International Surgery Journal

A case of spontaneous splenic rupture causing hemorrhagic shock in a 74-year-old on Apixaban

Nana Marfo — 2026-08-26

Spontaneous splenic rupture is a rare, life-threatening cause of atraumatic intra-abdominal hemorrhage and may occur in patients receiving anticoagulation. We present a 74-year-old woman with atrial fibrillation treated with apixaban who presented with one day of worsening abdominal pain and near-syncope without preceding trauma. She was hypotensive on arrival, with hemoglobin of 5.8 g/dl, elevated lactate, and acute kidney injury. Computed tomography (CT) of the abdomen and pelvis demonstrated a lower-pole splenic laceration with active contrast extravasation, subcapsular hematoma, and hemoperitoneum. She underwent immediate resuscitation with intravenous fluids, packed red blood cells, and prothrombin complex concentrate for anticoagulant reversal, followed by emergent exploratory laparotomy. Operative findings confirmed hemoperitoneum and an actively bleeding spleen with capsular avulsion; splenectomy was performed. Her postoperative course included intensive care monitoring, additional transfusion support, temporary pharmacologic thromboprophylaxis that was discontinued because of incisional bleeding, and post-splenectomy vaccination. She was discharged on postoperative day 7 without anticoagulation pending cardiology follow-up and remained clinically well at subsequent postoperative visits. This case highlights spontaneous splenic rupture as an important diagnostic consideration in anticoagulated patients presenting with unexplained abdominal pain, anemia, or hemodynamic instability despite no history of trauma. Prompt imaging, anticoagulant reversal, resuscitation, and definitive operative management are critical to survival, while post-hemorrhage anticoagulation decisions require individualized multidisciplinary assessment.

Oncological treatment and upper lip reconstruction in basal cell carcinoma: case report and review of reconstructive options

Carla M. Cruz Rocha — 2026-08-26

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and frequently affects sun-exposed facial regions. Lesions of the upper lip are considered high risk due to their tendency for local invasion, recurrence, and involvement of critical functional and aesthetic subunits. Optimal management requires complete oncologic excision followed by anatomically precise reconstruction. We report the case of a 66-year-old woman with a recurrent nodular BCC of the upper lip after prior incomplete excision. Margin-controlled surgical resection was performed with intraoperative frozen-section analysis. Persistent deep margin involvement required extension of the excision to include the upper lip, anterior nasal vestibule floor, and premaxillary periosteum, resulting in a defect involving approximately 40% of the upper lip. Immediate reconstruction was carried out using a layered anatomical approach, including separate repair of the mucosa and orbicularis oris muscle, bilateral perialar advancement flaps, and an additional local cutaneous flap to reconstruct the central tubercle. This case highlights the importance of achieving complete tumor clearance in recurrent BCC, particularly in high-risk anatomical regions such as the upper lip. Reconstructive planning must balance oncologic safety with restoration of oral competence, symmetry, and aesthetic subunits. Local advancement flaps, especially perialar techniques, represent reliable options for moderate defects (30–50%), providing good functional and cosmetic outcomes when combined with meticulous layered repair. The presence of recurrence and periosteal involvement underscores the need for multidisciplinary evaluation, including consideration of adjuvant therapies. Recurrent upper-lip BCC requires an integrated approach combining aggressive oncologic resection with tailored reconstruction. Layered repair and local advancement flaps allow effective restoration of both function and aesthetics in moderate-sized defects, supporting their role as first-line reconstructive options in appropriately selected cases.

Primary peritoneal cystic echinococcosis: a rare surgical entity

Mahmoud Dabbagh — 2026-08-26

Hydatidosis is a cosmopolitan parasitic disease that represents a major public health concern in endemic regions such as Morocco. Secondary peritoneal hydatidosis results from intraperitoneal dissemination of Echinococcus granulosus larvae. This rare condition is polymorphic in presentation, and its diagnosis relies on a combination of epidemiological, clinical, biological, and radiological findings. We report a rare case of peritoneal hydatidosis in a patient referred for management of recurrent hepatic hydatid cysts. Physical examination was unremarkable, while serological testing for hydatidosis was strongly positive. Abdominal computed tomography was essential in demonstrating hepatic recurrence associated with multiple peritoneal cystic lesions. The patient underwent surgical management consisting of cyst excision and drainage. Postoperative recovery was uneventful, and adjuvant albendazole therapy was initiated. Peritoneal hydatidosis remains a rare and diagnostically challenging entity. This case highlights the pivotal role of imaging in establishing the diagnosis and supports combined surgical and antiparasitic management as the cornerstone of treatment.

Overlapping symptoms of pelvic metastasis and degenerative spine disease in colorectal cancer: a challenge in early diagnosis

Muhammad Adib Fajar Anwar — 2026-08-26

Colorectal cancer (CRC) is the second leading cause of cancer mortality worldwide. 90% of CRC-related deaths are due to metastasis. One of the rarer CRC metastases is bone metastasis, especially pelvic metastasis, with minor symptoms that frequently overlap with other degenerative diseases. The 85-year-old woman with CRC experienced progressive lower back pain radiating to both legs. CT scan showed degenerative spine disease. Further bone scan revealed lytic lesions on the superior pubic ramus, prompting a rare diagnosis of pelvic metastasis in CRC. The clinical symptoms exhibited by a late-onset CRC patient, consisting of lower back pain radiating to both legs, accidentally concealed the rare presence of pelvic metastasis. In this case, the bone metastasis was successfully diagnosed following a routine bone survey, underscoring the importance of this procedure. Delayed diagnosis plummets the median survival from 20-30 months to just 2-3 months; clinicians must be aware of minor skeletal symptoms and utilize early advanced imaging to avoid catastrophic diagnostic delays and poor treatment outcomes. This rare case of pelvic metastasis in a CRC patient highlights the importance of not undermining minor skeletal symptoms in CRC patients and thoroughly exploring the possible cause of symptoms to avoid underdiagnosis or delays in diagnosing rare metastasis that could potentially alter outcomes for the worse.

Proximal extensor mechanism reconstruction: modern principles in zone IX injuries: a case report

Mauricio A. Espinosa-Romero — 2026-08-26

Zone IX extensor tendon injuries of the forearm are uncommon but complex lesions involving the musculotendinous unit and, frequently, the posterior interosseous nerve, resulting in significant functional impairment despite limited external injury. We present the case of a 27-year-old woman with a sharp laceration to the proximal dorsal forearm causing complete loss of active extension of the second through fifth digits. Surgical exploration confirmed complete transection of the extensor digitorum communis tendons with proximal retraction, which were repaired primarily using U-shaped 3-0 absorbable Vicryl sutures, followed by postoperative immobilization in a functional extension position. A narrative review of the current literature addressing epidemiology, anatomy, imaging, surgical management, suture biomechanics, and rehabilitation of zone IX extensor injuries was also performed. This case highlights that successful management requires comprehensive anatomical assessment, evaluation of posterior interosseous nerve integrity, stable primary repair with appropriate tension, and structured rehabilitation. It also emphasizes the limited evidence available for these injuries and the need for further research on zone-specific epidemiology, rehabilitation protocols, and biological augmentation strategies to optimize functional outcomes.

Delayed diagnosis of appendicovesical fistula following orchidectomy for testicular abscess: a case report

Ahmad Farid Nazmi Ahmad Shukri — 2026-08-26

Appendicovesical fistula (AVF) is a rare subtype of enterovesical fistula that most commonly develops as a complication of chronic or recurrent appendicitis. Owing to the predominance of urinary rather than gastrointestinal symptoms, diagnosis is frequently delayed, resulting in recurrent infections, repeated investigations, and unnecessary interventions. A 31-year-old man presented with recurrent urinary tract infections (UTIs) complicated by a testicular abscess requiring orchidectomy. Histopathological examination demonstrated non-specific chronic active inflammation. Previous cystoscopy identified a small posterior bladder opening, which was managed as a bladder diverticulum, while colonoscopy was unremarkable. Persistent urinary symptoms prompted referral to the colorectal team, and computed tomography urography suggested an enterovesical fistula. Exploratory laparotomy demonstrated the appendiceal tip adherent to the bladder dome with a calcified faecolith within the appendiceal lumen. Appendicectomy with partial cystectomy was performed. Histopathological examination confirmed a benign AVF. The patient recovered uneventfully with complete resolution of urinary symptoms. AVF should be considered in patients with recurrent or persistent UTIs when conventional urological investigations are inconclusive. Early recognition with contrast-enhanced computed tomography (CT) and timely definitive surgical management can prevent prolonged morbidity and achieve excellent clinical outcomes.

A rare case of submassive pulmonary embolism after spontaneous rupture of superficial femoral artery pseudoaneurysm

Catherine Kilada — 2026-08-26

Spontaneous rupture of a superficial femoral artery (SFA) pseudoaneurysm without prior trauma or intervention is exceedingly rare. This report includes a 45-year-old man with morbid obesity (BMI 38) who presented with acute left lower extremity pain and swelling after experiencing a “pop” in his posteromedial thigh while bending. Imaging revealed a ruptured distal SFA branch pseudoaneurysm with a large hematoma, successfully treated with thrombin injection. On postoperative day one, he developed bilateral pulmonary emboli with right heart strain, progressing to submassive pulmonary embolism by day three. This case highlights hematoma-induced venous compression as a potential mechanism for venous thromboembolism.

Complex pleural complications in metastatic cholangiocarcinoma: a case report highlighting massive subcutaneous emphysema, bronchopleural fistula and palliative hemostatic radiotherapy

Carlos Alberto Sánchez Soto — 2026-08-26

Cholangiocarcinoma (CCA) is an aggressive biliary malignancy with poor prognosis, typically diagnosed at advanced stages. Common metastatic sites include liver, lymph nodes, and peritoneum, while pleural involvement remains rare and poorly described. Such atypical presentations may lead to significant morbidity and complex clinical scenarios requiring invasive management. This study reports a rare case of metastatic CCA with pleural involvement complicated by severe pleuropulmonary manifestations, including infection, bronchopleural fistula, (BPF) and massive subcutaneous emphysema occurring in the setting of malignant pleural disease and persistent pleural air leak requiring one-way valve drainage, as well as life-threatening intrapleural bleeding successfully managed with palliative hemostatic radiotherapy. This case highlights the diagnostic and therapeutic challenges associated with uncommon metastatic patterns in CCA.

Small-intestinal Castleman disease mimicking a neoplastic lesion: a case report

Gowshika Seetharaman — 2026-08-26

Castleman disease (CD) encompasses a group of rare lymphoproliferative disorders with diverse clinical presentations, histopathological features, and treatment approaches. This most commonly involves the mediastinal lymph nodes. Involvement of the small intestine is exceedingly uncommon and it often mimics more prevalent pathologies such as gastrointestinal stromal tumours (GIST), lymphoma, or neuroendocrine tumours. Early recognition is essential as surgical excision is typically curative in unicentric disease. A 38-years old male presented with complaints of dull aching pain in left upper abdomen for 1 year. CECT abdomen showed a soft tissue mass in the left lumbar region suggesting of neoplastic etiology. He underwent laparoscopic jejunal mesenteric soft tissue tumour excision with resection and anastomosis of jejunum. Post operative biopsy was suggestive of CD. CD of the small intestine is exceptionally rare and it is often misdiagnosed as other small bowel tumours. Pre-operative identification is extremely challenging due to non-specific clinical and radiological findings. Complete surgical excision remains the cornerstone of management for unicentric disease and is associated with excellent outcomes.

A rare presentation of intraabdominal desmoid tumour

P. S. Sarangi — 2026-08-05

Desmoid tumors are rare deep-seated tumors of mesenchymal origin with 2-4 cases per million. Etiology is multifactorial with variable prognosis. These are highly locally invasive but have no ability to metastasize. A 51-year-old male patient who presented with swelling in the right upper abdomen and heaviness in abdomen. On investigating, there was a mass arising from the anti-mesenteric border of the ileum, caecum and ascending colon. Resection of the tumor with the attached ileum, caecum, ascending colon along with the ileo-colic anastomosis was performed. Post operatively, no chemo-radiotherapy was given and patient was on follow-up since then with no recurrence. Desmoid tumor also commonly known as fibromatosis are large soft tissue tumors of mesenchymal origin are locally aggressive tumors with almost no ability to metastasize. Asymptomatic tumors and small tumors can be managed conservatively with close follow-up. Symptomatic and large tumors are usually managed with surgical resection and radiotherapy. Positive margins lead to higher rates of recurrence. This case, reports the rare presentation of a large intra-abdominal sporadic desmoid tumor arising from the anti-mesenteric border of the bowel. Such cases require multi-disciplinary approach with cautious and meticulous resection to prevent capsular rupture.

The deceptive groin mass: encysted hydrocele of the canal of Nuck mimicking an inguinal hernia in an adult female

Hima Pavan — 2026-08-05

An encysted hydrocele of the canal of Nuck is a rare developmental anomaly in adult females, resulting from the incomplete obliteration of the processus vaginalis. It frequently mimics an inguinal hernia, leading to diagnostic challenges. We present the case of a 38-year-old female who presented with a right inguinal swelling present for five months. The patient exhibited a reducible right groin swelling that became prominent on straining, initially diagnosed clinically as a right inguinal hernia. Magnetic resonance imaging (MRI) demonstrated a 10-mm defect in the right inguinal region with an adjacent 18×10 mm cystic lesion. The patient underwent an open surgical exploration under spinal anesthesia. Intraoperatively, a well-defined cystic swelling containing clear fluid was identified along the round ligament, with no indirect hernia sac or peritoneal communication. The sac was completely excised, and the weakened posterior wall was reinforced using a 6×11 cm polypropylene mesh. Histopathological examination confirmed fragments of fibrocollagenous to muscular tissue with chronic inflammatory cells, consistent with a hydrocele sac. The patient had an uneventful postoperative recovery. The canal of Nuck hydrocele is a rare embryological relic that acts as a diagnostic chameleon in adult females, easily masquerading as a standard inguinal hernia. Definitive management requires a high index of intraoperative suspicion, complete surgical excision of the cyst, and concurrent prosthetic reinforcement of the frequently attenuated inguinal floor to ensure recurrence-free recovery.

Large retroperitoneal cystic schwannoma causing mass effect

Maharshi Vyas — 2026-08-26

Retroperitoneal schwannomas are rare benign tumors originating from Schwann cells of the peripheral nerve sheath. Due to their deep location and slow growth, they often remain asymptomatic until they reach a considerable size, leading to pressure symptoms on adjacent structures. We reported a case of a 52-year-old male, who presented with progressive abdominal swelling and urinary symptoms. Imaging revealed a large retroperitoneal cystic mass, which was completely excised. Histopathological examination confirmed the diagnosis of schwannoma. Retroperitoneal schwannoma should be considered in the differential diagnosis of retroperitoneal cystic lesions presenting with urinary complaints. Complete surgical excision is both diagnostic and curative.

Case report of intestinal malrotation with midgut volvulus

Paulia Devi Thanislas — 2026-08-26

Intestinal malrotation is a congenital anomaly resulting from the failure of the midgut to undergo normal rotation and fixation during embryonic development. This anatomical aberration predisposes patients to midgut volvulus, a life-threatening torsion of the primary mesenteric axis where the bowel twists around the superior mesenteric artery (SMA). If left untreated, this can rapidly progress to catastrophic bowel ischemia and necrosis.The clinical profile, comprehensive diagnostic findings, and emergent surgical management of a rare case of midgut volvulus in an adolescent patient were thoroughly evaluated. Radiological evaluation included an Upper Gastrointestinal (GI) Contrast Series and contrasted abdominal imaging to critically assess anatomical landmarks and confirm the diagnosis prior to operative intervention. Following resuscitation, the patient underwent an emergent open Ladd procedure. Intraoperative findings included the presence of chylous ascites, and the midgut volvulus was carefully untwisted in a counterclockwise direction. Ladd’s bands were systematically divided, the mesenteric base was significantly broadened to prevent recurrence, and a routine inversion appendectomy was performed. The patient had an uneventful postoperative recovery. The Ladd procedure remains the definitive and gold-standard surgical treatment for this critical diagnosis, effectively placing the bowel in a stable state of non-rotation. Clinicians must maintain a high index of suspicion in patients presenting with signs of high intestinal obstruction, intermittent abdominal pain, or unexplained feeding intolerance, regardless of the patient's age.

Spontaneous knotting of infant feeding tube in the urinary bladder

Lakshman Singh Pal — 2026-08-26

In neonatal intensive care settings and paediatric wards, healthcare providers frequently use infant feeding tubes for urinary bladder catheterization when appropriately sized Foley catheters are unavailable. Though it is a safe procedure, it can lead to a serious problem if the catheter knots spontaneously inside the urinary bladder. This report describes an unusual complication where a 6 French feeding tube became knotted spontaneously within the bladder of a 3-month-old male infant during routine urinary catheterization performed for urine sample collection and output monitoring. The knotted catheter was extracted via percutaneous endoscopic suprapubic cystotomy. The patient had a successful post-operative recovery.

From obstructive uropathy to syndromic suspicion: a case of multiglandular primary hyperparathyroidism and pancreatic nodule mimicking multiple endocrine neoplasia type 1

Vinodh Duraisamy — 2026-08-26

Multiple endocrine neoplasia type 1 (MEN-1) is an autosomal dominant disorder characterized by synchronous or metachronous tumor development within the parathyroid glands, enteropancreatic neuroendocrine framework, and anterior pituitary. A 48-year-old female presented with severe bilateral loin pain and anuria lasting 1 month. Comprehensive imaging revealed bilateral hydroureteronephrosis from staghorn and renal calculi requiring urgent bilateral double-J (DJ) stenting. Subsequent endocrine evaluations demonstrated hyperparathyroidism (PTH: 191.9 pg/ml). Targeted 99mTc-Sestamibi SPECT-CT and 68Ga-Trivehexin PET-CT localized multiple hyperfunctioning parathyroid adenomas. Systemic staging via MRCP identified an additional 1.7 cm cystic neuroendocrine tumor within the uncinate process of the pancreas, structurally mimicking a classic MEN-1 phenotypic cluster. The clinical constellation of multiglandular parathyroid adenomas/hyperplasia combined with a cystic neuroendocrine tumor of the pancreatic uncinate process presents a classic phenotypic presentation mimicking MEN-1 syndrome (Wermer's syndrome).While the pituitary MRI was completely unremarkable at this stage, the coexistence of primary hyperparathyroidism and a suspicious pNET strongly mandates long-term genetic screening (MEN-1 gene mutation analysis) and close clinical surveillance. The patient's acute obstructive uropathy has been successfully managed via bilateral DJ stenting, and metabolic control has been targeted via targeted parathyroidectomy.

Giant recurrent cutaneous squamous cell carcinoma of the gluteal region managed with wide local excision and split-thickness skin grafting in a medically complex patient: a case report

Swarnava Chanda — 2026-08-26

Cutaneous squamous cell carcinoma (cSCC) is an invasive malignancy that rarely presents as a giant, exophytic mass in non-sun-exposed regions like the buttocks. We report the case of a 74-year-old male tiles worker with a 15-year history of plaque psoriasis, coronary artery disease (triple vessel disease), hypertension, and type II diabetes mellitus, who presented with a massive recurrent right gluteal cSCC measuring 15×15 cm. The recurrence emerged two years following a primary excision done in 2024. Contrast-enhanced computed tomography (CECT) scan demonstrated extensive superficial infiltration tracking from the L3 to S5 vertebral levels, strictly confined to the skin and subcutaneous layers with completely preserved underlying musculoskeletal planes. Concomitant necrotic bilateral inguinal lymphadenopathy was pathologically confirmed via fine-needle aspiration cytology (FNAC) to be reactive lymphadenitis driven by tumor superinfection rather than metastatic spread. Following optimization of his dual antiplatelet and antidiabetic therapy, the patient underwent an aggressive, margin-negative wide local excision. The massive soft-tissue defect was successfully reconstructed using a meshed split-thickness skin graft (STSG). This case illustrates that giant, locally advanced cSCC can remain anatomically confined to superficial tissue planes, rendering surgical curative resection and immediate autologous skin grafting achievable even in a highly complex cardiovascular patient.

Newer method of segmental lateral internal sphincterotomy in chronic fissure-in-ano: a case report

Shubham R. Bobade — 2026-08-26

Fissure-in-ano is a common anorectal condition characterized by a linear tear distal to the dentate line, presenting with severe burning pain during defecation, constipation, and bleeding per rectum. Lateral internal sphincterotomy (LIS) remains the gold standard surgical intervention for chronic fissure-in-ano refractory to conservative management; however, it carries a well-recognized risk of postoperative anal incontinence, which has prompted investigation into technically modified approaches. Segmental lateral internal sphincterotomy (S-LIS), in which the internal anal sphincter is divided in two parts at different planes rather than as a single continuous cut, has been proposed as a continence-preserving alternative. In the present case report, a novel single-incision technique of segmental lateral internal sphincterotomy was employed, wherein both segments of the internal anal sphincter were sequentially elevated and divided through a single stab incision. The patient experienced an uneventful postoperative recovery, was discharged on postoperative day three, and demonstrated complete fissure healing with no recurrence on long-term follow-up. A systematic review of the literature identified four published studies, of which three clinical trials met eligibility criteria for inclusion. The single-incision segmental lateral internal sphincterotomy technique described herein may effectively eliminate the risk of postoperative anal incontinence while offering the additional advantages of a single wound, reduced procedural morbidity, and a minimally invasive operative approach.

A rare case of heterologous breast leiomyosarcoma in a pregnant female: challenges in diagnosis and management

Rachna — 2026-08-26

Primary breast sarcomas are exceptionally rare malignancies, accounting for less than 1% of all breast neoplasms and fewer than 5% of all soft tissue sarcomas. Primary leiomyosarcoma (LMS) of the breast is a rarer subtype, comprising less than 0.0006% of all breast malignancies. Fewer than 90 cases have been documented in the global literature since the disease was first described. The occurrence of a malignant phyllodes tumour harbouring heterologous leiomyosarcoma during pregnancy represents a rare case presentation. We present the case of a 37-year-old G2P1L1A0 women with gestation period of 24 weeks presented with a left breast lump of one year duration of size 10x8 cm that was painless and without any concerning features. Patient did not have any comorbidities or a significant family history. Ultrasonography was suggestive of a benign lactational adenoma. Core biopsy revealed borderline phyllodes tumour. Simple Mastectomy was done in second trimester with the final histopathological diagnosis of malignant phyllodes with heterologous component of leiomyosarcoma. Although breast leiomyosarcomas are rare and carry a more favourable prognosis than other primary non-phyllodes breast sarcomas, the presence of a malignant phyllodes tumour with heterologous LMS component the patient at a substantial risk for local recurrence or delayed hematogenous metastasis. Given that recurrence and metastasis can arise even after prolonged latent periods of 15 to 20 years, rigorous, lifelong clinical and radiological follow-up remains mandatory.

Gallbladder carcinoma presenting as hemorrhagic cholecystitis in a patient living with HIV: a diagnostic challenge

Gowshika Seetharaman — 2026-08-26

Hemorrhagic cholecystitis is an uncommon but potentially life-threatening surgical emergency characterized by hemorrhage into the gallbladder lumen. Although it is usually associated with severe inflammation, trauma, anticoagulant therapy, or vascular disorders, its occurrence secondary to gallbladder carcinoma is exceedingly rare. Intraluminal hemorrhage may obscure an underlying malignancy, posing a diagnostic challenge. A 39-year-old woman living with HIV on antiretroviral therapy presented with severe right upper quadrant pain and fever of one day's duration. Ultrasonography and contrast-enhanced computed tomography demonstrated a markedly distended gallbladder with heterogeneous hyperdense intraluminal contents, suggestive of hemorrhagic acalculous cholecystitis. In view of the acute abdomen, an emergency open cholecystectomy was performed. The gallbladder was grossly distended and contained approximately 100 ml of organized blood clot. Gross examination of the resected specimen revealed an irregular intraluminal mass. Histopathological examination demonstrated a poorly differentiated gallbladder carcinoma invading the muscular layer (pT1b). Retrospective review of the preoperative CT images revealed an enhancing intraluminal lesion that had been masked by hemorrhagic contents. Gallbladder carcinoma should be considered in patients presenting with hemorrhagic cholecystitis, particularly when imaging demonstrates focal intraluminal abnormalities. This case highlights the diagnostic challenge posed by intraluminal hemorrhage and underscores the importance of meticulous gross examination and routine histopathological evaluation of all cholecystectomy specimens to identify occult malignancy.

Extensive tumour thrombosis from a differentiated thyroid carcinoma masquerading as a right atrial mass

Saloni Chheda — 2026-08-26

Thyroid carcinomas are well recognized for their propensity to cause tumour thrombosis, most confined to the cervical vessels. However, extensive thrombosis involving the mediastinal veins and right atrium is exceedingly rare. Such advanced tumour thrombosis is associated with a high risk of hematogenous dissemination and pulmonary metastasis, adversely affecting overall survival. We report the case of a 74-year-old man with papillary thyroid carcinoma presenting with tumour thrombus extending into the right atrium in the absence of pulmonary metastases. The patient underwent successful single-stage complete surgical resection without significant perioperative morbidity. He remains on regular follow-up and has been disease-free for 2 years following surgery.

A brief review of lifestyle modification strategies for the management of anal fissure

Shubham Bobade — 2026-08-26

Lifestyle includes an individual's daily habits, behaviors, and routines, including dietary choices, physical activity, work schedules, and sleep patterns. Anal fissures are small, superficial tears in the lining of the anal canal, causing significant pain and discomfort, often affecting patients’ quality of life. Classified as either acute or chronic, anal fissures commonly result from lifestyle factors such as diets high in spicy, junk, or fast foods, irregular sleep patterns, sedentary behavior, night shifts, alcohol consumption, and smoking. These factors contribute to the onset and persistence of fissures by promoting constipation and increasing sphincter spasm. Traditional management options for anal fissures include stool softeners, topical anesthetics, and surgical interventions like lateral anal sphincterotomy, which, despite their efficacy, carry risks such as incontinence, fistula formation, and other complications. While numerous reviews have addressed the surgical and conservative treatment approaches, the role of lifestyle modification as a complementary strategy has not been extensively studied. This applied review aims to evaluate the impact of lifestyle interventions, such as dietary adjustments, increased fiber and fluid intake, regular sitz baths, pelvic floor physical therapy (PFPT), yoga, and self-massage, in the management of anal fissures. These non-invasive strategies can significantly reduce sphincter spasm, alleviate symptoms, and promote healing, offering a patient-centered approach that minimizes reliance on pharmacological or surgical interventions. The review discusses the potential benefits of integrating lifestyle modification as both primary and adjunctive therapy for anal fissures, providing evidence that supports improved patient outcomes and reduced recurrence rates. Emphasizing lifestyle changes can empower patients with self-management tools that enhance the overall effectiveness of treatment and improve quality of life.

Modified “keyhole” technique for preservation of the uterine round ligament during transabdominal preperitoneal with groin hernias: a case series of 9 patients

Lihua Zhao — 2026-08-26

The "keyhole" technique, utilized in laparoscopic transabdominal preperitoneal (TAPP) hernia repair, sacrifices the integrity of the mesh, which is critical for preventing hernia recurrence. We present a series of 9 female patients with inguinal hernias who underwent TAPP using a modified "keyhole" technique at our hospital between January 2022 and June 2025. The modified technique involved precise mesh positioning using a dual-mesh configuration, with the two mesh pieces straddling the round ligament from above and below, and the openings closed with sutures to restore mesh integrity. The mean operative time was 46.8±8.9 min, and the mean estimated blood loss was 7.7±2.8 ml. No postoperative complications were observed, and all patients reported satisfactory recovery. At a mean follow-up of 12 months, no recurrence, mesh infection, or chronic pain was documented. This modified "Keyhole" technique appears to be a feasible and effective approach for female patients with inguinal hernias, offering favorable short-term outcomes while preserving the round ligament and maintaining mesh integrity. Our series suggests that this technique may reduce the risk of recurrence associated with conventional Keyhole repair, though long-term follow-up in larger cohorts is warranted.

Gracilis muscle flap reconstruction as a surgical alternative in anorectal pathology: a report of three cases at ISSEMYM Medical Center

Eduardo Daniel Tafolla Madriz — 2026-08-11

Recurrent anovaginal and rectovesical fistulas, and recurrent rectal prolapse, remain challenging for colorectal and reconstructive surgeons because of high recurrence rates, fibrosis from prior surgery, impaired sphincter function, and poor local tissue quality. The pedicled gracilis muscle flap is a versatile option, used as an interposition flap for complex fistulas or as static graciloplasty to support the sphincter complex and pelvic floor in selected prolapse cases. We describe the characteristics, management, and early outcomes of three patients who underwent gracilis reconstruction at ISSEMYM Medical Center between 2025 and 2026: two with complex fistulas and one with recurrent rectal prolapse. The first, with a history of radical prostatectomy, developed a persistent rectovesical fistula treated by fistula takedown and gracilis interposition after failed primary repair. The second, a 59-year-old woman with a recurrent low rectovaginal fistula, underwent resection of fibrotic tissue and gracilis interposition after failed fistulectomy and sphincter repair, later showing persistent recurrence. The third, an 81-year-old woman with recurrent rectal prolapse after prior rectopexy, underwent static graciloplasty with a Thiersch ring; her course was complicated by wound dehiscence, intestinal obstruction requiring colostomy, and hospital-acquired pneumonia, but she achieved a favorable outcome with no recurrence. The pedicled gracilis flap is a safe, reproducible option for complex fistulas and static graciloplasty in recurrent rectal prolapse, particularly after failed conventional treatment. It delivers well-vascularized tissue, reinforces tissue barriers, and supports the sphincter complex, though success depends on lesion etiology, fibrosis, prior surgeries, tissue quality, and patient selection.

Evaluation of arthroscopic pull-through fixation in posterior cruciate ligament avulsion fractures: clinical and radiological results from a case series

Ritwika Nandi — 2026-08-26

Posterior cruciate ligament (PCI) avulsion fracture is a rare type of ligamento osseous injury which is usually caused by high velocity injuries. The objective of this case series is to evaluate the improvement of knee function over time by measuring Lysholm knee score of patients treated by arthroscopic pull through fixation technique. This is a case series study of patients with PCI avulsion fractures from January 2024 to December 2025. All the patients were subjected to a single tibial tunnel pull through fiber tape fixation of the PCL over the anterior aspect of tibia. The results were analyzed by measuring knee ROM and Lysholm score over time and clinico-radiological confirmation of bony union. The patients which were included in the study consisted of 9 males and 1 female. Mean age of all the patients came around 37.6. The average knee flexion of all the patients at 6 weeks was 82 degrees, at 12 weeks was 124 degrees, at 6 months-128 degrees and at the end of 12 months was almost 130 degrees. None of the patients had any sort of extension lag. Radiological union was determined over serial X-rays and none of the study participants had non union. The mean Lysholm knee score at 6 weeks was 72.6, at 12 weeks was 80, at 6 months-88.2 and at end of 12 months it came around 95. Arthroscopic pull through fixation of PCI Avulsion fractures yielded good results with satisfactory knee function over time and faster rehabilitation.

Necrotizing enterocolitis: what is the role of social determinants of health

Jordan Stone — 2026-08-26

Background: Neonatal necrotizing enterocolitis (NEC) is a gastrointestinal emergency predominantly affecting premature and low-birth-weight infants. NEC mortality rates range from 20-40%, but can be as high as 100% in severe forms of the disease. Recent studies have examined social determinants of health (SDOH) in neonatal disease and emerging evidence suggests that they may also influence outcomes in NEC. This study aimed to evaluate the association between maternal socioeconomic disadvantage, measured by the Area Deprivation Index (ADI) and NEC in a community hospital setting (Queens, NY). We examined whether higher ADI levels in a diverse patient population were associated with disease presentation, severity index and adverse clinical outcomes.

Methods: We conducted a single-center retrospective study at Flushing Hospital Medical Center in Queens, NY of 21 neonates diagnosed with NEC between October 2012 and 2024; neonates without a confirmed diagnosis of NEC during this period were excluded. Utilizing state ADI from the Neighborhood Atlas, neonates were categorized into less disadvantaged (ADI <5) or more disadvantaged (ADI >5). Bivariate analysis determined differences among demographics and clinical characteristics, including maternal BMI and neonatal birth weight, laboratory values and treatments. IRB approval was obtained.

Results: 21 neonates with NEC between 2012 and 2024 were studied, 9 females and 12 males, with a median gestational age of 24-25 weeks and 6 days. Twenty mothers had government-provided insurance. Among 21 neonates with NEC, 18 were categorized as less disadvantaged and 3 as more disadvantaged based on ADI. The more disadvantaged cohort showed a median birth weight of 600-699 g and less acidosis with a base deficit (BD -3.7-7.8) compared to the less disadvantaged cohort: BW 650-750 g and more acidosis with base deficit (-12.5-16.1). The more disadvantaged maternal cohort was younger (20-29 y), of Hispanic descent, with a higher BMI (34-37.9) and 33% positive for Group B Streptococcus (GBS). The less disadvantaged cohort had a median age of 30-39 y, BMI 30-33.9 and 27.8% positive for GBS. The neonates from the less disadvantaged cohort underwent surgical intervention more than the more disadvantaged, 38.9% versus 33%.

Conclusions: Social determinants of health should be considered among risk factors associated with NEC. Surgeons may need to include them in their initial evaluation. We recognize that our small sample from a single center provided limited data, but replication could lead to earlier recognition and potentially improved outcomes.

Elective surgery cancellations: the experiences and reasons in a tertiary hospital in port Harcourt, Nigeria

Sunday Imasuen — 2026-08-26

Background: Elective surgery cancellations have been reported in major centres in developed and developing economies and its occurrence is avoidable. This study explored the experiences and reasons for elective surgery cancellations and proffered solutions for improved service delivery at the Rivers State University Teaching Hospital.

Methods: A cross-sectional observational study was carried out among total population of consenting staff of Surgical Departments from April 2023 to March 2024. Self-administered questionnaire was used and data was analysed using SPSS.

Results: There were 66 (54.5%) male and 55 (45.5%) female respondents. Their mean age was 34.09±9.14 years and mean years of practice was 6.39±3.92 years. Ninety-one (75.2%) were aware of elective surgical cases cancellation and this varied from 1-3 per week (n=81; 66.9%), 4-6 per week (n=7; 5.8%), >6 per week (n=4; 3.3%). The most common reason for case cancellation was poor patient preparation (n=37; 30.6%), followed by financial challenges on the part of the patient (n=30%; 24.8%), etc. Patient-related factors, central sterile supply department (CSSD) factor, anaesthetists’ factor, surgeon's factor, perioperative nurses' factor, theatre technicians' and potters’ factor, were notable contributors. Suggestions were made relating to patients, staff and the hospital/government.

Conclusions: Multiple factors lead to occurrence of elective surgical case cancellations. Predominant reasons were poor patients’ preparation, brought about by patient-related and other factors. Joint efforts are recommended for mitigation.

Effects on pulmonary arterial systolic pressure after surgical closure of ventricular septal defect

Nawrin Hossain — 2026-08-26

Background: Pulmonary arterial hypertension (PAH) is a common complication of ventricular septal defect (VSD) caused by chronic left-to-right shunting and increased pulmonary blood flow. This study evaluated the effect of surgical VSD closure on pulmonary arterial systolic pressure (PASP) in patients with varying degrees of pulmonary hypertension.

Methods: This prospective observational study was conducted in the Department of Cardiac Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from July 2022 to June 2024. Sixty patients with isolated VSD and pulmonary hypertension who underwent elective surgical closure were enrolled and divided into three groups according to preoperative PASP: Group A (36–45 mmHg), Group B (46–60 mmHg) and Group C (>60 mmHg). PASP was assessed by transthoracic Doppler echocardiography before surgery, on the first postoperative day, at one month and at three months after surgery. Data were analyzed using SPSS version 26 and a p value <0.05 was considered statistically significant.

Results: The mean age ranged from 5.98±4.31 to 6.33±3.88 years, with no significant differences in age or sex distribution among the groups. PASP decreased progressively following surgical closure in all groups. Significant reductions were observed on the first postoperative day and at one month (p<0.001). By three months, mean PASP decreased to 27.80±7.96 mmHg, 28.40±4.95 mmHg and 30.05±9.83 mmHg in Groups A, B and C, respectively, with no significant difference among the groups (p=0.285). One postoperative death occurred in the severe pulmonary hypertension group.

Conclusions: Surgical closure of VSD significantly reduces pulmonary arterial systolic pressure across all grades of pulmonary hypertension. Early surgical intervention may facilitate reversal of pulmonary hypertension and improve postoperative hemodynamic outcomes.

Perioperative serum lactate as a predictor of postoperative morbidity and mortality in major abdominal surgery: a prospective observational study

Akhil Yadav — 2026-08-26

Background: Major abdominal surgery carries significant postoperative morbidity and mortality, driven by tissue hypoperfusion and metabolic derangement. Serum lactate, a sensitive marker of anaerobic metabolism, is a recognised prognostic indicator in surgical and critically ill patients. This study evaluated perioperative serum lactate as a predictor of in-hospital mortality and morbidity in major abdominal surgery.

Methods: This prospective observational cohort study was conducted in the Department of General Surgery, R.N.T. Medical College, Udaipur, over one year. Sixty consecutive adults (18–80 years) undergoing elective or emergency major abdominal surgery were enrolled. Arterial lactate was measured preoperatively (L0), at 12 hours (L1) and 24 hours (L2). Complications were graded by Clavien-Dindo. ROC analysis, Mann-Whitney U, Chi-square and logistic regression were applied.

Results: Among 60 patients (55.0% male; mean age 47.6±17.8 years), morbidity was 43.3% (n=26) and mortality 15.0% (n=9). Lactate differed significantly between survivors and non-survivors at all three time points (p < 0.001). L2 best predicted mortality (AUROC 0.993; 95% CI 0.956–1.000) at a 2.35 mmol/l cut-off (sensitivity 100%, specificity 96.1%, PPV 81.8%, NPV 100%). Mildly elevated L0 (2–4 mmol/l) carried 22-fold higher odds of death (OR=22.0; 95% CI 3.4–141.2; p=0.001). On regression, L2 was the strongest predictor (OR=18.24; p=0.002), followed by L1 (OR=6.82; p=0.008).

Conclusions: The 24-hour postoperative serum lactate is a near-perfect predictor of in-hospital mortality in major abdominal surgery, with a validated cut-off of 2.35 mmol/l. Routine three-point perioperative serum lactate monitoring is strongly recommended as a cost-effective tool for early risk stratification in patients undergoing major abdominal surgery, particularly in resource-limited tertiary care settings.

Randomised controlled trial of mesh fixation with nonabsorbable versus delayed absorbable suture in open inguinal hernia patients undergoing open inguinal hernioplasty in tertiary health center of Ahmedabad

Divya Jyoti Banerjee — 2026-08-26

Background: Inguinal hernia repair is a globally frequent surgical procedure. The Lichtenstein tension-free hernioplasty is highly effective, yet the optimal suture material non-absorbable versus delayed absorbable for mesh fixation remains debated regarding its impact on postoperative pain and complications.

Methods: A prospective, single-center, randomized controlled trial was conducted on 200 adult patients with primary inguinal hernias. Patients were randomized to undergo open Lichtenstein hernioplasty using either 2-0 polypropylene (non-absorbable, n=100) or 2-0 polyglactin (delayed absorbable, n=100) sutures. Postoperative pain (visual analog scale), recurrence rates, hospital stay, and complications were evaluated over a 6-month follow-up.

Results: Postoperative pain scores showed no statistically significant difference between the polypropylene and polyglactin groups at any time point up to 6 months. The incidence of complications, including wound infection, local swelling, seroma, and recurrence, was comparable across both groups. Duration of hospital stay was also similar.

Conclusion: Delayed absorbable polyglactin sutures provide a safe and effective alternative to non-absorbable polypropylene sutures for mesh fixation in open Lichtenstein inguinal hernioplasty, offering comparable short-term outcomes in pain and complication rates.

Diagnostic accuracy of ultrasonography and fine needle aspiration cytology in thyroid swellings: correlation with final histopathology

Usha Kiran Kondepati — 2026-08-26

Background: Thyroid nodules are common in clinical practice and accurate preoperative differentiation between benign and malignant thyroid nodules is essential to avoid unnecessary surgery while ensuring timely management of malignancy. Ultrasonography (USG) and fine needle aspiration cytology (FNAC) are commonly used diagnostic tools, but their accuracy varies across clinical settings. To evaluate the diagnostic accuracy of USG and FNAC in thyroid swellings by comparing preoperative findings with final histopathological examination.

Methods: This retrospective observational study included 190 patients with thyroid swellings who underwent thyroidectomy at a tertiary care centre between January 2015 and May 2022. Preoperative USG and FNAC findings were correlated with postoperative histopathology. Sensitivity, specificity and diagnostic accuracy of each modality were calculated.

Results: Of the 190 patients screened, 187 with complete histopathological data were included in the final correlation analysis. Histopathology confirmed malignancy in 75 cases (40.1%) and benign disease in 112 cases (59.9%). When correlated with final histopathology, FNAC demonstrated sensitivity of 77.3%, specificity of 87.5% and diagnostic accuracy of 83.4% as compared to USG with sensitivity of 82.7%, specificity of 63.4% and diagnostic accuracy of 71.1%. Sonographic features such as taller-than-wide shape, solid composition and punctate echogenic foci showed significant association with malignancy (p<0.01).

Conclusions: USG and FNAC are valuable complementary tools in evaluating thyroid swellings. FNAC is a highly specific and accurate diagnostic modality for thyroid swellings, while USG serves as an effective screening and risk stratification tool. Their combined use significantly improves diagnostic accuracy and helps reduce unnecessary thyroid surgery, although histopathology remains the definitive diagnostic modality.

Role of pro- and anti-inflammatory cytokines in diabetic neuropathy

Ravikumar Gopalakrishnan — 2026-08-26

Background: Diabetic neuropathy (DN) is one of the most prevalent complications of type 2 diabetes mellitus, characterized by progressive peripheral nerve damage primarily resulting from chronic hyperglycaemia. Emerging evidence implicates inflammation as a key contributor to its pathogenesis. Pro-inflammatory cytokines such as IL-2, TNF-α and IL-6 promote neural injury, whereas anti-inflammatory cytokines like IL-10 and IL-4 may exert neuroprotective effects. This study aims to evaluate the serum levels of selected pro-inflammatory (IL-2, TNF-α, IL-6) and anti-inflammatory (IL-10, IL-4) cytokines in patients with diabetic neuropathy and to analyse their correlation with neuropathy severity.

Methods: A prospective, observational case control study was conducted involving 80 participants, comprising 40 diabetic neuropathy patients and 40 healthy controls at Thanjavur Medical College, Thanjavur, Tamil Nadu, India during the period of June 2025 to December 2025. Demographic characteristics, biochemical parameters and serum cytokine levels including interleukin (IL)-10, IL-4, IL-2, IL-6 and tumor necrosis factor-alpha (TNF-α) were analysed. Statistical analysis was performed using SPSS version 26.0.

Results: This study results showed that, IL-6 was significantly increased in diabetic neuropathy patients (median 8.35 (3.27–22.89) pg/mL) compared with healthy controls (2.39 (2.13–3.00) pg/ml) (p=0.007). IL-10 also demonstrated a significant change between groups (p=0.0003). No significant differences were observed for IL-4, IL-2 and TNF-α levels. Correlation analysis revealed that no significant association between HbA1c and cytokine levels. ROC curve analysis demonstrated that IL-10 exhibited the greatest diagnostic performance with an AUC of 0.882, followed by IL-6 with an AUC of 0.784.

Conclusions: The findings of the present analysis indicate that inflammatory dysregulation is associated with diabetes neuropathy patients. IL-6 and IL-10 emerged as the most significant potential cytokines and demonstrated promising diagnostic utility. These biomarkers may serve as valuable indicators of inflammation in diabetic patients and may contribute to the development of future diagnostic and therapeutic strategies. Further studies with larger sample sizes are warranted to validate these study findings.

Role of preoperative upper gastrointestinal endoscopy in patients with symptomatic cholelithiasis: a prospective study

Snolin Shiromi Antonyrajan — 2026-08-26

Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic cholelithiasis. However, several upper gastrointestinal (UGI) disorders may present with symptoms similar to gallstone disease and can contribute to persistent symptoms following surgery. This study aimed to evaluate the diagnostic yield of preoperative UGI endoscopy (UGIE) in patients with symptomatic cholelithiasis and identify coexisting UGI pathologies.

Methods: A prospective observational study was conducted among patients with symptomatic cholelithiasis diagnosed by ultrasonography who underwent preoperative UGIE. Demographic data, clinical presentation, and endoscopic findings were reviewed and analyzed.

Results: Ninety patients with symptomatic cholelithiasis were included in the study. UGIE was normal in 17 (18.89%) patients, while 73 (81.11%) patients demonstrated abnormal findings. The stomach was the most commonly affected site, with gastritis being the predominant pathology. Other UGI abnormalities were also identified, indicating a substantial coexistence of gastrointestinal disorders in patients presenting with symptomatic gallstone disease.

Conclusions: A significant proportion of patients with symptomatic cholelithiasis demonstrated concomitant UGI pathology on endoscopic evaluation. Preoperative UGIE may aid in identifying coexisting gastrointestinal disorders and facilitate comprehensive management of patients presenting with symptoms attributed to gallstone disease.

Management of empyema in paediatric patients: experience at a tertiary care centre

Shivani Ganesh Trivedi — 2026-08-26

Introduction: Lung empyema is an ancient disease that remains a significant clinical problem in paediatric patients. The most common precursor is bacterial pneumonia and subsequent pleural effusion. Despite widespread antibiotic use and pneumococcal vaccines, empyema continues to be a major complication of pneumonia and a leading cause of morbidity and mortality worldwide.

Methods: A retrospective review of medical records of paediatric patients diagnosed with lung empyema at Parul Sevashram Hospital from January 2022 to August 2025 was conducted. Treatment modalities ranged from conservative management (injectable antibiotics) to surgical interventions, including intercostal drainage (ICD) tube insertion, intrapleural streptokinase therapy, video-assisted thoracoscopic surgery (VATS), and thoracotomy.

Results: Sixty patients were included in the study. 20 were treated conservatively with injectable antibiotics. Surgical interventions were employed in 40 patients: ICD insertion (40 patients), intrapleural streptokinase (16 patients), VATS (2 patients), and thoracotomy (16 patients).

Conclusion: This study compares the management of lung empyema at different stages and evaluates associated morbidity and mortality.

Evaluation of a structured patient education protocol to achieve symptomatic pain relief and reduction in anxiety in patients with mastalgia: a randomized controlled trial

Pavithra Balakrishna — 2026-08-26

Background: Mastalgia is the most common presentation to Breast Clinics, reassurance forms the first line of management. No studies have explored structured patient education in mastalgia till date.

Methods: Patients with mastalgia for more than 1 month were randomized to structured patient education and reassurance group. The structured patient education format was designed by the principal investigator and validated by 3 subject experts. Both the groups were assessed with visual analog scale (VAS) for pain, 12-item short form health survey (SF-12) for quality of life and generalized anxiety disorder-7 scale (GAD-7) for anxiety at baseline, 4 and 12 weeks after intervention. The assessor was blinded.

Results: A total of 64 patients were randomized equally into two groups. Both groups showed improvement in pain and anxiety scores over time. A statistically significant improvement in the SF-12 physical component summary (PCS) was observed in the structured education group at 12 weeks (p=0.032). Improvements in mental component summary (MCS) and GAD-7 anxiety scores were observed in both groups, but without statistically significant difference. Analgesic use decreased in both groups, with a trend toward greater reduction in the structured education group.

Conclusions: Structured patient education improves the physical component of quality of life in women presenting with mastalgia and may contribute to better overall symptom control compared to routine reassurance alone. While both interventions reduce pain and anxiety, structured education provides a standardized and potentially more effective approach to patient counselling.

Effect of rigid cystoscopy and Foley urethral catheterisation on serum prostate-specific antigen levels: a prospective observational study

Deepika Bishnoi — 2026-08-26

Background: Serum prostate-specific antigen (PSA) is the cornerstone biomarker for prostate cancer detection, but its interpretation is complicated by transient elevations from non-malignant causes including mechanical urinary-tract manipulation. How much rigid cystoscopy and Foley catheterisation raise serum PSA individually and combined in one sitting remains poorly defined in the Indian setting. This study evaluated the magnitude and persistence of procedure-induced PSA elevation.

Methods: This prospective observational study was conducted at RNT Medical College and Maharana Bhupal Government Hospital, Udaipur, over one year (January–December 2025). Sixty male patients were grouped by procedure: Group 1 diagnostic rigid cystoscopy alone (n=39); Group 2 Foley catheterisation alone (n=14); Group 3 Foley catheterisation followed immediately by cystoscopy in the same sitting (n=7). Serum total PSA was measured by ELISA at baseline, 1 hour and 24 hours. Paired t-tests and one-way ANOVA with Bonferroni correction were applied.

Results: In Group 1, PSA rose from 1.96±1.51 to 2.72±1.81 ng/ml at 1 hour (ΔPSA 0.76 ng/ml; 38.7% rise; p<0.001) with no recovery at 24 hours (p<0.001). Group 2 showed only a small rise (ΔPSA 0.54 ng/ml; p=0.035). Group 3 showed the largest elevation (ΔPSA 3.97±5.17 ng/ml; 69.1% rise) and was significantly greater than Group 1 at 1 hour (Bonferroni p=0.001) and 24 hours (p=0.024). BPH patients had greater ΔPSA than non-BPH (1.95 vs 0.54 ng/mL; p=0.011); baseline PSA correlated strongly with ΔPSA (r=0.753; p<0.001).

Conclusions: Rigid cystoscopy causes a clinically significant, sustained PSA elevation that does not recover within 24 hours. Combining Foley catheterisation and cystoscopy in one sitting produces a markedly greater rise. PSA should be deferred at least 48–72 hours after these procedures and longer in BPH patients, to avoid misleading results and unnecessary biopsies.