International Surgery Journal

Comparative safety and efficacy study of laparoscopic and open appendectomy

Ganesh J. Shinde — 2025-02-27

Background: Appendicitis is a common surgical emergency and the choice between laparoscopic and open appendectomy can significantly affect patient outcomes. This study aimed to compare the clinical outcomes and resource utilization associated with these two surgical approaches.

Methods: A prospective study was conducted on patients who underwent either laparoscopic or open appendectomy. Demographic and clinical characteristics including age distribution, type of appendicitis, leukocytes and additional surgical findings were evaluated. The two groups were evaluated and compared based on various postoperative outcomes. These included assessments of pain scores, opioid requirements, oral feeding tolerance, time taken to resume normal activities, length of hospital stay and overall expenses.

Results: This study included 100 appendicitis patients. The age distribution showed that young adults were most commonly affected. Laparoscopic appendectomy was linked to lower pain scores (2.77 vs 5.36 on day 0), reduced opioid requirement (6.7% vs 93.3%), faster oral feed tolerance (87% on day 0 vs 3% for open appendectomy) and quicker return to normal activity (2.42 days vs 5.15 days). Complications, such as wound infections and urinary retention, were lower in the laparoscopic group. However, the total cost of laparoscopic appendectomy is high.

Conclusions: Laparoscopic appendectomy yields superior clinical outcomes, including reduced pain, fewer complications and faster recovery, despite being more costly than open appendectomy. These findings suggest that laparoscopic surgery is the preferred approach for managing appendicitis when feasible.

Anterolateral thigh free flap: a superior solution for reconstruction of complex soft tissue defects in the distal leg and foot

Romana Parvin — 2025-02-27

Background: Large soft tissue defects in the lower leg and foot pose significant challenges due to exposed critical structures. This study evaluates the effectiveness of the anterolateral thigh free flap for reconstructing these complex defects. The aim of the study was to assess the effectiveness of the anterolateral thigh free flap in reconstructing complex soft tissue defects in the distal leg and foot.

Methods: This prospective observational study was conducted in the department of plastic surgery at Ibn Sina Medical College Hospital, Bangladesh, from July 2022 to December 2023, involving 30 patients with complex soft tissue defects in the distal leg and foot. Participants provided informed consent, and data collected included demographics, smoking status, comorbidities, and surgical details. The ALT flap procedure included debridement, flap design, elevation, and microsurgical techniques. Postoperative care involved monitoring, splint use, and antithrombotic prophylaxis. Outcomes were analyzed using SPSS 23.

Results: Most patients undergoing ALT free flap reconstruction were male (83.33%), with a mean age of 34.83 years. Trauma was the main cause (83.34%), affecting the lower leg (36.67%). Musculocutaneous perforators (66.67%) and the posterior tibial artery (66.66%) were common. Donor site closure used split-thickness skin grafts (60.00%). Complications included wound dehiscence, partial flap necrosis, and venous congestion (6.67% each), 73.34% had excellent outcomes.

Conclusions: The anterolateral thigh free flap is highly effective for reconstructing complex soft tissue defects in the distal leg and foot, resulting in excellent functional and aesthetic outcomes for the majority of patients.

Single-stage laparoscopic management for concomitant gallstones and common bile duct stones versus two stages using endoscopic retrograde cholangiopancreatography procedures

Ahmed Abd El-Kahaar Aldardeer — 2025-02-27

Background: The optimal treatment for common bile duct (CBD) stones remains debated, with options including open or laparoscopic exploration, and endoscopic retrograde cholangiopancreatography (ERCP) before, during, or after laparoscopic cholecystectomy (LC). This study compared outcomes of one-stage (LECBD+LC) and two-stage (ERCP+LC) procedures for patients with gallstones and CBD stones, focusing on complications and patient satisfaction.

Methods: A randomized retrospective and prospective study included 200 patients with gallstones and CBD stones. Patients were divided into group I (n=100), undergoing one-stage laparoscopic CBD exploration (transcystic or transcholedochal) plus LC, and group II (n=100), undergoing two-stage preoperative ERCP then LC. Outcomes included operative time, complications, hospital stay, residual stones, and patient satisfaction.

Results: Mean age was 43.16±12.66 in group I and 41.52±9.44 in Group II, with no significant gender differences. Preoperative jaundice was present in 88 group I and 86 group II patients. Operative times, conversion rates, and complication rates were similar. The visual analogue scale (VAS) score at 24 hours was lower in group I but comparable at 3 days. Hospital stays were similar, with 3% residual stones in group I and 0% in group II. Patient satisfaction and mortality rates showed no significant differences.

Conclusions: One-stage LCBDE with LC is equivalent to two-stage ERCP plus LC in terms of operative time, complications, hospital stay, residual stones, and patient satisfaction. Both approaches are effective, with no significant differences in outcomes.

Correlation between Glasgow prognostic score and tumor-node-metastasis staging in colorectal cancer

Asif Yazdani — 2025-02-27

Background: Colorectal cancer (CRC) prognosis is closely linked to clinical stage, with early-stage CRC offering better survival. This study aims to evaluate the relationship between the Glasgow prognostic score (GPS) and tumor-node-metastasis (TNM) staging in CRC. The aim of the study was to evaluate the relationship between the GPS and TNM staging in colorectal cancer

Methods: This cross-sectional study, conducted from June 2018 to May 2019 in the Department of Surgery at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, included 100 colorectal cancer patients. It assessed the correlation between GPS and TNM staging. Data on demographics, tumor site, GPS, and TNM stage were analyzed using Chi-square tests in statistical package for the social sciences (SPSS) version 22.0, with significance set at p<0.05.

Results: The study included 100 participants, predominantly male (59%), with a mean age of 65±10 years. The most common tumor sites were the left colon (42%) and rectum (29%). Elevated CRP levels (>10 mg/l) were observed in 25% of participants, and 34% had low albumin levels (≤35 g/l). Most participants had a GPS of 0 (56%), with 29% and 15% having GPS 1 and 2, respectively. Half of the participants were classified as TNM stage III, and 26% as stage IV. Higher GPS values significantly correlated with advanced TNM stages (p=0.0123).

Conclusions: The study demonstrated a significant relationship between the GPS and TNM staging in colorectal cancer, highlighting GPS as a potential tool for assessing disease progression.

Corneal epithelial thickness in healthy Saudi eyes: a cross-sectional study

Abdulaziz Mohammed Alshehri — 2025-02-27

Background: Corneal epithelial thickness (CET) mapping is a critical tool for corneal and refractive surgeons, aiding in the differentiation of true corneal ectasia from suspicious cases. This study aimed to establish normative CET values for a healthy Saudi population in the Taif region and investigate variations based on age and gender using anterior segment optical coherence tomography (AS-OCT).

Methods: CET was measured in 450 eyes of 225 individuals aged 10 to 70 years using the MS-39 AS-OCT device. Thickness maps were generated for three zones: central (0–3 mm), paracentral (3–6 mm) and midperipheral (6–8 mm). Each zone was subdivided into superior, inferior, nasal and temporal sectors. Statistical analyses assessed correlations between CET, age and gender. Paracentral and midperipheral zone was subdivided into superior, inferior, nasal and temporal sectors. Statistical analyses assessed correlations between CET, age and gender.

Results: Males exhibited slightly thicker central CET compared to females (53.4±4.2 µm vs. 52.8±4.0 µm, p=0.045). The central CET increased with age, with the oldest group (61–70 years) showing a 4.6% increase compared to the youngest group (10–20 years, p=0.041). Regional analysis revealed that the superior and temporal sectors were significantly thinner than the nasal and inferior sectors (p<0.05).

Conclusions: CET distribution in the Saudi population is non-uniform, with significant variations based on gender, age and corneal region. These findings provide valuable normative data for clinical practice, particularly in refractive surgery planning and corneal disease diagnosis.

Outcome of re-exploration and continuous irrigation with gentamicin-mixed normal saline via tri-channel Foley's catheter in postoperative discitis patients at a tertiary care hospital

M. Mahamudul H. Morshed — 2025-02-27

Background: Discitis, an inflammation of vertebral plates due to infection, can occur post-lumbar discectomy, affecting 0.2–4% of cases. This study assessed outcomes of re-exploration and continuous irrigation with gentamicin-normal saline via a tri-channel Foley catheter for postoperative discitis (POD).

Methods: A retrospective observational study at Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh, analyzed 30 patients with POD post-lumbar disc surgery (March 2020–February 2022).

Results: The mean age was 43.0±12.90 years, with L4/5 being the most affected level (60%). Persistent pain and fever were common (80%), with Staphylococcus aureus identified in 73.33% via blood cultures. Treatment showed significant improvements: erythrocyte sedimentation rate (ESR) reduced from 58.32±18.02 mm to 28.00±4.18 mm, CRP from 68.82±19.82 mg/l to 13.42±3.40 mg/l (both p<0.001), VAS scores from 7.52±1.73 to 1.32±1.59 (p<0.01), and JOA scores across sensory, motor, and activity parameters (p<0.01). Satisfactory outcomes were achieved in 80% of patients, with excellent results in 46.67% and good results in 33.33%.

Conclusions: Continuous irrigation with gentamicin-normal saline was effective in reducing inflammation, improving functionality, and achieving favorable outcomes in the majority of patients.

Etiologies, patterns and management outcomes among adult patients with intestinal obstruction: a 5 years’ retrospective observation at a regional referral level hospital, Eastern Zone, Tanzania

Seth Jotham — 2025-02-27

Background: Despite having centuries of existence, intestinal obstruction is still the commonest culprit among the existing causes of surgical admissions especially on emergency bases. Its persistence and piling up nature of the risk factors with the untoward management outcomes are great concerns considering the negative impacts brought down to the individual and the existing health care system.

Methods: This was a retrospective hospital based observational study of patients with intestinal obstruction for over a period of five years from January 2015 to January 2020. A standardized checklist was used to secondarily collect data from the health management information system (HMIS) books. We relied on the descriptive statistics, univariate analysis was done to check for statistical association to the outcomes of interest.

Results: We enrolled 423 patients, 23 excluded as per criteria and 400 recruited for the study. Males were more than females at a ratio of 2:1 with the mean age of 45 years (16 SD). Obstructed or strangulated abdominal wall hernia was the commonest etiology (43.4%) followed by intraperitoneal adhesions (22.1%). Patient’s age, diagnosis and management modality all influenced occurrence of the outcomes of interest with the p values of 0.03, 0.04 and <0.001 respectively.

Conclusions: Most patients in our study had complicated abdominal wall hernia followed by intraperitoneal adhesions. Given their modifiability, we recommend for an early elective intervention to patients with abdominal wall hernia but also encouraging the use of all necessary adhesion prevention strategies in all abdominal and pelvic surgeries.

Surgical outcomes of stapled hemorrhoidopexy and open Milligan Morgan procedure for treatment of hemorrhoids in tertiary level hospital

M. Mahamudul Hasan — 2025-02-27

Background: Milligan-Morgan open hemorrhoidectomy (MM) is the standard surgical method for hemorrhoids. Stapled hemorrhoidectomy (SH) is now considered a well-established procedure that is used to minimize postoperative discomfort, facilitate rapid wound healing, and accelerate recovery to regular activity. This study aimed to evaluate the surgical outcomes of SH and MM open hemorrhoidectomy.

Methods: This quasi-experimental study was conducted at the department of surgery, Rajshahi medical college hospital (RMCH), Rajshahi, Bangladesh, from January 2022 to December 2022. A total 108 hemorrhoids patients underwent SH and MM open hemorrhoidectomy are included in this study and divide equally in two group. SPSS software was used to perform statistical analysis of the quantitative data.

Results: The mean operative time for SH (27.59±8.56 min) was shorter than MM (35.21±7.13 min). SH resulted in significantly lower pain scores at 6, 12, and 24 hours postoperatively (p<0.05). Patients undergoing SH had significantly shorter hospital stays (1.32±0.84 days) compared to MM (3.1±2.8 days; p<0.001). Although SH patients had lower incidences of postoperative hemorrhage (7.4% vs. 12.96%) and wound infections (7.4% vs. 11.11%), these differences were not statistically significant. Anal stenosis decreased over time in both groups, with SH showing the lowest rate at six months (1.85%).

Conclusions: SH offers superior postoperative outcomes with reduced pain and length of hospital stay, making it a favorable alternative to the MM procedure for grade III hemorrhoids.

Predictive factors for the mortality of acute pancreatitis at the time of admission

Arpit Anand — 2025-02-27

Background: Acute pancreatitis (AP) is a potentially life-threatening condition with an unpredictable course. Prognosis is influenced by organ failure and secondary infections related to pancreatic necrosis. Identifying mortality predictors at the time of admission can guide management and improve outcomes. This study aimed to examine clinical, laboratory, and demographic factors associated with mortality in AP patients to identify early predictors of adverse outcomes.

Methods: A prospective observational study was conducted at Sri Aurobindo Medical College and Hospital, Indore, from September 2022 to February 2024, involving 174 patients with acute pancreatitis confirmed by clinical symptoms, elevated serum lipase/amylase levels, and CT imaging. Demographic, clinical, and laboratory data were collected, and binary logistic regression was used to identify mortality predictors. A p value of <0.05 was considered statistically significant.

Results: The cohort included 135 males (77.6%) and 39 females (22.4%), with the largest age group being 21-40 years. The overall mortality rate was 12.1%. A significant association was found between age and mortality, with the highest mortality rate (33.3%) in patients over 60 years. Serum albumin levels were significantly lower in deceased patients (p=0.001). No significant correlations were found between mortality and factors such as serum amylase, lipase, liver enzymes, or sex. Binary logistic regression confirmed age as the only independent predictor of mortality, with a 1.371 increase in mortality odds per additional year of age.

Conclusions: The cohort included 135 males (77.6%) and 39 females (22.4%), with the largest age group being 21-40 years. The overall mortality rate was 12.1%. A significant association was found between age and mortality, with the highest mortality rate (33.3%) in patients over 60 years. Serum albumin levels were significantly lower in deceased patients (p=0.001). No significant correlations were found between mortality and factors such as serum amylase, lipase, liver enzymes, or sex. Binary logistic regression confirmed age as the only independent predictor of mortality, with a 1.371 increase in mortality odds per additional year of age.

Comparative study between stapler hemorrhoidectomy and open hemorrhoidectomy

Sagar Batheja — 2025-02-27

Background: Hemorrhoids are very common condition, affecting approximately 1 in 4 individuals. The open hemorrhoidectomy, also known as the Milligan Morgan hemorrhoidectomy, is the gold normal for treating third- or fourth-degree hemorrhoids, The stapler hemorrhoidectomy was successfully introduced with enthusiasm because it is associated with low level of postoperative discomfort. The clinical result of stapler hemorrhoidectomy and open hemorrhoidectomy was compared in this research based on post-operative problems and return to regular activities.

Methods: This potential observational analytical study was led on 80 patients diagnosed with grade II-IV hemorrhoids over 18 months. Patients were owed into group A (OH, n=30) and group B (SH, n=50) based on surgeon in consultation with the patient after usual counselling. The above study arms group were studied and compared.

Results: Stapler hemorrhoidectomy demonstrated significant advantages, severity of pain was documented to be significantly lower, reduced hospital stay (2.06±0.77 days versus 3.57±0.73 days), earlier return to normal activities (1.82±0.75 versus 3.03±1.16), rate of complications in the form of pain and bleeding were significantly lower during 1st week and second week of follow up.

Conclusions: When compared to open hemorrhoidectomy, stapler hemorrhoidectomy has a better clinical outcome because it is linked to fewer postoperative complications, especially pain and bleeding, early bowel movements, early hospital discharge, and an early return to normal activities. To determine the incidence of recurrence after stapler haemorrhoidectomy, further clinical studies with long-term follow-up are necessary.

Prediction of the grade of acute cholecystitis by plasma level of C-reactive protein and ESR

Kundan Rai — 2025-02-27

Background: Acute cholecystitis is a common complication of gallbladder stones and common surgical disease. Tokyo guidelines have been introduced to standardize the diagnosis and evaluation of the disease. The guidelines include physical examination, laboratory results like C-reactive protein (CRP), white blood cell levels, and radiologic evaluation. The clinical severity of the disease is assigned to one of three grades based on these criteria. CRP levels are used as a diagnostic criterion. The 2018 Tokyo Guidelines include increased CRP levels as a criterion for diagnosis.

Methods: Observational analytical prospective cohort study, conducted in General Surgery Peoples hospital, Bhopal from Nov 2022 to Feb 2024, patients visiting OPD with investigations suggesting any Gallbladder infection & inflammation S/o acute cholecystitis.

Results: The study found a significant association between raised CRP levels and severe cholecystitis, with CRP levels exceeding 6 mg/L in 100% severe cases and 40% moderate cases. Additionally, ESR was significantly associated with cholecystitis grade, with all cases having raised ESR above 39 mm/hr.

Conclusions: The study found that 60% of patients with acute cholecystitis had mild symptoms, with the majority being young (57.8%). The majority of cases were male, with 62.2% of mild cases being female. The study found no significant association between the grade of cholecystitis and past history of upper abdominal surgery, pancreatitis, or acute cholecystitis. However, the presence of cirrhotic liver disease was significantly associated with moderate to severe cholecystitis. Severe cholecystitis was associated with gall bladder wall thickness, CBD diameter, multiple stones, and bile spillage.

Nigam’s scoring system: a reliable and accurate scoring system to diagnose acute appendicitis

Vinod Kumar Nigam — 2025-02-27

Background: Acute appendicitis is one of the commonest surgical emergencies. The early diagnosis of acute appendicitis is essential and should be treated by appendicectomy at earliest to avoid complications like perforation and gangrene. Various scoring systems are in use for this purpose. Nigam’s scoring system (NSS) is a reliable, easy and accurate scoring system to diagnose acute appendicitis. NSS covers up the shortcomings of other commonly used scoring systems and thus increases its accuracy factor.

Methods: NSS is based on clinical features and basic investigations without depending upon advanced investigative techniques such as USG and CT scan. The scoring points in NSS are 17 which are divided into the 3 groups, 6 and less, 7 to 10 and 11 and more. The study includes 72 patients of acute appendicitis between January 2014 and January 2024. The results of operation were compared with histopathological results.

Results: Out of 72 patients 4 patients scored 6 and less, 7 patients scored 7 to 10 and 61 patients scored 11 and more. The histopathological reports did not show any normal appendix (negative appendicectomy). Diagnostic accuracy of NSS is found to be 100% correct.

Conclusions: NSS is found as the ideal scoring system among available scoring systems due to its 100% accuracy and 0% negative appendicectomy rate (NAR). It is a reliable, simple and accurate scoring system. It requires awareness about NSS among surgeons so can be adopted in various hospitals globally.

A randomized controlled study on early and delayed laparoscopic cholecystectomy in acute calculus cholecystitis

Harshika S. Shetty — 2025-02-27

Background: Acute calculus cholecystitis, characterized by inflammation of the gallbladder due to gallstone obstruction, is a common emergency requiring effective management. Laparoscopic cholecystectomy is the gold standard treatment, but optimal timing remains debated. This study evaluates outcomes of early versus delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis.

Methods: A prospective, randomized controlled trial conducted at Srinivas Institute of Medical Sciences, Mangalore, from July 2022 to July 2023. Ninety-six patients diagnosed with acute calculus cholecystitis were randomized into early (surgery within 72 hours) or delayed (surgery after 6-12 weeks) laparoscopic cholecystectomy groups. Outcomes assessed included operative time, hospital stay, intraoperative bleeding, conversion to open surgery and complications.

Results: The early group had significantly longer mean operative time (95.47±11.41 minutes) compared to delayed group (73.69±17.67 minutes, p=0.04) but a shorter hospital stay (5.2±1.40 days vs. 7.8±1.65 days, p=0.04). The early group experienced higher intraoperative bleeding rates (38 (79.16%) versus 26 (54.16%, p˂0.001). Conversion to open surgery 8 (16.66%) versus 3 (6.25%) p=0.156) and bile duct injuries (2 (4.16%) versus 0%, p=0.241) were slightly more frequent in the early group, though not statistically significant.

Conclusions: Early laparoscopic cholecystectomy is associated with longer operative time and higher bleeding rates but offers shorter hospital stay compared to delayed surgery. Both approaches are safe and the choice should be guided by individual patient factors and surgical expertise. Early surgery can be a viable option, potentially reducing hospital length of stay without significantly worsening postoperative outcomes.

A prospective cohort study of clinical presentation and outcomes of acute pancreatitis at tertiary care center

Vivek Pahuja — 2025-02-27

Background: Acute pancreatitis present with varied symptoms and etiologies and had variety of outcomes based on severity. The study was conducted to see the clinical presentation and outcomes of acute pancreatitis at tertiary care center.

Methods: The study was carried out on 47 patients of acute pancreatitis. The clinical presentations and outcomes were noted. The severity is assessed by modified computed tomography severity index (MCTSI). Statistical analysis was done on Microsoft Excel version 21. P value<0.05 is considered significant.

Results: The mean age of patients was 36.94±10.63 years with male to female ratio of 2.6:1. Alcohol was the common etiological factor seen in 59.57% (n=28). MCTSI score was significant in detecting necrosis (p=0.00001) and predicting mortality (p value=0.000048).

Conclusions: Severe acute pancreatitis has high mortality. MCTSI is good prognostic factor for assessing morbidity and mortality.

A clinical study of the role of split-thickness skin autograft in management of wounds and identification of factors influencing the graft uptake

Shafiqa Haris — 2025-02-27

Background: Wound management is a significant concern in surgical care, with split-thickness skin grafting (STSG) being a common treatment option. To evaluate the clinical outcomes of STSG in wound management and identify factors influencing graft uptake.

Methods: This observational descriptive study was conducted at a tertiary care center among patients requiring STSG for wound management. Patients were followed up for 3 months post-STSG.

Results: A total of 40 patients were enrolled. Diabetes, hypoproteinemia, and positive wound culture was significantly associated with partial graft loss (p<0.05). The duration of the ulcer was significantly longer in patients with graft loss (p<0.05). Pain scores improved significantly after grafting in both patients with and without graft loss. Complications such as serous discharge were more common in patients with partial graft loss.

Conclusions: This study highlights the importance of optimizing wound conditions and addressing underlying comorbidities to improve graft outcomes. Diabetes, hypoproteinemia, and positive wound culture were identified as significant factors influencing graft uptake.

A comparative study between combination of topical metronidazole and diltiazem vs diltiazem alone in treatment of acute anal fissure

Abhishek Jain — 2025-02-27

Background: Anal fissure is a common anorectal condition characterized by severe pain and bleeding. Topical diltiazem is a widely used treatment, but its efficacy can be enhanced by combining it with metronidazole. To compare the efficacy of topical diltiazem with metronidazole versus topical diltiazem alone in treating acute anal fissure.

Methods: This non-randomized clinical trial was conducted among 174 patients with acute anal fissure. Patients were allocated into two groups: combination group (topical diltiazem with metronidazole) and diltiazem alone group. Patients were followed up at 1, 2 and 4 weeks.

Results: The combination group showed significant pain reduction (7.30±0.89 to 0.48±0.21, p<0.05) and higher healing rates compared to the diltiazem alone group. The requirement for surgery was significantly lower in the combination group (8% vs 20.7%, p<0.05).

Conclusions: The combination of topical diltiazem with metronidazole is a safe and effective treatment for acute anal fissure, offering rapid and sustained pain relief, improved healing rates and reduced need for surgery.

A study of the incidence of malignancy and clinicopathological correlation of incidence of malignancy in peptic perforation disease

Jishnu Chatterjee — 2025-02-27

Background: Gastrointestinal perforation, a common emergency in surgery, often results from peptic ulcer disease but can also be caused by gastric cancer. Peptic ulcers, with a lifetime risk of 10%, are more prevalent in developing countries and linked to factors like H. pylori infection, NSAID use, smoking, and stress. Complications include bleeding, perforation, obstruction, and cancer. Perforation leads to peritonitis, requiring treatment via perforation closure. Although gastric cancer accounts for 10-16% of perforations, many patients don't undergo post-operative biopsy, potentially missing cancer diagnoses. This study aimed to determine the true incidence of malignancy in perforation cases as well as in specific demographics and identify contributing factors.

Methods: The present study was aimed at determining the true incidence of malignancy in perforation cases as well as in specific demographics and identify contributing factors. Biopsies taken from the margins of gastric (antral) perforation during the operation, were subjected to histopathological examination.

Results: Our study found only 1 case of perforation in a male patient, in the 61-70-year age bracket with history of both smoking as well as alcohol, to have an associated malignancy.

Conclusions: The incidence of malignancy in gastric perforation is very low and as a result, often goes undiagnosed, resulting in lack of appropriate treatment of the underlying cancer.

Comparative study between ‘Limberg flap’ and ‘excision with secondary wound healing’ in the management of sacrococcygeal pilonidalsinus

Nirbhay Singh — 2025-02-27

Background: We conducted this comparative study between ‘Limberg flap’ and ‘excision with secondary wound healing’ to have a more informative data as far as surgical outcome is concerned for patients of sacro-coccygeal pilonidal sinus.

Methods: This study was conducted as prospective observational study on patients of sacrococcygeal pilonidal sinus admitted in the Department of General Surgery, People’s Hospital, who have been selected for operative intervention by either of two procedures during the study period of 18 months. Depending upon surgical procedure, patients were divided into two groups, group A- Limberg flap (study group) and group B- excision with secondary wound healing (control group).

Results: Mean duration of surgery was significantly higher in cases managed using Limberg flap technique as compared to excision and secondary healing. Mean pain scores, wound infection, time to wound healing, duration of hospital stay and time to return to normal activity were significantly lower in cases managed using Limberg flap as compared to excision at all the follow up (p<0.05). Mean patient satisfaction was found to be significantly higher in cases following Limberg flap group (p<0.05).

Conclusions: Rhomboid excision with Limberg’s flap technique is better technique as compared to open excision with secondary healing technique in terms of less post-operative pain, less complications, early recovery, early wound healing, short duration of hospital stay, early return to normal activity and higher patient satisfaction. The only disadvantage with Limberg flap technique is higher mean duration of surgery, attributed to additional time required for raising and suturing of flap following excision.

A one-year cross sectional study of peritoneal fluid cultures and antibiotic sensitivity patterns in cases of surgical peritonitis

Nidhi Shah — 2025-02-27

Background: Surgical peritonitis is a serious complication with significant morbidity and mortality. Understanding the microbiological profile and antibiotic sensitivity patterns is crucial for optimal management. This study aimed to evaluate the peritoneal fluid cultures and antibiotic sensitivity patterns in cases of surgical peritonitis.

Methods: This was a hospital-based prospective study conducted at D. Y. Patil University School of Medicine, Nerul, Navi Mumbai, over a one-year period. Patients presenting with peritonitis were included, and peritoneal fluid samples were collected during surgery for microbiological analysis. Antibiotic treatment was guided by the culture and sensitivity results.

Results: A total of 50 patients were enrolled. The most common etiologies were appendicitis (32%), diverticulitis perforation (24%), and perforated duodenal/peptic ulcers (44%). The predominant pathogens isolated from peritoneal fluid cultures were E. coli (16%), Bacteroides fragilis (14%), S. aureus (14%), and Streptococcus anginosus (14%). Antibiotic sensitivity patterns revealed high susceptibility to multiple antibiotics for E. coli, Bacteroides fragilis, and Klebsiella pneumoniae. However, Enterococcus faecalis exhibited concerning resistance to vancomycin and linezolid.

Conclusions: This study provides valuable insights into the microbiology and antibiotic susceptibility profiles of pathogens involved in surgical peritonitis cases. The findings can inform empiric antimicrobial treatment strategies and guide antibiotic stewardship efforts in the management of this serious condition.

Study of distal arrangement of common bile duct and pancreatic duct according to distal classification in choledochal cyst

Sasikanth Uddagiri — 2025-02-27

Background: Most widely accepted classification for choledochal cyst was Todani classification. In which, Distal extent of choledochal cyst and its resection was not clearly defined. So, this distal classification may be supplementary in guiding distal extent of cyst and its resection in various types of choledochal cysts.

Methods: This was a prospective observational study done in surgical gastroenterology at Nizams Institute of Medical Sciences, Hyderabad. All patients radiologically diagnosed as choledochal cysts were included. Patients with malignant distal bile duct stricture, refused to participate were excluded. Distal arrangement of all patients were interpreted in magnetic resonance cholangiopancreatography (MRCP) and classified distally.

Results: In the present study of 44 patients, median age was 39 years with female preponderance. Median cyst diameter was 20.5 mm. Most common types were Todani I and distal I followed by other subtypes.

Conclusions: Distal type I was the most common arrangement. So, extensive intrapancreatic dissection may be avoided to prevent dreadful complications like pancreatic fistula. Studies with larger sample and correlation with postoperative pancreatic complications should be done further.

Embryology of the non-recurrent laryngeal nerve and advancements in detection prior to surgery

Harrison H. K. Gregory — 2025-02-27

The non-recurrent laryngeal nerve (NRLN) is an uncommon anatomical variant of the recurrent laryngeal nerve (RLN). A right-sided NRLN is exceedingly more common than a left-sided NRLN, and almost all are associated with abnormalities of the aortic arch, especially a right aberrant subclavian artery (ASCA). The NRLN has a strong embryological basis, resulting from the premature obliteration of the right fourth aortic arch. Absence of this structure during longitudinal development allows the laryngeal nerve to migrate superiorly, ultimately branching from the cervical vagus nerve without entering the mediastinum. Despite a low prevalence, the presence of a NRLN is associated with a six to eight-fold increase in iatrogenic injury during surgeries of the thyroid, parathyroid and carotid structures. Pre-operative ultrasound for identification of an ASCA and thus the presence of a NRLN has demonstrated a clinically-significant reduction in the risk of laryngeal nerve damage intra-operatively. Intraoperative nerve monitoring (IONM) has also been shown as an effective alternative approach for detection of a NRLN intra-operatively. Further prospective studies exploring the effectiveness of these strategies in identifying a NRLN would be beneficial.

The case of the disappearing aneurysm - spontaneous regression of a mycotic hepatic aneurysm secondary to intravenous drug use: a case report and literature review

Ryan J. Green — 2025-02-14

Hepatic artery aneurysms are a rare but potentially life-threatening vascular lesion which require urgent diagnosis and management. This case report and literature review highlights the case of a 41-year-old female with a history of intravenous drug use who developed a 14 mm mycotic hepatic artery aneurysm after being treated for infective endocarditis. The patient initially presented with fever and abdominal pain. Bedside echocardiogram demonstrated valvular vegetations requiring emergent metallic valvular replacement. During the patient’s admission they developed further sequelae from endocarditis including splenic capsular rupture, renal infarcts and eventually hepatic artery aneurysm. This patient’s hepatic artery aneurysm spontaneously thrombosed over less than a week and regressed without surgical or endovascular intervention. This case is not only the first documented case of spontaneous regression of mycotic hepatic artery aneurysm but highlights the importance of considerations for acute abdominal pain in those with a history of intravenous drug use and concomitant infective endocarditis. It also demonstrates the possibility of conservative management in visceral artery aneurysms.

Mucosa-associated lymphoid tissue lymphoma of the right colon: a rare presentation

Inês A. Sousa — 2025-02-27

Mucosa-associated lymphoid tissue lymphoma (MALT) lymphoma affects frequently the gastrointestinal tract, most commonly the stomach. The colon is rarely affected. Both clinical presentation and endoscopic findings are variable and the histopathological with immunohistochemical analysis are needed for diagnosis. There are several treatment modalities available, with low remission rates and favorable outcomes. We present the case of an 80-year-old man who, after a positive screening faecal occult blood test, underwent a total colonoscopy which revealed an ulcerated lesion in the hepatic flexure of the colon compatible with lymphoma. After a staging CT scan of the chest, abdomen and pelvis without relevant findings except for a narrowing of the lumen of the hepatic flexure of the colon (where the tumor was located), the case was discussed by a multidisciplinary team, and it was decided to operate the patient. He underwent a laparoscopic right colectomy which was uneventful. Histopathological analysis of the surgical specimen, combined with immunohistochemistry, showed colonic MALT lymphoma. The patient subsequently completed staging with bone marrow aspiration (negative for lymphoma involvement) and respiratory testing for Helicobacter pylori, which was also negative. The patient has been followed for four years without recurrence and is completely asymptomatic. Colonic MALT lymphoma is rare and lacks characteristic presentation and diagnostic features. Surgical resection is a good therapeutic option.

Electrocution induced cardiac dysrhythmia: an Izinyoka case

Shaan Marthinus Maritz — 2025-02-27

Electrical injuries, although rare, can result in significant morbidity and mortality particularly from cardiac complications. We present a 35-years-old male who developed paroxysmal atrial fibrillation after an electrical shock, had minor burns and no prior cardiac issues. The dysrhythmia resolved during hospitalization and the patient was treated with anticoagulation and wound care before discharge.

In South Africa, electrical injuries are commonly seen in patients who attempt illegal connections (Izinyoka) often for socio-economic reasons. While atrial fibrillation is uncommon after electrocution, ECG remains essential for diagnosing dysrhythmias. There is a lack of consensus on the management of electrocution-induced dysrhythmias and further research is needed to develop tailored guidelines for regions with high socio-economic challenges.

Spontaneous uncoupling of microvascular anastomotic coupler device causing post-operative haematoma - salvage with re-coupling of the device: a case report

Dilip Gahankari — 2025-02-27

We report here a case of spontaneous uncoupling of the microvascular anastomotic coupler device (MACD), commonly known as venous coupler, causing acute post-operative bleeding and haematoma in early post-operative period, in a patient with free muscle sparing TRAM flap. This was noticed as the patient suddenly abducted her right arm post-operatively while patient tried to get up in a bed. This acute emergency was salvaged by re-engaging the coupler rings, with a simple technique with reinforced 9-0 Nylon sutures, without the need for revising the entire anastomosis.

Human subcutaneous dirofilariasis infection in Grodno Region, Belarus

Shyla Ruslan — 2025-02-27

A major worldwide concern, dirofilariasis is a zoonotic helminth disease that is transmitted by vectors. The disease is caused by nematodes of the species Dirofilaria of the family Filariidae. Mosquitoes are intermediate hosts, along with dogs, cats, and wild carnivores. The larva that penetrates human tissues after a mosquito bite begins to grow, develops and spreads the disease. A multidisciplinary approach is required because the clinical symptom is dependent on the location of the helminth. A 60-year-old woman presented with a tumor-like formation in the right temporal region of the scalp. Preliminary diagnosis was made as “epidermal cyst of the right temporal region” upon the examination. An ultrasound of the soft tissues of the right temporal region of scalp was performed and it demonstrated a hypoechoic formation of spherical shape. A thread-like formation which was curled into a ball was found following the surgical excision of the tumor-like formation. Diagnosis was confirmed following the pathohistological examination. The result of the postoperative pathohistological examination was; fibrous tissue with focal chronic inflammation with the presence of a helminth. The patient was diagnosed with “dirofilariasis of the subcutaneous fat of the right temporal region” (ICD-10, B74.8). Patients with subcutaneous Dirofilariasis should be treated with surgical excision following a thorough ultrasound examination. Early and efficient diagnosis of this disease can prevent the long suffering of the patient while misdiagnosis can lead to unnecessary investigations.

Spontaneous hemothorax in neurofibromatosis type 1: a rare case of intercostal artery aneurysm rupture and the role of permissive hypotension

Moataz Ahmed Salama — 2025-02-27

This case report presents the effective management of a rare and life-threatening spontaneous hemothorax resulting from the rupture of an intercostal artery aneurysm in a patient with undiagnosed neurofibromatosis type 1 (NF-1). The patient exhibited acute chest pain and hemodynamic instability, requiring a multidisciplinary strategy that included permissive hypotension and interventional radiology (IR). Coil embolization successfully managed the hemorrhage, resulting in hemodynamic stabilization and positive patient outcomes. This case highlights the significance of promptly identifying spontaneous hemothorax in NF-1, the necessity of targeted resuscitation strategies, and the effectiveness of minimally invasive endovascular techniques in addressing vascular complications. This case study highlights the complexities involved in addressing an atypical presentation of an undiagnosed case of NF-1, which was further complicated by a sudden spontaneous hemothorax resulting from the abrupt rupture of an intercostal artery aneurysm. This underscores the essential importance of promptly identifying life-threatening bleeding and the necessity for a resuscitation strategy that is customized to the individual patient. Additionally, it highlights the benefits of employing a permissive hypotension protocol in stabilizing the patient's hemodynamics and preventing exacerbation of bleeding. The conclusive management utilizing coil embolization through IR effectively accomplished hemostasis. This paper aims to demonstrate that an emergency medicine physician must consider uncommon differential diagnoses when faced with a patient presenting with chest pain. It is crucial to maintain a high level of suspicion for rare, life-threatening conditions, including neurofibromatosis.

Retained Endoloop ligature plastic tube, an unusual complication post appendicectomy

Lana Bricknell — 2025-02-27

Laparoscopic appendicectomies are one of the most common emergency operations. The use of ligatures is considered a safe technique for securing the appendiceal base. We describe a rare but important complication of this technique, with retention of the plastic tube from a polydioxanone (PDS) ligature in the abdominal cavity of a patient. A 64-year-old male presented with acute on chronic abdominal pain seven months following a laparoscopic appendicectomy. A CT demonstrated a bizarre linear tract extending from the bowel mesentery and right liver with associated pleural effusion. The patient underwent an exploratory laparoscopy, which identified a chronic peritonealised tract containing a plastic Endoloop^®(Ethicon, Bridgewater, NJ, USA) sheath, traversing through the small and large bowel mesentery, through the right liver and diaphragm. The hard plastic tube was retrieved from the abdomen and the diaphragm repaired laparoscopically. The patient’s severe chronic pain resolved immediately postoperatively. The use of Endoloop^®ligatures provides a simple and affordable method for appendiceal stump closure. Notably in many Australian hospitals, the Endoloop^® plastic sheaths are not part of the final instrument count in an appendicectomy. Retention of the plastic ligature tube is a rare complication, with the literature only reporting one other case of this occurring following a cholecystectomy. This rare case of retention of the Endoloop^®plastic sheath led to significant pain and morbidity and a second operation in this patient. This is the first reported case of this complication in the literature following an appendicectomy.

Breaking barriers in Boerhaave syndrome: a case of successful non-surgical treatment

Shivadev M. — 2025-02-27

Boerhaave syndrome is a rare and life-threatening condition characterized by spontaneous esophageal rupture, commonly resulting from severe vomiting. It carries a high mortality rate if untreated, particularly in delayed presentations. This report details a 44-year-old male with symptoms of breathlessness, chest pain, and vomiting after binge drinking. Initial management included nasogastric and intercostal drainage, antibiotics, and total parenteral nutrition. Diagnostic imaging revealed a left-sided esophageal tear with a fistula to the pleural cavity. Conservative treatment combined endoluminal vacuum therapy with other supportive measures, successfully reducing the esophageal defect and associated complications. The patient recovered without requiring additional surgical intervention, highlighting the potential of conservative approaches in carefully selected cases of Boerhaave syndrome. This case underscores the importance of timely diagnosis, multidisciplinary management, and advanced endoscopic therapies in achieving positive outcomes for a condition traditionally managed surgically.

Acute small intestine obstruction caused by migrating gastrostomy foley’s catheter

Vinod Kumar Nigam — 2025-02-27

Acute small intestine obstruction is a common problem and usually caused by adhesions, bands, hernias, volvulus, tumors and foreign bodies. Foreign bodies causing acute intestine obstruction is a rare occurrence. Common foreign bodies are ingested coins, marbles, small toys, bones of nonvegetarian foods, hairs and vegetable fibers. Foley’s catheter of gastrostomy, migrating in small intestine and causing acute small intestinal obstruction is one of the rarest causes. Here we presenting a case where the gastrostomy Foley’s catheter migrated to small intestine and caused acute intestinal obstruction.

Minimally invasive treatments for perforator vein thrombosis in varicose vein with recurrent thrombophlebitis: a case report

Birbal Kumar — 2025-02-27

Perforator vein thrombosis is less studied than deep vein thrombosis (DVT), because it has been considered to be a minor, self-limiting disease that is easily diagnosed on clinical grounds and that requires only symptomatic relief. The most frequently involved sites of the perforator vein are the lower limbs, especially mid leg below knee joint, mostly in relation to varicosities. Lower-limb perforator vein thrombosis shares the same risk factors as DVT; it can propagate into the deep veins, and have a complicated course with pulmonary embolism. We will report about a case of perforator vein thrombosis with recurrent thrombophlebitis and cellulitis and subfascial ligation along with thrombectomy of perforator vein thrombosis following the therapy of truncal varicose vein great saphenous vein (GSV) with endovenous laser ablation (EVLA) in one session after conservative treatment.

Enhancing intraoperative precision: transillumination technique for identification of small gut arteriovenous malformation

Shahbaz Bashir — 2025-02-27

Arteriovenous malformations (AVMs) in the small intestine, though rare, are significant causes of obscure gastrointestinal (GI) bleeding. This report discusses the use of a transillumination technique to enhance intraoperative localization and precision in the surgical management of a mid-ileum AVM. A 23-year-old male presented with a two-year history of melena and transfusion-dependent anemia. Despite normal findings on upper and lower GI endoscopy, CT enterography revealed multiple tortuous vascular channels in the mid-ileum. Surgical resection was performed, and intraoperative localization of the AVM was achieved using the transillumination technique. Postoperative recovery was uneventful, and the patient remained stable at follow-up. This case highlights the diagnostic challenges of small gut AVMs and the effectiveness of transillumination as a method to enhance intraoperative precision for identifying AVMs, complementing other diagnostic techniques such as CT enterography and video capsule endoscopy.

The deep circumflex iliac artery flap for central arch mandibular reconstruction in a patient of peripheral vascular disease: a case report

Sukanya Naskar — 2025-02-27

Carcinoma of oral cavity requires resection followed by reconstruction. For the carcinoma of alveolus, lower gingivo-buccal sulcus or gingivo-lingual sulcus of middle 3^rd bony reconstruction is required. Generally free fibula flap is preferred. But free fibula cannot be harvested if there is peripheral vascular disease. Here we present a case of carcinoma alveolus of mandible middle 3^rd in a case of peripheral vascular disease. Deep circumflex illiac artery used instead of free fibula flap. Patient had a very good outcome, facial cosmesis was good, no hernia in the donor site.

Unique and one of the longest appendix operated recently: a case report

Varsha Anna Varghese — 2025-02-27

Appendectomy is usually performed as an emergency operation to treat appendicitis, which is when the appendix becomes inflamed and infected due to an obstruction. We present the case of an 18-year-old boy with persistent pain in right iliac fossa, which was clinically diagnosed as appendicitis. On investigations, an ultrasound of abdomen and pelvis revealed inflamed appendix with free fluid surrounding appendix. Exploratory open appendectomy was done. Intraoperatively, it demonstrated a very long 17.2 cm inflamed appendix which was removed successfully and rest was uneventful Postoperatively, patient is doing well on follow-up. Hence, it is concluded that in patients with appendicitis, appendectomy is the definitive management along with antibiotics. If delayed can present as perforated appendix and leading to further complications.

Ultra early cranial and spinal metastasis in a post-operative case of 4th ventricle medulloblastoma case: a case report

Abhishek Kumar — 2025-02-27

Medulloblastoma is a type of brain tumour that occurs primarily in children and is relatively rare in adults. It has a tendency to spread through the cerebrospinal fluid pathways and can metastasize to other parts of the body, including the bones. Osseous extra-neural metastasis is uncommon, but the radiologic findings are usually sclerotic, lytic, or mixed when it occurs. In this paper, we present a case of medulloblastoma metastasizing to the cervical, dorsal and lumbar spine as well as intracranial spread and describe the magnetic resonance appearance of the lesion and also emphasize the importance of recognizing the imaging findings of metastatic lesions in patients with a history of medulloblastoma.

Duplicated common bile duct with pancreatic adenocarcinoma

Atul Kapoor — 2025-02-27

A 42-year-old South Asian male presented to our hospital with anorexia, abdominal pain, and jaundice. Abdominal ultrasonography revealed a 3.5×3.5 cm hypoechoic solid mass in the pancreatic head with central necrosis, resulting in dilatation of the proximal common bile duct, main pancreatic duct, and intrahepatic biliary system. Magnetic resonance cholangiopancreatography (MRCP) confirmed the ultrasonographic findings and identified complete duplication of the biliary system with a mildly dilated duplicated common bile duct that exhibited pancreaticobiliary maljunction (PBM) with narrowing and was opening into the main pancreatic duct at the pancreatic body level. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the pancreatic mass revealed adenocarcinoma. This case illustrates the rare occurrence of a duplicated common bile duct (DBCD) associated with a pancreatic head mass, underscoring the need for comprehensive imaging and a multidisciplinary approach in the management of complex hepatopancreatic biliary pathologies. This case also suggests a modification to the existing Choi classification of DBCD to include PBM anomalies. Further research is required to understand the long-term outcomes of these anatomical variations in pancreatic malignancies.

An unusual case of an elderly patient with multifocal pyomyositis

Vishesh Vashishtha — 2025-02-27

Pyomyositis is an uncommon infection of the skeletal muscle that typically results in the formation of an abscess. We report an unusual case of a 74-year-old lady who presented with impaired mobility for 04 months, bilateral diffuse lower limb swelling without other signs of inflammation and normal leucocyte count, which emerged as methicillin-resistant Staphylococcus aureus (MRSA) pyomyositis involving different compartments of both lower extremities and responded promptly with timely surgical intervention. The role of high index of suspicion, sequential multimodal imaging in assessing infectious musculoskeletal pathologies and prompt timely operative intervention for source control remains pivotal.

Management of chemical injury with total corneal scar and cicatrization treated with simple limbal epithelial transplantation and amniotic membrane transplantation: a case report

Sushma Suram — 2025-02-27

Chemical injuries to the eye are medical emergencies that can result in severe visual impairment or blindness, especially when complicated by limbal stem cell deficiency (LSCD) and cicatrization. Simple limbal epithelial transplantation (SLET) combined with amniotic membrane transplantation (AMT) has shown promise in treating such conditions, offering a path to restore corneal clarity and function. A 46-year-old male presented with sudden vision loss, redness, and pain in the left eye following a chemical injury. Examination revealed a total corneal scar with cicatrization, and the patient was diagnosed with LSCD. He underwent SLET combined with AMT for corneal restoration. Postoperatively, gradual corneal clarity was observed, and vision improved to counting fingers at 2 meters, though further improvement was limited due to a cataract. This case underscores the potential effectiveness of SLET + AMT in managing severe chemical injuries complicated by LSCD. While partial recovery was achieved, further surgical intervention for cataract removal may be necessary to optimize visual acuity. The case highlights the importance of early diagnosis and timely surgical management in such patients.

Not all that glitters is metal: a rare case of mechanical small bowel obstruction

Shrirang V. Kulkarni — 2025-02-27

Mechanical small bowel obstruction (MSBO) is a common surgical emergency presenting usually because of adhesions due previous abdominal surgeries. Fecolith are usually present in large bowel and are formed mainly due to stasis and dehydration. Small bowel fecolith are extremely rare cause of MSBO which are usually present in setting of inflammatory bowel disease and divertculae. We present a case of acute MSBO due to small bowel fecolith in a frail elderly lady with Dengue fever, who was suspected to have ingested metallic foreign bodies. An emergency mini laparotomy was performed with extraction of fecolith from the distal ileum with resection of strictured distal ileum and end to end ileo-ileal anastomosis. The patient developed features of peritonitis on post-operative day 4 and revealed massive hemoperitoneum with anastomotic leak and was managed with peritoneal lavage and double barrel stoma formation. She was resuscitated with blood products but continued to deteriorate during her post-operative course. This case report aims to analyse and present options which could have been done as a part of damage control surgery, rather than going ahead with a definitive procedure.

A case report of primary small bowel neuroendocrine tumor with large metastatic lymph node at root of mesentery with tumor fibrosis

Saravana Kumar I. — 2025-02-27

Small bowel neuroendocrine tumors (NETs) are rare but are increasing in incidence advances in imaging techniques. NETs are a heterogeneous group of tumors with diverse clinical and imaging presentations. Although these tumors are typically smaller in size, they can cause significant fibrotic reactions in the bowel wall, lymph nodes, and mesentery. Due to the relatively rare occurrence of these tumors, limited awareness among physicians and nonspecific clinical symptoms, patients with small bowel NETs often experience considerable delays in diagnosis and inappropriate management. We present a case of a 58-year-old female who came with recurrent abdominal pain, distension, vomiting, significant weight loss and poor appetite. Although imaging findings were suggestive of a mesenchymal tumor, intraoperatively we could find a stricturising lesion in the ileum with a mesenteric mass. She underwent resection and anastomosis of the small bowel lesion along with mesenteric nodal excision. Interestingly, the postoperative biopsy revealed a well-differentiated Grade 2 intermediate-grade ileal NET with mesenteric nodal involvement. On immunohistochemistry (IHC), tumour cells show low Ki-67 index with positive for chromogranin and synaptophysin.

Gastro-splenic fistula due to isolated splenic tuberculosis: an unusual case report

Ashok K. Baskar — 2025-02-27

Gastrosplenic fistula is an uncommon condition, usually associated with splenic malignancies especially lymphomas. Few cases of gastrosplenic fistula are reported secondary to post traumatic splenic abscess, gastric ulcer, miliary tuberculosis. Isolated splenic tuberculosis is very rare. Gastrosplenic fistula due to isolated splenic tuberculosis is an extremely rare presentation. Here, we report a case of a 53-year-old man who presented with upper abdominal pain and fever. Computed tomography (CT) of abdomen showed multiple splenic abscess with splenic vein thrombosis. Upper gastrointestinal (GI) scopy showed fundal varies and submucosal nodular lesion at fundus. Endoscopic ultrasound showed splenic abscess probably infiltrating the fundus of stomach. He underwent open splenectomy with fistulous tract resection and pancreatic tail resection. Intraoperatively, the fistulous tract was identified at posterior aspect of fundus. The fistulous tract was excised and stomach edges were closed primarily. He recovered well without any complications. Histopathological examination showed splenic tuberculosis, and he was started on anti-tuberculosis treatment.

Salmonella enterica and Entamoeba histolytica co-infection presenting as multiple liver abscesses in an immunocompetent patient

Jaiveer Singh — 2025-02-27

People living with the human immunodeficiency virus (PLHIV) are likelier to have Salmonella infections and bloodstream invasion than immunocompetent people. Here, we present a case with liver abscess due to co-infection Entamoeba histolytica and Salmonella enterica with no co-morbidities, immunocompromised states or any alcohol or other substance abuse history. A 36-year-old male with no significant co-morbidities presented with complaints of abdominal pain and fever. On examination, the right hypochondrium was tender without guarding or rigidity. Amoebic serology was positive. Stool culture isolated Salmonella group B and abscess culture revealed Salmonella enterica. HIV serology was negative. The ultrasound revealed hepatomegaly, two well-circumscribed abscesses in the liver, with right-sided pleural effusion. The patient was managed with ultrasound-guided pigtail drainage, followed by antibiotic therapy. Even though the co-infection of Salmonella and Entamoeba leads to abscess in immunocompetent individuals, which is rare, we should not overlook the possibility of the diagnosis.

A rare case of ancient Schwannoma of the ulnar nerve

G. Raghavendra Prasad — 2025-02-27

Schwannomas are benign tumors of neural crest origin that can arise from any nerve. Ancient Schwannomas are an exceedingly rare but benign variant characterized by degenerative changes on histopathology, often mimicking malignancy. Here, we report a case of a 45-year-old man presenting with a painful swelling in the left hand. Magnetic resonance imaging (MRI) suggested Schwannoma. Surgical excision revealed the tumor arising from a branch of the ulnar nerve. Histopathological examination confirmed the diagnosis of ancient Schwannoma through immunohistochemistry.

Nocturnal enigmas: a systematic review of bangungot and sudden death during sleep

Robert A. Bancod — 2025-02-27

Bangungot and sudden unexplained nocturnal death syndrome (SUNDS) remain complex phenomena at the intersection of culture and medicine. This systematic review investigates their epidemiological prevalence, cultural interpretations and genetic foundations. We highlight the urgent need for culturally sensitive public health interventions by synthesizing Southeast Asia and Fiji's findings. Key findings indicate Brugada Syndrome, associated with genetic mutations such as SCN5A, as a primary medical explanation, while environmental and lifestyle factors further elevate risk. Integrating cultural narratives with scientific research can improve strategies to address and reduce sudden nocturnal deaths.

Early postoperative outcomes and complications of laparoscopic versus open ventral/incisional hernia repair: a meta-analysis

Arjun Chinnappa — 2025-02-27

Laparoscopic repair has been increasingly utilized for ventral/incisional hernias, but its impact on early postoperative outcomes remains debated. We conducted a meta-analysis comparing early complications and recovery after laparoscopic versus open ventral hernia repair. A systematic literature search was performed using Medline, Embase, and Cochrane databases to identify studies comparing laparoscopic and open ventral/incisional hernia repair. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated for postoperative outcomes using random-effects models. Fourteen randomized controlled trials and observational studies encompassing 1,340 patients were included. Operative duration was longer for laparoscopic repair (pooled weighted mean difference 25.1 min, 95% CI 15.8-34.4 min), but length of stay was shorter (pooled weighted mean difference -1.52 days, 95% CI -2.04 to -1.00 days). Pain scores favoured the laparoscopic technique at 24 hours (pooled mean difference -1.54 units, 95% CI -2.09 to -0.99 units) and 1 week (pooled mean difference -1.74 units, 95% CI -2.67 to -0.81 units). Laparoscopic repair had lower risks of overall complications (OR 0.49, 95% CI 0.33-0.71) and surgical site occurrences (OR 0.22, 95% CI 0.12-0.40). The risks of mesh infection and bowel obstruction were similar between groups. Laparoscopic ventral hernia repair results in shorter hospital stays, less pain, faster recovery and fewer wound complications compared to open repair. These findings support the use of a minimally invasive approach. Technical training is necessary to avoid increased operative times.