting defect of the nasal tip was reconstructed using a frontonasal flap, selected to provide reliable vascularity and adequate tissue match for this region. This case shows the importance of oncologic and reconstructive planning in the management of BCC of the nasal tip. It also supports the reliability of the frontal flap as a reconstructive option, providing acceptable functional and aesthetic results following tumor excision.

Amyand-type congenital inguinoscrotal hernia in a 70-year-old male: a diagnostic pitfall

Ramandeep Kaur — 2026-04-27

Amyand hernia, defined as the presence of the vermiform appendix within an inguinal hernial sac, is a rare clinical entity and is most commonly described in pediatric and young adult populations. Presentation in elderly patients is exceptional and often represents a long-standing congenital indirect inguinoscrotal hernia. We report a case of a 70-year-old male presenting with a left-sided irreducible inguinoscrotal swelling, diagnosed as chronic hydrocele for long. Elective surgical exploration revealed a large, thickened hernial sac with dense adhesions, a tight internal ring, and the appendix with omentum as contents. The internal ring was partially incised to facilitate reduction, followed by Lichtenstein's open mesh hernioplasty. The appendix was non-inflamed, hence preserved. This case highlights a rare presentation of Amyand-type congenital inguinoscrotal hernia in old age and underscores the diagnostic challenges associated with long-standing hernias in elderly patients.

Peritoneal carcinomatosis of unknown primary site: a case report of metastatic mucinous adenocarcinoma

Nohtseu Vadzim — 2026-04-27

Metastatic mucinous adenocarcinoma, a distinct subtype associated with extensive mucin production presents diagnostic and therapeutic challenges. This case involves a 21-year-old male with high-grade mucinous adenocarcinoma manifesting as cancer of unknown primary site, characterized by widespread peritoneal carcinomatosis and rapid progression despite systemic chemotherapy. The tumor’s aggressive behavior and thromboembolic complications underscore the need for tailored, multidisciplinary management strategies.

Acute cholecystitis secondary to Haemophilus parainfluenza: a rare occurrence

Chloe Bodden — 2026-04-27

This case report is intended to contribute to the medical community’s knowledge of the rare occurrence of Haemophilus parainfluenzae (HPI) isolated from bile fluid in a 66-year-old male with acute cholecystitis complicated by septic shock. HPI, has predominantly been known as an oropharyngeal commensal bacterium, but it’s emergence to be recognized as an opportunistic pathogen may have been under exaggerated. The patient's clinical course included an initial expected presentation of abdominal pain, sudden deteriorating condition complicated by septic shock and complications demanded for flexible yet meticulous clinical management. Clinical course continues with successful percutaneous cholecystostomy tube placement, and close multidisciplinary management involving surgery, infectious disease and cardiology. This case report serves as an opportunity to consider unexpected infectious organisms in biliary infections, a documentation of clinical resilience, and especially in patients with significant interplaying comorbidities. Additionally, the discussion elaborates on the growth requirements of HPI in bile fluid, emphasizing the significance of factor V for its proliferation.

When day seven strikes: a cautionary tale of direct oral anticoagulation resumption following thyroidectomy

Swe Z. Phyoe — 2026-04-27

Delayed neck haematoma following thyroidectomy is an uncommon but potentially life-threatening complication due to the risk of rapid airway compromise. We report a 62-year-old man with non-valvular atrial fibrillation on rivaroxaban who developed a large anterior neck haematoma on postoperative day (POD) 7, three days after resumption of anticoagulation following an initially uncomplicated total thyroidectomy with lateral neck dissection. Emergency re-exploration revealed active bleeding from a small superficial vessel between the sternocleidomastoid and platysma. The patient recovered without further complications after evacuation, haemostatic adjuncts and delayed reintroduction of anticoagulation. This case highlights the potential for clinically significant delayed haemorrhage after thyroidectomy in the context of direct oral anticoagulation (DOAC) therapy. It also emphasises the importance of vigilant post-discharge counselling regarding late warning signs and supports individualised perioperative anticoagulation strategies in head and neck surgery.

Extrahepatic portal hypertension due to chronic portal vein thrombosis with cavernous transformation treated with distal splenorenal shunt and postoperative massive lymphocele: a case report

Maximiliano A. De La Torre-Lopez — 2026-04-27

Extrahepatic portal hypertension in childhood is an important condition, frequently caused by chronic portal vein thrombosis with cavernous transformation. When physiological reconstruction is not viable, the selective portosystemic shunts remain as a useful option to preserve liver function. It is presented the case of a 13-year-old male adolescent with extrahepatic portal hypertension secondary to portal cavernoma. He had antecedents of upper gastrointestinal bleeding and severe hypersplenism. Because the portal anatomy was not suitable for a meso-Rex bypass, it was decided to perform a distal splenorenal shunt. In the postoperative period, the patient presented a massive abdominal lymphocele of high volume. The management was conservative, placing a closed Blake drainage and initiating total parenteral nutrition with fasting. After these measures, the lymphatic output had a progressive reduction until its total resolution, without needing more invasive surgeries. The distal splenorenal shunt is a valid alternative in patients with preserved liver function that cannot receive a meso-Rex bypass. The postoperative lymphocele is a rare complication in this surgery, but its conservative management with close observation can be sufficient and successful.

Giant retroperitoneal lipoma: a case report and literature review

Dato O. Habib — 2026-04-27

Retroperitoneal lipomas are exceptionally rare benign tumors, with fewer than 20 cases documented over the past four decades. We present a case of a giant retroperitoneal lipoma managed surgically to highlight the diagnostic and therapeutic considerations. A 58-year-old woman presented with a slowly enlarging abdominal mass and pain. Imaging revealed a 16-cm encapsulated retroperitoneal mass originating in the left iliopsoas muscle consistent with a lipoma. The concurrent findings included an ovarian cyst and an umbilical hernia. The patient underwent resection involving a transperitoneal laparotomy with capsular preservation. Histopathology confirmed a mature lipocytic lipoma without malignancy. This case reinforces the understanding that retroperitoneal lipomas, though rare, require meticulous preoperative evaluation with magnetic resonance imaging to distinguish them from liposarcomas. Complete surgical excision remains the gold standard in terms of yielding excellent outcomes. The documentation of such cases is crucial to expand the understanding of this rare pathology.

Arterial missile embolism following penetrating chest trauma: a case report

Nadia M. Fourie — 2026-04-27

Missile embolism is a rare but potentially serious complication of penetrating trauma that occurs when a projectile enters the vascular system and migrates within the circulation. Although described in military literature, civilian reports remain limited. A 25-year-old male presented following a gunshot wound to the left chest and arm. He was haemodynamically stable on arrival. Initial radiography demonstrated a bullet in the posterior mediastinum with a small haemothorax. Extended focussed assessment with sonography for trauma revealed a small pericardial effusion. Computed tomography performed shortly thereafter demonstrated migration of the projectile to the level of the aortic bifurcation, consistent with arterial missile embolism. The patient was transferred for cardiothoracic evaluation due to a suspected cardiac injury, which was managed non-operatively. Following transfer back to our institution, angiography confirmed the bullet lodged at the aortic bifurcation. Endovascular retrieval was attempted but was unsuccessful due to projectile deformation. Open arteriotomy was subsequently performed allowing successful bullet removal and arterial repair with a vein patch. The patient recovered postoperatively and was discharged after several days. Missile embolism is an uncommon but important diagnosis following penetrating trauma. Early imaging and high index of suspicion are critical, particularly when projectile location is incongruent with the expected wound trajectory. Multidisciplinary management is essential to optimize outcomes.

Massive haemoperitoneum with lifesaving autotransfusion following ruptured ectopic pregnancy in a low-resource setting: a case report

Weyinmi E. Kubeyinje — 2026-04-27

Ectopic pregnancy is a potentially life-threatening obstetric emergency characterised by implantation of the fertilised ovum outside of the uterine cavity. It remains a leading cause of maternal morbidity and mortality. Ruptured ectopic pregnancy can cause massive intra-abdominal bleeding requiring urgent surgery. Survival after a very large haemoperitoneum is rare, especially in low-resource settings where rapid resuscitation and surgical care may be limited. This case is being reported due to the massive haemorrhage and the good outcome. We report the case of a 27-year-old woman who presented with symptoms suggestive of early pregnancy and severe anaemia. Transvaginal ultrasound revealed a normal non-gravid uterus with no intrauterine gestational sac and a complex left adnexal mass. There was significant intraperitoneal fluid extending to the pouch of Douglas and Morrison’s pouch, suggesting haemoperitoneum exceeding 1500 ml. The patient subsequently deteriorated and was diagnosed with a ruptured left tubal ectopic pregnancy. Emergency laparotomy revealed approximately 6.5 litres of haemoperitoneum and a ruptured left ampullary ectopic pregnancy. Left total salpingectomy was performed, and autotransfusion of 5 litres was carried out. Postoperative management included intravenous fluids, antibiotics, analgesics, and close monitoring. Massive haemoperitoneum resulting from ruptured ectopic pregnancy is associated with a high risk of hypovolemic shock and maternal mortality, particularly in settings where diagnosis and intervention may be delayed. Most reported cases involve smaller volumes of intraperitoneal bleeding, as patients often deteriorate before such extensive blood loss occurs. The survival of this patient despite massive haemoperitoneum is therefore remarkable. This outcome underscores the critical role of early recognition, rapid resuscitation, and prompt surgical intervention in the management of ruptured ectopic pregnancy. It also highlights the potential benefit of supportive measures such as blood transfusion and autotransfusion in managing severe haemorrhage. Reporting such rare survivals contributes to the existing literature by demonstrating that favourable outcomes are achievable even in extreme presentations when timely and appropriate management is instituted. This case highlights the importance of early diagnosis and prompt surgical management of ectopic pregnancy to prevent life-threatening complications. Strengthening early pregnancy evaluation and improving access to ultrasound services can significantly reduce maternal morbidity and mortality associated with ruptured ectopic pregnancy.

Successful recanalization of disconnected donor and recipient ducts due to severe anastomotic biliary stricture after liver transplantation using the rendezvous technique: novel solution to an old problem

Harnoor Singh — 2026-04-27

Biliary strictures are a common adverse event (AE) following liver transplantation (LT) and can be challenging to manage when severe. Standard treatment with endoscopic retrograde cholangiopancreatography (ERCP) and stenting may fail and require alternative approaches. A 27-year-old woman developed a severe biliary stricture six months post-LT for acetaminophen-induced acute liver failure. The patient’s clinical course was complicated by cholangitis. ERCP and percutaneous transhepatic cholangiography (PTC) showed complete obstruction at the anastomosis level, resulting in disconnected donor and recipient ducts. A combined endoscopic-percutaneous rendezvous procedure successfully achieved biliary recanalization and stent placement, relieving obstruction and avoiding surgical revision or re-transplantation. The rendezvous technique is a safe, effective, and minimally invasive option for complex post-transplant biliary strictures when conventional methods are unsuccessful.

Eagle’s syndrome: retromandibular approach as a surgical management

Amit Agarwal — 2026-04-27

Eagle's syndrome is a pathology characterized by sign and symptoms affecting the pharyngeal and cervical regions, due to enlarged styloid process or calcified stylomandibular or stylohyoid ligaments originating from same. The styloid process is thin, cylindrical and pointed bony structure originating from tympanic part of temporal bone projecting inferiorly and anteriorly at base of skull, which is in close proximity to vital neuro vascular structure of cervical region. The styloid process is considered normal in length in Asian population, when it's dimensions do not exceeds 30 mm. Diagnosis can be made clinically by palpating bony prominence between angle of mandible and mastoid process, and transoral palpation of tip of styloid process. Diagnosis can be confirmed by radiographic investigation, most preferably computed tomography (CT) imaging. Extraoral retromandibular approach of styloidectomy is best and most efficient.

Desmoid tumor of the rectus abdominis mimicking a rectus sheath hematoma

Khaled Abdul Rahman Bakoban — 2026-04-27

Aggressive fibromatosis, a synonym for desmoid tumours, is a rare kind of fibroblastic growth. Any musculoaponeurotic structure in the body may develop these tumours. They are categorized as benign because of a number of unique characteristics, including regular mitotic activity and no potential for metastasis but local recurrence is not uncommon. Surgical excision is highly recommended, and computed tomography (CT) is a valuable imaging modality. This report describes the appearance of a desmoid tumor in the anterior abdominal wall of a female patient, age 28, who had three prior caesarean sections. The procedure involved removing the tumor and then using polypropylene mesh to rebuild the abdominal wall. The patient was discharged 3 days post-surgery with no adverse complications and a follow up was done 6 months.

Emphasizing rarity - laparoscopic management of an adrenal schwannoma: a case report and review of the literature

Shashank N. R. — 2026-04-27

Schwannomas are benign tumors arising from Schwann cells of peripheral nerve sheaths and are most commonly encountered in the head, neck, and extremities. Adrenal schwannomas originate from Schwann cells innervating the adrenal medulla and are typically non-functional, asymptomatic lesions discovered incidentally during imaging performed for unrelated reasons. Adrenal schwannoma is an exceptionally rare entity, accounting for less than 0.2% of all adrenal neoplasms, with fewer than 60 cases reported in the literature. Due to their rarity and nonspecific radiological appearance, these tumors are frequently misdiagnosed preoperatively as adenomas, pheochromocytomas, or adrenocortical carcinoma. We present a case of a non-functional adrenal schwannoma in a 55-year-old female, highlighting the diagnostic challenges and emphasizing the importance of histopathological confirmation.

Retained Foley catheter fragment in the urinary bladder managed with open cystolithotomy and prostatectomy

Bhavana Verma — 2026-04-27

Retained Foley catheter due to balloon non-deflation is an uncommon but clinically relevant complication. We report a rare case in which the catheter was inadvertently retained after the patient cut the external portion of the Foley catheter, leading to proximal slippage and inability to deflate the balloon. Although the patient had no documented psychiatric illness, such behavior raises the possibility of underlying psychological or behavioral factors. Conventional methods failed, the patient was successfully managed through open cystolithotomy and simultaneous open prostatectomy. This case highlights the importance of considering patient-related factors in catheter complications and emphasizes a structured management approach to prevent morbidity.

Hyaluronidase injection for anal hematoma in a high-risk patient: a case report

Snehal G. Pansare — 2026-04-27

Anal hematomas are benign anorectal lesions that often resemble thrombosed haemorrhoids. Conventional management ranges from conservative therapy to excision. In elderly patients with major comorbidities, surgical intervention may be unsafe. This report describes the first known documented use of intralesional hyaluronidase to treat a large anal hematoma in a high-risk patient. A 70-year-old woman with hypertension, ischemic heart disease, and hypothyroidism (ejection fraction 55%) presented with a 4-cm bluish swelling at the 7 o’clock perianal position, initially mistaken for a prolapsed haemorrhoid. She was deemed unfit for anaesthesia. After counselling and informed consent, intralesional hyaluronidase was injected directly into the lesion. The swelling regressed rapidly, symptoms resolved, and bowel function normalized with supportive medication. No complications or recurrence were observed during three months of follow-up. Hyaluronidase breaks down hyaluronic acid in the extracellular matrix, reducing tissue turgor and promoting resorption. It is well established in dermatology and ophthalmology but has not been reported in anorectal conditions. This case suggests it may provide a minimally invasive alternative in carefully selected patients for whom conventional surgery is contraindicated. Limitations include the single-case nature of the report and lack of standardized dosing. Intralesional hyaluronidase may be a safe and effective treatment for large anal hematomas in high-risk surgical patients. Further clinical studies are warranted.

Parathyroid carcinoma presenting as severe necrotising pancreatitis: early recognition and cure

Shikhil Puzhakkal — 2026-04-27

Parathyroid carcinoma (PC) is rare and typically presents with severe hypercalcemia. Acute pancreatitis as the initial manifestation is uncommon and may delay diagnosis. A 50-year-old lady with no comorbidities presented to the medical Gastroenterology Department with acute severe necrotising pancreatitis (CTSI 9, BISAP 2), complicated by multiorgan dysfunction. Laboratory evaluation revealed marked hypercalcemia (corrected calcium 12.3–11.3 mg/dl), hypophosphatemia (1.5 mg/dl), and a significantly elevated parathyroid hormone (PTH) level (217 pg/ml). No gallstones were identified on imaging. Further localisation with neck ultrasound and sestamibi scan highlighted a right superior parathyroid lesion. Following optimisation, the lesion was excised. Intraoperative PTH fell to 9.7 pg/ml at 30 minutes postoperatively and serum calcium normalised (POD1 9.9 mg/dl, POD2 8.4 mg/dl). Histopathology confirmed parathyroid carcinoma (25×20×15 mm) with capsular and vascular invasion. In severe or “idiopathic” pancreatitis, concurrent hypercalcemia with elevated PTH should prompt evaluation for primary hyperparathyroidism, including rare parathyroid carcinoma. Timely surgery can be curative; vigilant postoperative surveillance is essential.

Bilateral synchronous presentation of Langerhans cell histiocytosis of maxilla and mandible: a rare case report and literature review

Venkatesh Anehosur — 2026-04-27

Previously known as histiocytosis X, Langerhans cell histiocytosis (LCH) is a rare haematological condition that primarily affects new-borns and young children. The uncontrolled activation and proliferation of normal antigen-presenting cells, specifically Langerhans cells, are the defining features of this condition. A positive immunohistochemistry result for CD1a/CD207 and S100 is the gold standard for a conclusive diagnosis. There are various therapy options available for individuals with LCH. Due to its comparatively low occurrence, little information is known about the epidemiology of LCH; cases are estimated to occur 3-5 times annually per million population. In this report, we have highlighted a case of 35-year-old adult who reported to the department with Bilateral synchronous gingival enlargements in maxilla and mandible. On clinical, radiological, histopathological (Incisional biopsy) and immunohistochemical examinations revealed a diagnosis of LCH. even though LCH incidence in adults is uncommon, LCH must be taken into account when evaluating multiple osteolytic bony jaw lesions in young adults that have an unclear aetiology. So here we present a rare case of Bilateral synchronous presentation of LCH of maxilla and mandible in adult with its management.

Rare, rapid and resolved: a case of primary aggressive testicular non-Hodgkin’s lymphoma

Samit Himanshu Doshi — 2026-04-27

Primary testicular lymphoma (PTL) is a rare and aggressive extra nodal manifestation of non-Hodgkin’s lymphoma (NHL), accounting for 1-2% of all NHL cases and 5% of testicular tumors. We report a case of a 62-year-old male presenting with a rapidly enlarging painless right testicular mass and right inguinal lymphadenopathy. Imaging and PET-CT revealed a metabolically active testicular mass with regional lymph node involvement. He underwent right high inguinal orchidectomy with inguinal lymph node excision. Histopathology and immunohistochemistry confirmed diffuse large B-cell lymphoma (DLBCL), non-germinal center type, double expressor phenotype. The patient received systemic R-CHOP chemotherapy with CNS prophylaxis and adjuvant radiotherapy. Follow-up PET-CT at 1 year showed complete remission. This case highlights the importance of a multimodal approach including surgery, immunochemotherapy, CNS prophylaxis, and scrotal irradiation for optimal disease control in PTL.

Left is right and right is left: a case report of gastric antral perforation in situs inversus totalis

Ayesha Reshma V. M. K. — 2026-04-27

Situs inversus totalis (SIT) is a rare congenital anomaly in which thoracoabdominal organs are arranged in a complete mirror-image pattern. Although SIT does not increase the risk of gastrointestinal disease, it can obscure the diagnosis of acute abdominal emergencies because symptoms may appear on the opposite side. Gastric perforation in SIT is extremely uncommon, with very few cases reported worldwide. A 20-year-old male presented with two days of worsening abdominal pain and vomiting. Examination showed diffuse tenderness, guarding, rigidity, and liver dullness on the left side. A chest X-ray performed earlier revealed dextrocardia. At our centre, abdominal X-ray showed free air under the left hemidiaphragm. Computed tomography (CT) confirmed situs inversus totalis with complete visceral transposition and identified a right-sided gastric antral perforation. Emergency laparotomy revealed mirror-image anatomy of abdominal organs and great vessels. A 0.5×0.5 cm antral perforation near the lesser curvature on the right was repaired with primary closure and an omental patch. Recovery was uneventful, and the patient was discharged on postoperative day 10. SIT may delay diagnosis due to reversed symptom localisation. Early radiological evaluation, especially CT, is crucial for identifying organ transposition and guiding safe operative planning. Despite the inverted anatomy, standard surgical principles for small perforations remain effective. Gastric perforation in SIT is rare and easily missed. Prompt imaging, careful intraoperative orientation, and awareness of reversed anatomy enable safe surgical management and good outcomes.

Modified Kessler technique for extensor tendon reconstruction: a case report

Jose M. H. Rodriguez — 2026-04-06

Tendon injuries in the upper extremities are among the most prevalent types of traumatic injuries that are seen in emergency rooms. Due to the fact that the mechanism of the extensor is distinct from the mechanism used by the flexor system, it can be difficult to execute surgery to correct the issue. Discovering the optimal equilibrium between tendon mobility, sliding, and joint stability is the single most significant factor in determining one's level of competitiveness.