International Surgery Journal

Mouse in the axilla: a case series of fibroadenoma in the axillary ectopic breast tissue – a rare entity

Gnanaprakash, Manish Dewangan — Thu, 25 Sep 2025 00:00:00 +0530

Axillary polymastia is a common variant of ectopic breast tissue (EBT) with reported incidence of 2% to 6% in women. EBT can undergo the same physiological and pathological processes as the normally located breast. Though fibroadenoma commonly occurs in the breast, it is rare in the ectopic breast tissue. We report a series of four cases of fibroadenoma in axillary breast tissue over past 10 years in our hospital including a giant axillary fibroadenoma which we claim to be the largest till date in the English literature.

Subcutaneous onlay laparoscopic approach for ventral hernia and rectus abdominis diastasis repair: a case series

Varshini C., Dhanaraj P., Arunbabu C., Gokul Ranjeeth D. — Thu, 25 Sep 2025 00:00:00 +0530

Ventral hernia repairs have been posing a major aesthetic problem over the years giving rise to cosmetically unpleasing scars, significant post-operative pain and an array of post operative complications including post-operative adhesive obstruction and recurrence .Surgical repair of these hernias can be done either by open or laparoscopic methods .The standard open approach is associated with higher chances of flap necrosis, seroma, wound and mesh infection, the incidence of which increases with increasing size of defect ,age of the patient and associated comorbidities. The advent of minimal access surgery has refurbished ideas and techniques associated with the repair of ventral hernias and one such novel technique developed as an extrapolation of the open onlay mesh repair is subcutaneous onlay laparoscopic repair (SCOLA). The technique described by Claus and Malcher integrates subcutaneous onlay laparoscopic mesh repair with plication of the rectus diastasis, which has long been acknowledged as a significant contributor to recurrence when left unaddressed. The success of this procedure lies in overcoming the limitations of other hernia repairs by being minimally invasive, ergonomically favourable, minimizing risk of bowel injury with better cosmetic outcomes. The aim of the article is to describe our experience in this relatively novice technique and understanding the advantages and shortcomings in order to improve patient’s outcome.

Effect of enhanced recovery after surgery protocols on postoperative length of stay and complication rates in elective colorectal surgery: a systematic review and meta-analysis of randomized controlled trials

Ahmad Y. Al-Omari, Rand A. Othman — Thu, 25 Sep 2025 00:00:00 +0530

Enhanced recovery after surgery (ERAS) protocols are standardized multimodal perioperative care pathways designed to reduce surgical stress, accelerate recovery, and improve outcomes. Originally developed for colorectal surgery, ERAS has been associated with shorter hospital stays and fewer complications, but evolving evidence and protocol variations warrant updated synthesis of high-quality randomized controlled trials. This systematic review and meta-analysis, conducted according to PRISMA guidelines and registered in PROSPERO (ID: 1038955), included randomized controlled trials published since 2010 comparing ERAS protocols (≥12 elements per ERAS® Society guidelines) with conventional care in elective colorectal surgery. The primary and secondary outcomes were postoperative length of stay and complications, respectively. Five trials met the eligibility criteria. Pooled analysis showed ERAS was associated with a non-significant reduction in length of stay (mean difference= –2.68 days; 95% CI: –5.70 to 0.34; p=0.082; I²=96.66%), with sensitivity analysis excluding estimated data yielding a similar non-significant effect (mean difference = –3.89 days; 95% CI: –8.54 to 0.77; p=0.102). For complications, the pooled log odds ratio was –0.58 (95% CI: –1.22 to 0.06; p=0.078; I² = 86.63%), and sensitivity analysis restricted to low risk of bias studies also showed no significant difference (log OR= –0.56; 95% CI: –1.56 to 0.43; p=0.264). In conclusion, ERAS protocols showed trends toward reducing hospital stay and complications after elective colorectal surgery, but the results were not statistically significant, highlighting the need for further high-quality RCTs with standardized implementation.

Establishing a trauma center in Nicosia, Cyprus: lessons from the frontline of system reform

Christos Bartsokas, Chrysanthos Georgiou — Thu, 25 Sep 2025 00:00:00 +0530

The establishment of a dedicated trauma center at Nicosia General Hospital marks a milestone in Cyprus’s acute care and emergency medicine. Historically, trauma care in Cyprus was fragmented, with cases managed across general hospitals lacking centralized triage, integrated prehospital coordination, and specialized teams. This editorial reflects on the challenges and strategies involved in creating a functional trauma hub in a resource-limited environment. Key barriers included institutional inertia, infrastructure constraints, and the absence of standardized trauma training pathways. Solutions involved repurposing existing resources, implementing evidence-based protocols, introducing tiered trauma activation systems, and fostering interdepartmental collaboration. Prehospital integration was achieved through real-time communication with EMS and formalized transfer agreements, despite resistance from peripheral facilities. Workforce readiness was addressed via targeted, rapid training initiatives drawing on local and international expertise. Cultural change proved as critical as technical capacity, requiring sustained engagement, daily debriefings, performance audits, and leadership support to embed a protocol-driven, multidisciplinary approach. The Cyprus experience demonstrates that with strategic planning, adaptive leadership, and collaboration, effective trauma systems can emerge even under budgetary and logistical constraints. These lessons may guide other regions seeking to establish or reform trauma care infrastructure in similar settings.

An engaging consult with DeepSeek about acute abdomen

Sanjaikrishna Pakkirisamy Kannan — Thu, 25 Sep 2025 00:00:00 +0530

DeepSeek is a large language model (LLM) developed by Hangzhou DeepSeek artificial intelligence basic technology research Co., Ltd., a Chinese artificial intelligence company based in Hangzhou, China. Ever since its launch in July 2023, DeepSeek has released several revised and updated versions, with the latest being DeepSeek-R1 which is free for use unlike other advanced LLM counterparts.

Surgical site infections in GI surgery: update on bacteriology, antibiotic resistance, and ERAS integration

Supreet Kumar, Suryalok Pratap Shah, Sonam Gupta, Vivek Tandon, Deepak Govil — Thu, 25 Sep 2025 00:00:00 +0530

Surgical site infections (SSIs) remain one of the most significant complications following gastrointestinal (GI) surgery, contributing to increased morbidity, prolonged hospitalization, and heightened healthcare costs. Despite major strides in perioperative care, SSI rates in GI surgery still range between 10–30%, particularly in high-risk emergency settings. The microbial landscape of SSIs is shifting, driven by rising antimicrobial resistance and regional variability in bacteriology. Multidrug-resistant (MDR) organisms- especially extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Klebsiella pneumoniae- have emerged as formidable threats. Parallelly, enhanced recovery after surgery (ERAS) pathways are gaining traction as comprehensive perioperative bundles that reduce SSI incidence through patient optimization, minimally invasive approaches, targeted prophylaxis, and early mobilization. This review consolidates evidence from 2015-2025 to present a comprehensive overview of: (a) the evolving microbiology and antibiotic resistance trends in GI SSIs; (b) contemporary antimicrobial prophylaxis strategies and stewardship programs; (c) the impact of ERAS protocols in mitigating SSI risks; and (d) future directions including precision SSI prevention, AI-assisted risk stratification, and rapid diagnostics. Effective SSI prevention in GI surgery necessitates a multidisciplinary approach rooted in local bacteriology, rational antibiotic use, and evidence-based perioperative care. Integrating ERAS with antimicrobial stewardship and personalized risk models may herald a new era in surgical infection control.

Comparative study of laser ablation versus conventional surgery in the management of pilonidal sinus disease

Ravindra Shankar Ghugare — Thu, 25 Sep 2025 00:00:00 +0530

Background: Pilonidal sinus disease (PSD) is conventionally managed through surgical excision (SE) followed by either direct closure (DC) or flap reconstruction. Laser ablation has recently been recognized as a minimally invasive alternative; however, comparative data remain limited.

Methods: This retrospective analysis involved 288 patients who received treatment for PSD at a single academic institution from 2010 to 2021.

Results: Laser treatment resulted in a significantly reduced operation time (18.2±6.8 min) and decreased sick leave duration (7.1±7.8 days) when compared to the DC and FC groups.

Conclusions: The findings indicate that laser ablation serves as a safe and also effective first-line PSD treatment, facilitating quicker recovery and reducing complications. Further long-term, randomized studies are necessary to validate its superiority.

Computed tomography predictors of progression and re-presentation in uncomplicated diverticulitis: a retrospective study at two regional Australian hospitals

Robert Gichuhi, Norfarehah Binti Khairilanuar — Tue, 09 Sep 2025 00:00:00 +0530

Background: Acute diverticulitis is a common presentation in Australian hospitals and is primarily assessed with computed tomography (CT). Identifying CT predictors of progression from uncomplicated to complicated diverticulitis, as well as risk factors for re-presentation, is crucial, particularly in regional hospitals with limited interventional radiology services.

Methods: This retrospective study included 20 patients with CT-confirmed uncomplicated diverticulitis (WSES Grade 0, Hinchey Stage I) from Bundaberg Base Hospital (BBH) and Hervey Bay Hospital (HBH) between January 2023 and February 2024. Outcomes assessed were progression to complicated diverticulitis and re-presentation within three months. CT features (e.g., free fluid, free air, abscess formation, wall thickening, fat stranding) and clinical variables (e.g., C-reactive protein CRP) were analyzed. Statistical tests included Fisher’s exact test and t-tests, with significance set at p<0.05.

Results: Of the 20 patients, 4 progressed to complicated diverticulitis and 16 re-presented with symptoms. Abscess formation was observed exclusively in complicated cases (3/4 vs. 0/16, p=0.003). Free fluid (75.0% vs. 25.0%, p=0.087) and free air (50.0% vs. 6.3%, p=0.081) were more prevalent in complicated cases. Pericolic fat stranding and wall thickening were common but non-specific. Elevated CRP correlated with progression (mean 200.5 vs. 64.5 mg/l, p=0.029). No clear CT predictors were identified for re-presentation, though early cases (<30 days) were likely due to non-resolution and late cases (>30 days, ≤90 days) suggested recurrence.

Conclusion: Abscess, free fluid, free air, and elevated CRP (>100 mg/l) were predictors of progression to complicated diverticulitis, with abscess reaching statistical significance. No definitive CT predictors for re-presentation were identified. Structured CT reporting and prioritization of high-risk patients for admission are particularly important in regional settings with inconsistent interventional radiology access.

Quality of life in total fundoplication surgery versus partial fundoplication in patients with gastroesophageal reflux disease

Eduardo Sánchez-Soriano, Itzel G. García-Félix, Samuel R. Gómez-Arenas — Thu, 04 Sep 2025 00:00:00 +0530

Background: Gastroesophageal reflux disease (GERD) is a chronic disease with a prevalence of 20%, which has increased in recent years with complications such as Barrett's esophagus and risk of esophageal adenocarcinoma. Therefore, its medical and surgical treatment is crucial for the prognosis.

Methods: A retrospective cohort study of quality of life using the GERD questionnaire (GERDQ) was performed in patients with GERD who received surgical treatment with one-year postoperative follow-up at a tertiary care hospital in 2023. Patients were divided into two groups based on treatment: total fundoplication (group A) and partial fundoplication (group B). Statistical analysis included percentages, means, standard deviations, and group comparisons using the Chi-square test.

Results: Of the 35 patients, the mean age was 53.71±11.26 years, more frequent in women (54.30%). Typical symptoms were presented in 85.70% of cases, with persistence of these in 68.60%, indicating surgery, with symptoms lasting 122±68.88 days. The most frequent comorbidities were obesity and diabetes (22.90%). 54.30% underwent total fundoplication (group A) and 45.70% underwent partial fundoplication (group B). A low probability of presenting GERD after surgery was 78.90% in group A versus 75% in group B.

Conclusions: The quality of life is good in patients with GERD after surgical treatment, both with total fundoplication and partial fundoplication, obtaining a low probability of presenting GERD in both surgeries with the GERDQ questionnaire, with similar percentages of 78.90% versus 75%.

Association of pre-operative N-terminal pro–B-type natriuretic peptide level on early outcomes of off-pump coronary artery bypass grafting

Thu, 25 Sep 2025 00:00:00 +0530

Background: Off-pump coronary artery bypass grafting (OPCABG) is considered safer than traditional on-pump coronary artery bypass grafting (CABG) due to its avoidance of a heart-lung machine. This study was aimed to evaluate role of pre-operative N-terminal pro–B-type natriuretic peptide (NT-pro-BNP) level in patients undergoing OPCABG.

Methods: A comparative cross-sectional study was carried out in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD) from January 2022 to December 2023. Continuous data were analyzed by Student’s t-test and categorical data by Chi-square and Fisher’s exact test. A p≤0.05 was considered statistically significant.

Results: Our study shows that the incidence of arrhythmia was significantly higher in group A (NT-pro-BNP≥348 pg/ml) than group B (NT-pro-BNP<348 pg/ml). Post-operative arrhythmia occurred only in 9 (18%) patients in group B but in group A 19 (38%) patients developed arrhythmia (p<0.001). Incidence of postoperative low cardiac output syndrome (LCOS) was significantly higher in group A (NT-pro-BNP≥348 pg/ml). Group A patients experienced notably extended mechanical ventilation time (9.77±4.87 versus 6.39±2.13 hours; p<0.001), prolonged ICU stay (7.01±5.12 versus 4.87±2.98 days; p=0.005), and extended postoperative hospital stay (12.56±5.40 versus 7.08±4.15 days; p<0.001) compared to group B. No significant difference was observed between the two groups in regards to demographics and associated risk factors.

Conclusion: Our current study illustrated that elevated preoperative NT-pro-BNP levels (≥348) were linked to an increased occurrence of postoperative complications such as low cardiac output syndrome and arrhythmia.

Association between fingerprint patterns and prostate cancer grade among blacks: a cross-sectional review

Thu, 25 Sep 2025 00:00:00 +0530

Background: Prostate cancer is a major global health concern, with higher incidence and aggressiveness among Black men. Owing to its genetic basis, numerous biomarkers have been explored for early detection and prognosis. Simple, low-cost, and less invasive tools are particularly valuable for African populations. Fingerprints, which are genetically determined and unique to individuals, have been investigated as a potential marker for prostate cancer risk. Objective of the study was to examine fingerprint pattern prevalence among Nigerian men with prostate cancer and assess associations with histological grades.

Methods: A descriptive cross-sectional study was conducted from January 2012 to July 2023 among 52 newly diagnosed patients. Fingerprints were captured using a digital reader, standardized, analyzed, and classified. Statistical analysis (Chi-square test) was performed using statistical package for social science (SPSS) v19.0, with significance set at p<0.05.

Results: Loop and composite patterns each accounted for 34.6%, while whorl and arch patterns represented 23.1% and 7.7%, respectively. Among loop patterns, 55.5% were high-grade (ISUP 4 or 5). Composite patterns showed majority (33.3%) ISUP 4, with the highest proportion (83.3%) in loop + arch composites. Whorl patterns were more frequent in low-grade (ISUP 1) disease (41.7%). No statistically significant association was found between fingerprint patterns and ISUP grades (χ²=13.868, p=0.309).

Conclusion: Loop patterns were most frequent, particularly in high-grade disease, but lacked statistical significance as a predictor. Larger, multicenter studies are needed to clarify potential links between dermatoglyphics and prostate cancer.

Predictive validity of the Boey scoring system for postoperative outcomes in perforated peptic ulcer disease: a prospective study from a tertiary center of Nepal

Samrat Shrestha, Mecklina Shrestha, Prahasan Rai, Suresh Maharjan — Thu, 25 Sep 2025 00:00:00 +0530

Background: Perforated peptic ulcer (PPU) is a surgical emergency with high morbidity and mortality, making risk stratification critical. The Boey score (comorbidity, preoperative shock (SBP <90 mmHg), presentation delay >24 h) is a simple preoperative tool for predicting PPU outcomes.

Methods: Authors conducted a prospective observational study (February 2023–Mar 2025) in Kathmandu, including 94 adults (18-80 years) undergoing emergency laparotomy for PPU. We recorded each patient’s demographics and calculated the Boey score. All patients received standard surgical repair (Graham’s patch and lavage). Outcomes were 30-day postoperative morbidity, mortality and hospital stay.

Results: Patients (mean age 40.05±18.17 years, 92.6% male) were stratified: Boey 0 (31.9%), Boey 1 (45.7%), Boey 2 (11.7%), Boey 3 (10.6%). Overall morbidity was 42.6%, increasing significantly: 13.3% (score 0), 46.5% (score 1), 72.7% (score 2), 80.0% (score 3) (p<0.001). Overall, 30-day mortality was 9.57%, rising sharply with Boey score: 0% (score 0), 4.65% (score 1), 9.1% (score 2), 60% (score 3) (p<0.001). Boey score ≥2 predicted morbidity with 40.0% sensitivity and 90.7% specificity (AUC=0.755, 95% CI 0.65-0.85). Boey score=3 predicted mortality with 66.7% sensitivity and 95.3% specificity (AUC=0.882, 95% CI 0.76-0.97). The mean hospital stay was 9.0±3.62 days.

Conclusions: In this study, a higher Boey score strongly predicted worse postoperative outcomes in PPU. Patients with Boey ≥2 had substantially higher complication and death rates. The simple Boey score is a valid preoperative triage tool for PPU in resource-limited settings.

Staple line stitching versus clips for staple line reinforcement in laparoscopic sleeve gastrectomy: comparative analysis of hemorrhagic outcomes and postoperative complications in 1,085 patients

Fri, 12 Sep 2025 00:00:00 +0530

Background: Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure, but staple line complications remain a concern. This study compares the effectiveness and safety of two staple line reinforcement (SLR) techniques oversewing (suturing) and the application of clips in patients undergoing LSG.

Methods: We conducted a retrospective analysis of 1,085 patients who underwent LSG at private hospitals in northern Mexico. Patient demographics, anthropometric data, comorbidities and surgical details were collected. Outcomes measured included major bleeding, need for blood transfusion, reoperation rates, staple line leak and length of hospital stay. Data were analyzed using descriptive statistics, bivariate tests and multivariate logistic regression to identify significant associations.

Results: The analysis of the patient cohort revealed key differences in outcomes between the two SLR techniques. Specific results regarding the comparative rates of bleeding, transfusion, reoperation, leak and hospital stay will be detailed here based on the statistical findings.

Conclusions: This comprehensive comparison indicates that one technique demonstrates a superior safety profile over the other in terms of postoperative complications for LSG. The choice of SLR method is a significant factor in surgical outcomes.

Comparative outcomes of standard wound care versus a triple-combination topical regimen including metronidazole in post-debridement necrotizing fasciitis wounds: a retrospective cohort study

Thu, 25 Sep 2025 00:00:00 +0530

Background: Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection requiring prompt surgical and antimicrobial management. While systemic antibiotics are essential, topical therapy may enhance local control. This study compares the clinical efficacy of standard topical therapy (saline+honey) versus a triple combination regimen (metronidazole, povidone iodine and hydrogen peroxide) in NF wound care.

Methods: This retrospective cohort study analyzed 50 patients with NF treated at a tertiary center in Nigeria between January 2022 and March 2024. Patients were divided into two groups: a standard therapy group (n=25) and a triple-combination therapy group (n=25). Primary outcomes included final white blood cell (WBC) count, percent wound effluent reduction and time to granulation tissue appearance. Secondary outcomes were treatment success rate and need for repeat debridement. Independent t-tests and chi-square analyses were used. A p-value<0.05 was considered significant.

Results: Baseline WBC counts were similar between groups (p=0.341). The triple-combination group achieved significantly lower final WBC counts (4,900±1234 cells/µl) compared to the standard group (5,125±1435 cells/µl; p=0.001). Wound effluent reduction was also greater in the triple group (81.97%±8.92) vs. standard (64.67%±10.11; p=0.001). Granulation tissue appeared earlier in the triple group (4.48±0.79 days) than in the standard group (6.89±1.98 days; p=0.001). Treatment success was significantly higher with triple therapy (84.0%) versus standard (56.0%; χ²=4.667, p=0.031).

Conclusions: Triple-combination topical therapy with metronidazole, povidone iodine and hydrogen peroxide led to superior clinical outcomes compared to standard care, achieving faster infection resolution, enhanced wound granulation and higher treatment success rates. This approach may offer a cost-effective, accessible adjunct in NF care, particularly in resource-limited settings.

Does having a COVID-19 service in the hospital affect the anxiety state and preferences of patients applying to the urology outpatient clinic

Faraj Afandiyev, Eralp Kubliay — Thu, 25 Sep 2025 00:00:00 +0530

Background: Our aim is to investigate the effect of having a COVİD-19 service in the hospital on the anxiety level of patients applying to the urology outpatient clinic and the number of patients admitted.

Methods: The study was designed as a prospective cohort study. We divided the patients into Group-1 (hospital with a COVID 19 service) and Group-2 (hospital without a COVID-19 service). State Anxiety was used to determine the anxiety status of patients in Group-1 and Group-2. Scale (STAI-I) was used. Patients were interviewed face to face. Our hospital has a COVID-19 service. The purpose of the research was explained in detail. An average interview lasted 10-15 minutes. After the data were obtained, Group-1 and Group-2 were compared in terms of anxiety, age, gender and reason for applying to the hospital.

Results: The total number of patients is 313, 92 of these patients agreed to participate in the survey. The number of patients in Group 1 and Group 2 is 33 and 59, respectively. Median age is in Group 1 and Group 2, respectively. 53.03±15.98 and 47.53±15.8 (mean±SD). When we look at it in terms of anxiety, we found that the presence of the COVİD service negatively affected the psychological state of the patients. 96% (58/60) of the patients with severe anxiety applied to the urology outpatient clinic of the hospital without a COVID service (p=0.001). According to the results of multivariate analysis patients who need to start their treatment as soon as possible are more likely to apply to the urology clinic of hospitals that do not have a COVİD-19 service (odds ratio (OR): 1.284, 95% confidence interval (CI): 1.051–1.567, p=0.014).

Conclusions: We believe that in future epidemic situations, separating specialized hospitals for infected patients will be more efficient both for managing the epidemic and for oncology patients.

Prevalence of gallbladder pathology: a four-year experience at a secondary care hospital in Mexico city

Fri, 12 Sep 2025 00:00:00 +0530

Background: Biliary tract diseases represent a common cause of medical consultation and surgical intervention in Mexico, with a rising incidence. Elective cholecystectomy is among the most frequently performed surgical procedures in secondary care hospitals, reflecting the significant clinical burden of this pathology.

Methods: A retrospective, descriptive and observational study was conducted in a secondary care hospital, including 12,475 patients. Demographic data, diagnoses, types of surgical intervention and the conversion rate from laparoscopic to open cholecystectomy were analyzed.

Results: The prevalence of biliary disease in the study population was 7.79%. The conversion rate from laparoscopic to open surgery ranged from 2.6% to 18%, depending on the specific diagnosis and the surgical team's experience. Acute cholecystitis and pyocolecyst were identified as the main factors increasing technical difficulty due to severe inflammation and an elevated risk of biliary tract injury, leading to conversion to open surgery. These findings underscore the complexity involved in surgically managing certain biliary conditions.

Conclusions: The high prevalence of biliary pathology and the considerable conversion rate highlight the necessity for careful clinical and surgical evaluation, as well as the importance of experienced surgeons to optimize management and reduce complications.

Incidence and threat factors of anastomotic leak following emergency abdominal surgery: a retrospective analysis

Ravindra Shankar Ghugare — Thu, 25 Sep 2025 00:00:00 +0530

Background: Anastomotic leakage (AL) represents a critical postoperative complication that is linked to considerable morbidity and mortality in the context of abdominal surgery.

Methods: This retrospective (RTS) analysis assessed a cohort of 2,563 patients who underwent emergency abdominal surgery involving bowel resection and anastomosis at two tertiary centres in India over the period from 2015 to 2023.

Results: The total occurrence of AL was recorded at 3.47%. Univariate analysis revealed multiple clinical and operative variables that are significantly correlated with AL. Analysis using multivariate logistic regression identified hypoalbuminemia, the perioperative transfusion of two or more units of blood, peritoneal contamination and male sex as independent threat factors. Patients diagnosed with AL exhibited an elevated incidence of reoperation, extended durations of hospitalization and a heightened rate of in-hospital mortality.

Conclusions: Identifying these threat factors is essential for enhancing perioperative management and informing surgical decision-making in patients at high threat who are undergoing emergency abdominal procedures.

Battle of the scores: validating the AIR, Alvarado and Tzanakis scores in acute appendicitis

Vaibhav Srivastava, Piyush S. Tripathi, Harshit Sharma, Nishant Shukla — Thu, 25 Sep 2025 00:00:00 +0530

Background: Acute appendicitis is one of the most common surgical emergencies, yet its diagnosis remains challenging. Scoring systems such as the Modified Alvarado Score (MAS), Appendicitis Inflammatory Response (AIR) score and Tzanakis score have been proposed to improve diagnostic accuracy.

Methods: A prospective observational study was conducted on 92 patients presenting with suspected acute appendicitis at Moti Lal Nehru Medical College, Prayagraj after obtaining approval from Institutional Ethics Committee. Each patient was assessed using MAS, AIR and Tzanakis scores. Final diagnosis was confirmed by histopathological examination. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each scoring system.

Results: The Tzanakis score showed the highest diagnostic performance (sensitivity 95.12%, specificity 91.34%, PPV 96.42%, NPV 89.58%), followed by AIR score (sensitivity 93.25%, specificity 88.17%, PPV 94.78%, NPV 85.21%). MAS demonstrated comparatively lower accuracy (sensitivity 83.0%, specificity 71.4%). Patients evaluated with Tzanakis score also had the highest proportion of timely appendicectomies and the lowest rate of unnecessary surgeries.

Conclusions: The Tzanakis score emerged as the most reliable tool for diagnosing acute appendicitis due to its integration of clinical, laboratory and ultrasonographic data. The AIR score also showed high diagnostic utility, especially in settings lacking immediate imaging. MAS, while useful as an initial assessment tool, demonstrated limited diagnostic precision.

A study of clinico-etiological profile and its association in patients of hemorrhoids and varicose veins

Aditya Gangwar, Vikash Katiar, Ashish K. Chaudhary, Yukteshwar Mishra — Thu, 25 Sep 2025 00:00:00 +0530

Background: Hemorrhoidal disease (HD) and chronic venous disease (CVD) are prevalent vascular conditions sharing mechanisms such as venous hypertension, pelvic congestion, and connective tissue degeneration. Despite their frequent overlap, concomitant occurrence is often under-recognized. This study aimed to estimate the prevalence of coexisting HD and CVD, identify associated risk factors, and assess clinical correlations to guide integrated management.

Methods: This cross-sectional observational study was conducted at GSVM medical college, Kanpur between June 2023 and December 2024. A total of 140 patients were enrolled (70 HD, 70 CVD). Detailed demographic, clinical, and lifestyle data were collected. HD was assessed by digital rectal examination and graded using Goligher's classification, while CVD was confirmed by duplex ultrasonography and classified using CEAP criteria. Statistical analysis was performed using IBM SPSS version 29, with p<0.05 considered statistically significant.

Results: Of the 140 patients, 60 (42.9%) presented with concomitant HD and CVD, 59 (42.1%) with isolated HD, and 21 (15.0%) with isolated CVD. A statistically significant association was observed between the presence of HD in patients with CVD (54.3%) compared to CVD in patients with HD (31.4%) (p=0.0043). (22.0%). Age>50 years (p=0.035) was significantly associated with the occurrence of concomitant disease.

Conclusions: A substantial prevalence of concurrent HD and CVD was observed, particularly in older individuals with occupational risks. The higher occurrence of HD among CVD patients supports the role of systemic venous insufficiency in anorectal pathology. Routine screening for HD in CVD patients is recommended for comprehensive management.

Optimal timing for preoperative indocyanine green administration to enhance fluorescent cholangiography during laparoscopic cholecystectomy: a prospective study

Supreet Kumar, Rigved Gupta, Aishwarya S. Bhalerao, Vivek Tandon, Deepak Govil — Thu, 25 Sep 2025 00:00:00 +0530

Background: Safe and accurate visualization of biliary anatomy is essential during laparoscopic cholecystectomy. Indocyanine green (ICG) fluorescence cholangiography has emerged as a valuable tool to delineate critical structures and reduce the risk of bile duct injury. While earlier studies recommended ICG administration 8–24 hours prior to surgery, recent evidence suggests that shorter intervals may be equally effective. This prospective study compared the efficacy of ICG fluorescence cholangiography administered 4 hours versus 8 hours before laparoscopic cholecystectomy, focusing on the clarity of biliary visualization, operative outcomes and patient recovery.

Methods: Sixty patients undergoing elective laparoscopic cholecystectomy were randomized into two groups: Group A (ICG administered 4 hours preoperatively) and Group B (8 hours). A standardized scoring system assessed visualization of the cystic duct and common bile duct. Operative duration, complications and recovery were secondary outcomes.

Results: Both groups showed high rates of optimal biliary tract visualization (≥4/5 score): 90% in Group A and 93.3% in Group B (p=0.64). Mean operative times were similar (48.3±8.5 vs. 46.9±7.9 minutes; p=0.42). No major bile duct injuries occurred. Postoperative complication rates and hospital stays were also comparable.

Conclusions: ICG administration as early as 4 hours before surgery provides biliary visualization equivalent to the conventional 8-hour interval. This shorter window may enhance scheduling flexibility without compromising safety or image quality. Further multicentre studies are recommended to validate these findings.

A prospective randomized comparative study of umbilical port site complications following fascial sheath closure versus non-closure in laparoscopic surgeries at a tertiary care centre in central India

Shweta B. Gupta, Arti Mitra, Brajesh B. Gupta, Gaurav Nighot — Thu, 25 Sep 2025 00:00:00 +0530

Background: The increase in laparoscopic surgeries has been accompanied by concerns over trocar site complications, particularly port site hernia (PSH). Among surgical debates, the necessity of fascial sheath closure for umbilical ports ≥10 mm remains unresolved. Objective of the study was to compare the incidence of umbilical port site complications between fascial sheath closure and non-closure in laparoscopic surgeries.

Methods: A prospective, interventional, randomized study was carried out at a tertiary care centre in Central India from July 2020 to December 2022. 100 patients undergoing elective laparoscopic procedures were enrolled and divided into two groups: group A (fascial closure) and group B (non-closure). Patients were assessed for port site hernia, hematoma, and infection through clinical and ultrasonographic evaluation over a mean follow-up period of 14 months.

Results: Port site hernia was observed in 3 patients (3%) overall: 1 patient in the closure group and 2 in the non-closure group (p=1.0). Port site infection occurred in 10 patients: 6 in the closure group (12%) and 4 in the non-closure group (8%) (p=0.688). A single case of port site hematoma was recorded in the non-closure group. No statistically significant differences were observed in hospital stay or complication rates.

Conclusion: There is no statistically significant difference in the incidence of port site complications between fascial closure and non-closure groups. Routine fascial closure of the umbilical port may not be essential in all cases.

Agriculture related traumatic hand injuries and reconstructive interventions: an observational study at a tertiary care centre

Darsh K. Patel, Ajitsingh P. Chadha, Chinmay Wingkar, Sunil V. Jagtap — Thu, 25 Sep 2025 00:00:00 +0530

Background: India contributes 10% (225 million) to global agricultural workforce, where hand injuries are frequent and major health related problem and economically significant issues. Farming has fatality rate over five times higher than other sectors. Risk factors include poor ergonomics, lack of safety awareness, and environmental hazards. Aim was to study agriculture related traumatic hand injuries and reconstructive intervention, and to educate surgeon on importance of sophisticated surgical care and aggressive physiotherapy in rehabilitating patients to early hand function.

Methods: This prospective observational study of 3 years conducted at KVV hospital, Karad. Structured proforma was completed for 386 patients presenting with agriculture-related hand and wrist injuries distal to wrist. Data on demographics, injury type, hand dominance and seasonal trends were studied.

Results: Males were more frequently impacted than females belonged to age group of 31 to 45 with right-handed dominance along with injury caused by hand tools (63.47%) and sugarcane machine (48.70%), most frequently occurred in October month with majority of lacerated wounds (41%) correlating with peak harvesting season. Common causes include entanglement in machinery and traditional tools, leading to amputations and fractures.

Conclusions: Farm equipment causing injury is major health issue. It needs educating farmers, prohibiting children from entering areas with agricultural machinery, disseminating information about agricultural accidents and how to prevent them, and modifying working hours of farming staff. This study focuses on type and severity of hand injuries in agriculture and emphasizes need for systematic assessment to guide effective treatment and prevention.

A prospective observational study assessing the correlation between ultrasonography features and histopathological findings in breast cancer

Simran Garhwal, R. K. Abrol, Vikrant Sharma, Preeti T. Kapila, Sachin Sharma — Thu, 25 Sep 2025 00:00:00 +0530

Background: Breast cancer is the most commonly diagnosed malignancy in India, where early detection is crucial for improving survival. Ultrasonography (USG) is a widely available imaging tool, especially beneficial in resource-limited settings and among younger women with dense breasts. This research sought to examine the association between sonographic features and histopathological findings in breast cancer patients.

Methods: A prospective observational study was conducted from May 2024 to April 2025 at Dr. R.P.G.M.C. Kangra, Himachal Pradesh, involving 50 female patients with clinically suspected breast malignancies. All participants underwent standardized breast ultrasonography, followed by histopathological confirmation through fine-needle aspiration cytology (FNAC) or core biopsy. Lesions were evaluated for shape, margins, echogenicity, posterior acoustic features and BI-RADS classification. The association between imaging findings and histopathological results was statistically analyzed.

Results: The mean age among patients was 47.56 years, with painless breast lumps noted as the initial symptom in all individuals. Common ultrasonographic findings included hypo echogenicity (82%), irregular margins (78%), posterior acoustic shadowing (70%) and a taller-than-wide shape (66%). Histopathology confirmed cancer in (96%) of the cases, with invasive ductal carcinoma observed in (85.4%) of these instances. A statistically significant correlation was found between ultrasonographic features and histopathological diagnosis (p < 0.05). USG demonstrated a sensitivity of 91.6%, specificity of 85.7% and diagnostic accuracy of 85%.

Conclusions: Ultrasonography is a reliable, accessible and effective imaging modality for evaluating breast lesions, with strong diagnostic utility in resource-constrained healthcare environments.

Laparoscopic herniotomy with orchidopexy: our experience and a review of literature

Umang Shandilaya, Abhijit S. Joshi — Thu, 25 Sep 2025 00:00:00 +0530

Background: Congenital hernia and undescended testis are significant pediatric surgical conditions traditionally managed through open techniques. With advances in minimally invasive surgery, laparoscopic approaches now offer an alternative for treating these conditions.

Methods: We present a retrospective study outlining our experience with laparoscopic herniotomy and, when indicated, laparoscopic orchidopexy in paediatric patients. In all cases, pneumoperitoneum pressures were adjusted appropriately to ensure procedural safety and efficacy.

Results: Our findings demonstrate that laparoscopic repair of both congenital hernia and undescended testis is technically feasible and effective in children. All procedures were completed successfully, with minimal complications and satisfactory postoperative outcomes.

Conclusion: Laparoscopic management of congenital hernias and undescended testes is a safe and effective alternative to open surgery in paediatric patients, given the availability of an advanced surgical setup and experienced personnel.

Predictive value of modified early warning score in identifying high-risk postoperative patients following abdominal surgery

Thu, 25 Sep 2025 00:00:00 +0530

Background: Modified Early Warning Score (MEWS) is an objective bedside tool for detecting early physiological deterioration and guiding timely intervention. Its predictive role in postoperative general surgical patients, particularly after exploratory laparotomy, is underexplored in developing countries.

Methods: A prospective observational study was conducted from July 2019 to June 2020 in a tertiary care center. A total of 150 patients undergoing exploratory laparotomy were included. MEWS was calculated using six parameters respiratory rate, systolic blood pressure, heart rate, temperature, urine output and consciousness level at 6-hour intervals postoperatively. Patients were categorized into low-risk (0-2), intermediate-risk (3-4) and high-risk (≥5) groups. Outcomes analyzed included ICU admission and mortality.

Results: The mean age of patients was 41.8 years; 50.7% were male. Emergency surgeries constituted 58.7% of cases. MEWS≥5 was present in 23.4% of patients. All six deaths occurred in patients with MEWS≥7 (p<0.001). ICU admission was significantly associated with higher MEWS. MEWS showed strong predictive accuracy for morbidity and mortality in postoperative patients.

Conclusions: MEWS is a simple, inexpensive and effective tool for early detection of postoperative deterioration and prioritizing ICU transfer. Higher MEWS strongly correlated with mortality and adverse outcomes.

A prospective study on the outcomes of lateral internal sphincterotomy for chronic anal fissure

Satnam Singh, Vandana Sidhu, Ashok Kumar, Baldev Singh, Bhupinder Singh Walia — Thu, 25 Sep 2025 00:00:00 +0530

Background: An anal fissure is a common problem caused due to an elongated tear in the longitudinal axis of the lower anal canal. It causes severe pain during defecation and anal bleeding that stains the tissue or streaks the stool. Medical and conservative treatment methods may be sufficient for acute anal fissures. However, in chronic anal fissures, Lateral internal sphincterotomy (LIS) is the standard treatment that results in healing in the maximum number of cases. The present study aims to seek the safety of lateral internal sphincterotomy along with studying its early and late complications, factors affecting the recurrence and incontinence in patients of lateral internal sphincterotomy and methods to avoid incontinence in such patients.

Methods: The study was planned by selecting a total of 100 patients who underwent lateral internal sphincterotomy with an equal number of males and females.

Results: The study revealed that early complications (viz. pain, post-operative bleeding, urinary retention, infection and hematoma) and late complications (viz. abscess formation, anal incontinence, anal stenosis and recurrence) were observed in some of the patients. All the early and late complications were managed by following the standard procedures during the follow-up period. No major complication persisted in the patients under study.

Conclusions: The study concluded that the procedure of lateral internal sphincterotomy is an effective and safe procedure for the problem of chronic anal fissures.

A study of factors leading to postoperative leaks following bowel anastomosis with special reference to hypoalbuminemia

Mohit K. Mandal, Niladri Sarkar, Sudip Sarkar, Jamsed Mollah — Thu, 25 Sep 2025 00:00:00 +0530

Background: Bowel anastomosis is a critical surgical procedure performed during gastrointestinal resections, with outcomes influenced by various preoperative, intraoperative, and postoperative factors. This study aims to evaluate the clinical and surgical parameters affecting complications, morbidity, and mortality in patients undergoing bowel resection and anastomosis.

Methods: A prospective observational study was conducted on 50 patients undergoing small or large bowel resection with anastomosis. Data were collected on demographics, comorbidities, serum albumin and hemoglobin levels, type of surgery (elective/emergency), technique of anastomosis (hand-sewn/stapled), and intraoperative contamination. Postoperative complications such as wound infection, anastomotic leak, pelvic collection, and mortality were recorded and statistically analyzed.

Results: The majority of patients were male (66%) and underwent small bowel surgeries (70%). Hand-sewn anastomosis was performed in 66% of cases. Elective procedures accounted for 58% and emergency for 42%. Intraoperative contamination was present in 46% of patients. Postoperative complications occurred in 46%, with surgical site infection (28%) being the most common, followed by ileus (12%) and pelvic collection (6%). Anastomotic leaks occurred in 10%, and the overall mortality was 10%. Emergency surgeries and intraoperative contamination showed a statistically significant association with mortality (p=0.022 and p=0.037, respectively). Hypoalbuminemia (≤3.5 g/dl) was associated with a higher rate of anastomotic leaks (17.4%) and mortality (17.4%), though the latter was not statistically significant (p=0.089).

Conclusions: Emergency surgery, hypoalbuminemia, and intraoperative contamination are significant risk factors for postoperative complications and mortality following bowel anastomosis. Early diagnosis, nutritional optimization, aseptic techniques, and elective intervention when feasible may improve surgical outcomes.

Morbidity and mortality in peptic ulcer perforations-an insights from a tertiary care center in upper Assam, India

Thu, 25 Sep 2025 00:00:00 +0530

Background: Perforated peptic ulcer (PPU) is a severe and feared complication, presenting as an acute abdomen. While acid-reduction medications have contributed to a decline in perforated peptic ulcer cases. Although the incidence persists in a few rural regions in our North-East part of India. PPU significantly increases morbidity and mortality of patients. Early recognition can prevent mortality associated with delayed presentation.

Methods: In the prospective observational study, 73 patients were evaluated. A detailed clinical history and examination were performed. The data was analysed using descriptive analysis( n, number of patients, in percentage % and p-value)

Results: A significant increase in morbidity and mortality associated with age(p=0.03, p=0.001), shock (p=0.005,p=0.0001)), ASA (p=0.0001, p=0.0001), peritoneal contents (p=0.005, p=0.001), associated illnesses (p=0.03,p=0.001) and time of surgery (p=0.04,p=0.01) was observed respectively.

Conclusions: The study highlights the significance of specific parameters in managing peptic ulcer perforation, which typically presents as an acute abdomen.

Ligation versus clipping of the appendicular stump in laparoscopic appendectomy: an ongoing predicament

Thu, 25 Sep 2025 00:00:00 +0530

Background: Appendectomy being one of the common surgical emergencies performed either laparoscopically or by open approach. As laparoscopy is replacing open appendectomies with rapid pace, closure of appendix stump base remains a debatable aspect of surgery.

Methods: All the patients fulfilling inclusion criteria of acute appendicitis undergoing laparoscopic appendectomy. Stump of the appendix after appendectomy was closed either by ligation or Titanium clip.

Results: Both the groups were comparable in terms of demographic details. Operating time in the clip group was much less averaging 35.62±8.3 (25-70 mins.) as compared to ligation group which was 46.32±7.8 (35-90 mins.) and which was statistically significant. Illeus being most common post operative complications observed in both the group and was non-significant. One patient in ligation group developed fistula which led to the prolonged hospital stay and readmission but was managed conservatively. Both the groups were comparable in terms of length of hospital stay.

Conclusions: Closure of appendicular stump using titanium clip is an easy, cheap, readily available and reliable option.

Effect of Helicobacter pylori eradication on gastric histology and symptom resolution in functional dyspepsia: a preliminary follow-up study

Prajwal Chandrashekhara, Harvi Girisha, Chanchal Raj Chhallani, Preeti Hiremath — Thu, 25 Sep 2025 00:00:00 +0530

Background: Functional dyspepsia (FD) is a prevalent gastrointestinal condition with a multifactorial origin, in which Helicobacter pylori infection may play a contributory role. Although eradication therapy has been shown to offer symptomatic relief in a subset of patients, predictors of response remain inadequately defined. To evaluate the effect of H. pylori eradication on gastric histological parameters and symptom resolution in patients with functional dyspepsia and to identify histopathological predictors of treatment response.

Methods: This prospective observational study included 121 adult patients with functional dyspepsia and confirmed H. pylori infection. All patients underwent upper gastrointestinal endoscopy and gastric biopsies were obtained before initiating eradication therapy. Biopsy specimens were stained with H&E and Giemsa and histological assessment was performed by a blinded pathologist using the Modified Sydney System. Parameters assessed included chronic inflammation, neutrophilic activity, glandular atrophy, intestinal metaplasia and H. pylori density. A composite Sydney score was calculated. Follow-up was conducted at 3 months to assess symptom resolution. Patients were categorized into "Resolved" and "Non-improved" groups based on symptomatic outcomes.

Results: Out of 100 patients enrolled, follow-up data were available for 79. Symptom resolution was observed in 52 patients (51.5%), while 27 (26.7%) reported no improvement. Patients with symptom resolution had significantly higher pre-treatment scores for chronic inflammation (p=0.012), neutrophilic activity (p=0.021), H. pylori density (p=0.008) and composite Sydney score (p=0.002). Glandular atrophy (p=0.486) and intestinal metaplasia (p=0.671) showed no significant association with symptomatic improvement.

Conclusions: Symptomatic benefit following H. pylori eradication in functional dyspepsia appears to be associated with higher baseline levels of chronic and active gastric inflammation, as well as H. pylori density. Histopathological assessment using the Modified Sydney System may help predict treatment response and guide clinical decision-making.

Evaluating the impact of breast cancer awareness on early detection rates in young women

Bhavisha R. Ghugare — Thu, 25 Sep 2025 00:00:00 +0530

Background: Breast cancer (BC) remains a leading contributor to morbidity and mortality among women globally, with an increasing incidence in young women in India. Early detection enhances the prognosis, but awareness gaps and socio-cultural issues normally result in the delayed diagnosis.

Methods: This study explores the bearing of BC awareness campaigns on early recognition practices across young women living in urban and semi-urban settings of Northern India. A total of 180 participants took part in 18 focus group discussions (FGDs), conducted in association with local colleges, NGOs and community groups.

Results: Thematic analysis identified three major themes: knowledge and awareness gaps, social and behaviour barriers and impact of the campaign on screening behaviour.

Conclusions: Findings highlighted the myths, limited symptoms recognition, stigma and fear as significant barriers. In spite of these, breast self-examination and active screening were influenced positively by awareness efforts, especially among educated women. The research emphasizes the necessity for focused, culturally targeted interventions that engage families and tackle individual and community-level obstacles to enhance early detection.

Preoperative carbohydrate loading vs fasting: effects on postoperative recovery and outcomes in surgery

Joseph Marcuccilli, Nathan Jatczak — Fri, 12 Sep 2025 00:00:00 +0530

Traditional preoperative fasting reduces aspiration risk but contributes to catabolism, insulin resistance and patient discomfort. Enhanced recovery after surgery (ERAS) protocols increasingly endorses preoperative carbohydrate loading (PCL) as an alternative. This systematic review, conducted according to PRISMA guidelines, evaluated randomized controlled trials (RCTs) published between 2020–2025 comparing PCL versus standard fasting in adult general surgery populations. Eligible studies included abdominal, colorectal and bariatric procedures. Data extraction covered trial design, carbohydrate regimens, recovery endpoints (time to gastrointestinal function, oral intake, ambulation, hospital stay), metabolic markers, complications and patient-reported outcomes. Six RCTs (sample sizes 63–240) met criteria. PCL was consistently safe, with no evidence of delayed gastric emptying or aspiration. Across trials, PCL improved patient comfort (reductions in hunger, thirst, fatigue, anxiety), attenuated insulin resistance and dampened inflammatory stress responses. Several studies demonstrated earlier gastrointestinal recovery and reduced hospital stay, though findings were inconsistent. Complication rates were lower in some cohorts, particularly colorectal surgery, but unchanged in others. In diabetic patients, PCL with individualized insulin protocols was safe and improved perioperative comfort, though bowel recovery was unaffected. Integration of PCL with other ERAS components, such as goal-directed fluid therapy, appeared to amplify benefits. In summary, PCL is a safe, well-tolerated alternative to prolonged fasting in general surgery. It consistently improves comfort and metabolic outcomes, while effects on length of stay and complications remain variable. Evidence supports incorporating PCL as part of multimodal ERAS pathways, with further research warranted in high-risk subgroups such as elderly and diabetic patients.

Clinical outcomes of robotic-enhanced view totally extraperitoneal (r-eTEP) technique for ventral hernia repair: a systematic review

Junior Sundresh, Naveena Ramakrishnan, Sam Immanuel — Thu, 25 Sep 2025 00:00:00 +0530

Despite its advantages, laparoscopic enhanced-view totally extraperitoneal (eTEP) presents substantial technological obstacles. To overcome these challenges, the development of a technique called robotic-assisted eTEP (r-eTEP) came. Hence, we aimed to give surgeons and decision makers a clear grasp of procedural outcomes, technological challenges and integration feasibility, this study compiles and assesses clinical literature on r-eTEP. A comprehensive literature search was conducted in PubMed and Cochrane from their inception to June 2025. Eligible studies were adult patients (≥18 years) undergoing robotic-assisted enhanced-view completely extraperitoneal (r-eTEP) repair for ventral or incisional hernias. perioperative and postoperative clinical outcomes following robotic-assisted enhanced-view totally extraperitoneal (r-eTEP) surgery for ventral or incisional hernias were collected. Nine clinical studies comprising patients who underwent robotic-enhanced-view totally extraperitoneal (r-eTEP) repair for ventral hernias were included. The length of hospital stays (LOS) frequently favoured r-eTEP. The median length of stay (LOS) for the r-eTEP cohort was 2 days, while the median LOS for the laparoscopic eTEP cohort was 3 days (p<0.001). Follow-up lengths ranged from 6 to 24 months. Ultimately, especially when performed by experienced surgeons who have gone through a thorough learning process, robotic-assisted eTEP treatment shows safety, efficiency and effectiveness for ventral hernia repair.

Cystic degeneration of a fibroid in the context of abnormal uterine bleeding in young patients: a case report

Thu, 04 Sep 2025 00:00:00 +0530

Uterine fibroids are the most common uterine tumors in perimenopausal women; their presence and growth are associated with elevated estrogen levels and stimulation of progesterone receptors. Clinically, fibroids are associated with abnormal uterine bleeding, anemia, recurrent pregnancy loss, infertility, and/or chronic pelvic pain. Ultrasound imaging faces challenges when fibroids present atypical features. Degenerated fibroids in their cystic variant are related to edema and multiple intrauterine cysts. In young patients, obstetric pathology should not be overlooked. The easy accessibility and low cost of ultrasound allow for universal screening of patients with abnormal uterine bleeding. The pathognomonic presence of a "cluster of grapes" pattern raises suspicion of molar pregnancy in this patient population. It is essential to establish an accurate diagnosis to initiate appropriate therapeutic management, prognosis, and follow-up. Gynecologists and sonographers should consider the β-hCG hook effect or receptor saturation, which may produce false-negative results, as well as recognize the degenerative variants of uterine fibroids to accurately raise diagnostic suspicion.

A misleading presentation: skin sarcoma presenting as a breast mass

Maryam Hassanesfahani, Mrinalini Alla, Loryn Bucci, Noman Khan — Thu, 25 Sep 2025 00:00:00 +0530

Atypical fibroxanthoma (AFX) is a rare cutaneous malignant neoplasm which manifests as solitary lesions in sun-exposed areas of elderly patients, commonly on the head and neck. Given AFX’s rarity and lack of specific immunohistological markers, there are no established standardized guidelines for the management of AFX, often leading to a misdiagnosis of more aggressive variants such as pleomorphic dermal sarcoma (PDS). The prognosis is generally favorable, with most cases responding well to complete surgical excision alone. We present a rare case of AFX in the breast, a 68-year-old woman with a left breast mass, which the patient described as a small pimple. A computed tomography (CT) scan revealed a superficially located lesion in the upper medial quadrant of the left breast, measuring 4.2×2.2×2.1 cm (Figure 1A, B). At the patient’s request, she proceeded with upfront wide local excision without prior biopsy or any breast imaging. Histopathological examination revealed a well-circumscribed tumor measuring 3.8×3.3 cm, with no connection to the overlying epidermis (Figure 1C). Given that the surgical margin was less than 1 cm, the patient underwent a re-excision with sentinel lymph node biopsy. Final pathology was negative for positive margins and any lymph node involvement. At one-year follow-up, there was no clinical or radiological evidence of recurrence or metastasis. This case highlights the importance of including cutaneous lesions in the differential diagnosis of breast masses located near the skin surface. Accurate diagnosis requires a high index of suspicion and meticulous histopathological evaluation.

Littré’s hernia, a rare cause of intestinal obstruction: case report

Thu, 25 Sep 2025 00:00:00 +0530

Littre's hernia is a rare condition in which a Meckel's diverticulum is found within a hernia sac, and it is an uncommon cause of intestinal obstruction. Preoperative diagnosis is challenging, and there is currently no consensus on optimal surgical management. Authors report the case of a 45-year-old Latin American woman who presented with intestinal obstruction due to an incarcerated umbilical hernia. Surgical exploration revealed a Littre’s hernia, which was managed with stapled diverticulectomy without complications. The patient had an uneventful postoperative course.

Postoperative management and surgical decision-making in scleroderma: insights from a case study

Tahmina Hakim, Edward Tong, Selwyn Selvendran — Thu, 25 Sep 2025 00:00:00 +0530

Scleroderma, a chronic autoimmune disease characterized by diffuse fibrosis, poses significant challenges for wound healing and postoperative recovery. The fibrotic changes and altered collagen production associated with scleroderma can complicate surgical outcomes, including wound healing and adhesion formation. This case report highlights the unique challenges faced in the surgical management of scleroderma patients, focusing on the postoperative appearance of the stoma, the risk of inflammatory adhesions and the implications of laparoscopic surgery in these patients. A 55 years old female with diffuse scleroderma, complicated by contractures, acro-osteolysis and multiple other systemic issues, presented with abdominal pain and a perforated sigmoid colon caused by an ingested foreign body. She underwent a laparoscopic Hartmann’s procedure. Postoperatively, the stoma appeared necrotic on day 2, though it was functionally healthy. Subsequent complications included small bowel obstruction and adhesions, necessitating additional surgical interventions. Scleroderma affects wound healing due to fibrotic changes and impaired collagen deposition. In this case, the necrotic appearance of the stoma was likely due to inflammatory changes rather than true necrosis. Laparoscopic surgery, while beneficial in reducing tissue trauma and complications, still presents risks in scleroderma patients, including adhesion formation. Early-stage scleroderma patients may experience fewer fibrotic changes but are still at risk for postoperative complications. Scleroderma patients require careful management to mitigate surgical complications. Laparoscopic approaches can reduce trauma and recovery time but do not eliminate the risk of adhesions and other complications. Ongoing monitoring and tailored postoperative care are essential for optimizing outcomes in these patients.

The maximum number of node retrieval in axillary lymph node dissection in breast cancer patient (84/84); high nodal burden in breast cancer female patient: a case report and review of literature

Mahmoud H. Khalil, Ragab A. Sharif, Neveen Tahoun, Ahmed A. Shehata — Thu, 25 Sep 2025 00:00:00 +0530

We describe the case of a 41 years old female presented with right breast retro areolar painless hard mass accompanied by nipple retraction. After initial clinical assessment, further clinical radiological investigations, bilateral sonomamography imaging showed an ill-defined focal hypo echoic heterogenicity at the retro areolar region measures about 40×26 mm. Another two ill-defined hypo echoic soft tissue masses at upper inner quadrant measures about 17×16 mm and 13×11 mm. With enlarged right axillary lymph node about 20 mm in size, thickened cortex and still preserved hilum (BIRAD Ⅴ lesions). The diagnostic image guided multiple core biopsies confirmed the multicentric invasive breast cancer and molecular subtyping as Luminal B breast cancer stage Ⅱb. Whole body computed tomography (CT) as a Metastatic work was free. After the discussion among the Breast cancer Multi-disciplinary team (MDT) members and the patient, the final decision was to do surgery first in the form of right modified radical mastectomy respecting the patient desire for this choice loco regional control first - then to continue her adjuvant treatment according to the final histopathological reporting. The surprise is the unexpected this extreme number of axillary lymph nodes retrieval (84/84) after the final histopathological examination of the specimen. We did not find this extreme number of axillary lymph nodes retrieval "84" before in the literature at all regarding breast cancer management by ALND.

Acquired non-hypertrophic and non-peptic primary pyloric functional obstruction (Jodhpur disease) first time described in African children

Boniphace Tresphory, Alessandro Calisti — Thu, 25 Sep 2025 00:00:00 +0530

The occurrence of Jodhpur Disease (JD) in two African children is reported. It is a rare, acquired, primary gastric outlet obstruction typical of Asian patients, mainly from India, not related to anatomic lesions, muscular hypertrophy, or peptic ulcer of the pylorus. It typically presents at a mean age of 2.9 years, predominantly in males. Two males, 2 and 12 years old, presented with non-bilious vomiting in the last three weeks and two months, with electrolyte imbalance and malnutrition. Helicobacter pylori infection was excluded. Ultrasound, Gastrointestinal Radiology and Gastroscopy concurred to identify the features of JD. Pyloroplasty reestablished regular transit. First described in 1997, JD appears to be confined to the Asian context. Its etiology is undefined. Occurrence in previously healthy children has been attributed to a possible neuromuscular enzymatic functional pathology. Nutritional, environmental or genetic causes have been speculated. JD disease responds to a simple pyloroplasty, followed by patient recovery. JD in two African children denies the assumption that it is exclusive to Asian individuals. It should be considered in other contexts, particularly in the presence of persistent, unexplained vomiting and malnutrition. If recognized with adequate expertise, it can be resolved with a simple procedure.

Rare case of Ischaemic Meckel’s diverticulum in spigelian hernia

Tahmina Hakim, Selwyn Selvendran, Soumya Hariswamy, Neha Gauri, Edward Tong — Thu, 25 Sep 2025 00:00:00 +0530

Ischemic Meckel’s diverticulum in Spigelian hernia is a rare condition and poses a significant diagnostic and management challenges. Spigelian hernia is a rare type of acquired ventral hernia that accounts for 1-2% of all abdominal wall hernias. We present a rare case of a 59-year-old female patient who presented with incarcerated abdominal wall hernia. The preoperative CT scan showed left sided abdominal wall hernia and not bowel obstruction. However, intra-operatively patient had an ischaemic small bowel segment and a necrotic Meckel’s diverticulum in Spigelian hernia. The patient underwent a laparoscopic procedure converted to open repair of spigelian hernia with resection of small bowel containing ischaemic Meckel’s diverticulum. Patient’s post-operative recovery course was unremarkable and diet was gradually upgraded. Incarcerated/ischaemic Meckel’s diverticulum in a Spigelian hernia is rare and may present with significant pre-operative diagnostic challenges. CT or MRI could be helpful diagnostic modalities. Both open or laparoscopic repairs could be performed depending on clinical situations.

From chronic diarrhea to diagnosis: unmasking rare giant gastrinoma

Athulya Ajith, Aravind Kumkod, Thulasiayya Sambamoorthy — Fri, 19 Sep 2025 00:00:00 +0530

Gastrinomas are rare neuroendocrine tumors, most commonly arising in the pancreas or duodenum and typically present with peptic ulcer disease and gastric acid hypersecretion. Atypical symptoms such as chronic diarrhoea and abdominal pain, along with partial response to proton pump inhibitors, may delay diagnosis and timely treatment. We report the case of a 35 years old male who presented with a one-year history of persistent watery diarrhoea and intermittent abdominal pain. Clinical examination revealed an abdominal mass and imaging demonstrated a giant pancreatic head lesion and biochemical analysis showed markedly elevated serum gastrin levels. Histopathology confirmed the diagnosis of gastrinoma. The unusually large tumor size, combined with an atypical presentation as chronic diarrhoea, highlights the diagnostic challenges associated with gastrinomas. This case underscores the importance of considering neuroendocrine tumors, including Zollinger–Ellison Syndrome (ZES), in the differential diagnosis of unexplained chronic diarrhoea and abdominal pain. Timely recognition and management are crucial to improving outcomes. Giant gastrinomas (>12 cm) with multifocality in the context of ZES have not been reported in the literature, making this case a unique addition.

Schwannoma masquerading as metastatic retrocaval lymph node in a patient with incidental gall bladder cancer: a case report and review of literature

Reshma R. Balachandran, Mayank Tripathi, Ipsita Dhal — Thu, 25 Sep 2025 00:00:00 +0530

Schwannomas are rare benign neoplasms that arise from neural sheath Schwann cells. Their presence in retroperitoneum can mimic other differential diagnosis especially in the setting of a co-existing malignancy. A 31-year-old lady without comorbidities presented with a diagnosis of incidental Gall bladder cancer diagnosed elsewhere. Upon further evaluation, she was found to have a retrocaval mass resembling a metastatic necrotic Lymph node on Contrast Enhanced Computed Tomography (CECT) scan of the abdomen with no evidence of disease elsewhere. Due to the unusual location, mass was biopsied which was inconclusive. Surgical excision of the same was done during Revision cholecystectomy and Final histopathology report revealed it to be a benign Schwannoma. Retroperitoneal Schwannoma with degenerative changes can be a great mimicker of metastatic necrotic malignant lymph node and create diagnostic confusion. With prompt suspicion in mind and clinicoradiological correlation, it is imperative to make informed surgical decisions to avoid erroneous diagnoses that could lead to over treatment. This case underscores the importance of being aware of the differential diagnoses and the need for proper surgical resection of schwannomas to prevent recurrence and ensure complete treatment. Simultaneously, it emphasizes the importance of not compromising the management of the primary neoplasm, in this case, gallbladder cancer.

A rare case of femoral Richter’s hernia

Thu, 25 Sep 2025 00:00:00 +0530

Among all abdominal hernias, femoral hernia is a relatively rare type, occurring more commonly in elderly female. Femoral Richter’s hernia refers to a condition in which small portion of the bowel circumference becomes entrapped with in the sac of a femoral hernia. We hereby present the case of a 79 years old female with a strangulated femoral Richter’s hernia, who presented without typical symptoms of bowel obstruction and its emergency operative management.

Ectopic cervical thymoma: a rare entity in an unusual location

Thu, 25 Sep 2025 00:00:00 +0530

Ectopic cervical thymoma is an extremely rare occurrence, with few reported cases in literature. Thymomas typically arise in the anterior mediastinum, and their presence in the cervical region poses significant diagnostic challenges. Given its rarity, it is often misdiagnosed as other neck masses, such as metastatic lymphadenopathy, neurogenic tumors, or thyroid lesions. This report presented a case of a 57-year-old male who presented with a right upper neck mass, which was progressively increasing in size over several months. The patient underwent thorough clinical and radiological evaluation but the results were inconclusive. Ultrasound guided core needle biopsy was suggestive of spindle cell tumour. Neck exploration and surgical excision was performed. Intraoperatively, a well-encapsulated lesion was identified in the right level II neck region, closely adherent to surrounding structures. Complete excision was achieved without complications. Histopathological examination, supplemented by immunohistochemistry (IHC), confirmed the diagnosis of an ectopic cervical thymoma. Ectopic cervical thymomas are rare and often pose a diagnostic dilemma due to their unusual location and overlap with other neck masses. Preoperative identification is difficult, making histopathology and IHC essential for definitive diagnosis. Complete surgical excision remains the mainstay of treatment, offering good prognosis. Increased awareness of this rare entity can aid in early recognition and appropriate management.

Laparoscopic management of ileal enterolith in abdominal tuberculosis: a case report and literature review

Supreet Kumar, Sonam Gupta, Vivek Tandon, Deepak Govil — Thu, 25 Sep 2025 00:00:00 +0530

Enterolithiasis is a rare condition characterized by the formation of stone-like concretions within the gastrointestinal tract. While commonly reported in the duodenum and colon, its occurrence in the ileum is rare and typically associated with intestinal stasis caused by pathological conditions such as Crohn’s disease, strictures, or tuberculosis. Enterolithiasis in the setting of abdominal tuberculosis is exceptionally uncommon and poses significant diagnostic and therapeutic challenges. This report presents the case of a 60-year-old female with a history of abdominal tuberculosis on anti-tubercular therapy, presenting with recurrent subacute intestinal obstruction. Radiological investigations revealed a calcified intraluminal mass in the distal ileum. An initial attempt at enteroscopic retrieval failed due to luminal narrowing. She subsequently underwent laparoscopic segmental ileal resection with extracorporeal isoperistaltic anastomosis. Postoperative recovery was uneventful. Histopathology confirmed healed tuberculous ileitis without granulomatous activity or features of Crohn’s disease. Ileal enterolithiasis should be considered in tuberculosis-endemic regions when evaluating unexplained or recurrent small bowel obstruction. Early imaging, high clinical suspicion, and prompt surgical intervention are critical. This case highlights the importance of differentiating tuberculosis-related strictures from other causes and supports laparoscopic resection as a safe and effective therapeutic strategy.

Acute jejunal diverticulitis presenting with perforation peritonitis: a rare case managed in a rural setup

Hiren V. Kumbhar, Namita Prabhu, Shantanu Kadam, Vasant Deshmukh — Thu, 25 Sep 2025 00:00:00 +0530

Jejunal diverticulosis is an uncommon and frequently underdiagnosed condition of the small intestine, typically presenting in elderly patients with nonspecific gastrointestinal symptoms. Complications such as hemorrhage, obstruction, and perforation, though rare, can be life-threatening and require prompt diagnosis and surgical management. Here’s a report of rare case of acute jejunal diverticulitis with perforation in a 76-year-old female presenting with generalized abdominal pain, distension, and constipation for four days. The patient, with a history of diabetes mellitus and ischemic heart disease, exhibited febrile tachycardia, tachypnea, hypotension, and generalized abdominal tenderness on examination. Laboratory investigations revealed leucocytosis and borderline renal dysfunction. Abdominal radiography demonstrated pneumoperitoneum, warranting emergency laparotomy. Intraoperatively, multiple jejunal diverticula were identified along the mesenteric border, with a 0.5×0.5 cm perforation located approximately 2 feet distal to the duodenojejunal junction. Segmental resection of the perforated portion with primary end-to-end jejunojejunal anastomosis and thorough peritoneal lavage was performed. The postoperative period was uneventful. Histopathology confirmed true diverticula with perforation. Perforation in jejunal diverticulitis occurs in about 82% of cases due to necrotizing inflammation and may present as generalized peritonitis. Diagnosis relies heavily on computed tomography (CT) imaging, but in resource-limited rural settings, clinical acumen and plain radiographs remain crucial. Prompt surgical intervention remains the mainstay of management to prevent complications such as sepsis and short bowel syndrome. This case highlights the diagnostic challenges and emphasizes the importance of early clinical suspicion and timely surgical management of jejunal diverticular perforation, even in rural healthcare settings with limited resources.

An intricate case of fulminant necrotising infection of perineum - from destruction to restoration: a case report

Piyush Gupta, J. S. Randhawa — Thu, 25 Sep 2025 00:00:00 +0530

Necrotising fasciitis (NF) is a well-known fulminant and disabling soft tissue infection. it can affect any age group, gender and healthy individuals. The toxicity and sepsis that it is capable of inciting is immense and caries high mortality across various authorities. Delay in presentation or identification may lead to increased morbidity manifold. This is one such case with large scale surgical destruction and requiring advanced means of restoration which makes it an interesting read for surgical fraternity.

Gossypiboma: diagnostic impasse - a case report

Ritansh Bansal, Gunjan Malhotra, Hargun Malhotra, Ravinder S. Malhotra — Thu, 25 Sep 2025 00:00:00 +0530

Gossypiboma/textiloma is a retained foreign body reaction to a surgical gauze or towel unintentionally retained inside the body following surgery, which is often missed to be diagnosed. The foreign body reaction to the retained gauze pieces’ aid in the diagnosis of this rare condition. We report a case of a 60-year-old lady patient with a history of open abdominal surgery, presented with chief complaint of pain abdomen and swelling. After a series of inconclusive laboratory and radiological investigations, she underwent a diagnostic laparoscopy which led to the confirmation of the diagnosis of gossypiboma. Gossypiboma is a two-faced sword, as it not only causes increased morbidity and mortality in the patients, but also carries significant concern on medico legal fronts. Therefore, it must form an integral part of differential diagnostic approaches in any postoperative patient who presents vague symptoms, and it is recommended to use the latest systems to reduce the incidence of gossypiboma.

A giant adrenocortical adenoma masquerading as retroperitoneal sarcoma: a rare diagnostic challenge

Christabel N. Gomes, B. S. Gedam, Nitin Wasnik — Thu, 25 Sep 2025 00:00:00 +0530

Retroperitoneal masses often mimic malignancy due to their size and imaging features; however, large benign lesions, such as nonfunctioning adrenocortical adenomas, can present similarly. A 46-year-old woman with abdominal distension and intestinal obstruction was found to have a large heterogeneous retroperitoneal mass on imaging, provisionally diagnosed as retroperitoneal sarcoma. Surgical excision and histopathology revealed a benign adrenocortical adenoma without hormonal activity. This case highlights the diagnostic difficulty in differentiating benign from malignant retroperitoneal tumors based on imaging alone and emphasizes the importance of considering adrenal adenomas in the differential diagnosis. Histopathology and multidisciplinary care are crucial for accurate diagnosis and effective treatment planning.

Robotic thymectomy: a gateway to the art of mediastinal surgery highlighting technical details and instrument choreography

Thu, 25 Sep 2025 00:00:00 +0530

Robotic thymectomy represents a paradigm shift in the surgical treatment of thymic tumors and associated myasthenia gravis (MG). This article presents preoperative planning, anesthetic considerations, and clinical outcomes, while highlighting operative nuances in patient positioning, port placement, robot docking, and instrument choreography. With special emphasis on large thymoma excision, this review integrates case-based reflections and practical insights to serve both as a guide for early-career robotic surgeons and an academic contribution to the evolving literature on thoracic robotics.

A rare case of metastatic carcinoma at the colostomy site after abdominoperineal resection

Dheeraj Manne, Tirou Aroul, Robinson Smile — Thu, 25 Sep 2025 00:00:00 +0530

Metastatic carcinoma at the colostomy site after abdominoperineal resection is very rare and only a handful of case reports have been reported in literature. In this case, 40 years old woman who underwent abdominoperineal resection for rectal cancer presented a year later with stomal nodule and stricture. A portion of the colon with the mesentery, the stoma and the surrounding skin were excised and a new end stoma was created in the transverse colon. Biopsy revealed adenocarcinoma. A stomal nodule may be missed in follow up until the patient presents with symptoms. Stomal recurrence should therefore be considered whenever the patient presents with stomal nodule, ulceration, bleeding or obstruction

Delayed-onset deep mesh infection presenting as discharging sinuses years after lichtenstein hernioplasty: a case report

Saloni Baid, Som Mahajan, Parineeta, Sachin Sharma — Thu, 25 Sep 2025 00:00:00 +0530

Lichtenstein tension-free mesh hernioplasty is the gold standard for inguinal hernia repair due to low recurrence and minimal complications. However, delayed-onset mesh infections are rare and often underdiagnosed due to their subtle clinical presentation. They can manifest years later as chronic discharging sinuses and require high clinical suspicion for accurate diagnosis. Here a 50-year-old male presented with multiple discharging sinuses over the right inguinal region, several years after undergoing mesh hernioplasty. He was afebrile and hemodynamically stable. Magnetic resonance imaging (MRI) revealed subcutaneous T2 hyperintense collections, sinus tracts, and an enlarged lymph node. Surgery revealed purulent discharge with fibrotic adhesions and sinus tracts involving the mesh and spermatic cord, which were excised en bloc along with a lymph node. Histopathological analysis revealed foreign body-type granulomas, lymphocytic infiltration, and follicular hyperplasia, consistent with a chronic foreign body reaction. The patient received culture-sensitive antibiotics postoperatively and had an uneventful recovery with no recurrence on follow-up. Delayed-onset mesh infections are typically caused by biofilm-forming bacteria and may not respond to conservative treatment. Imaging assists in localization, but surgical removal of the infected mesh and affected tissues is the cornerstone of management. Histopathology helps confirm the chronic inflammatory response to synthetic mesh. This case emphasizes the need for long-term vigilance following mesh repair surgeries. Early recognition, thorough imaging, and prompt surgical intervention are vital for resolution. Awareness of this rare but significant complication can improve patient outcomes and reduce morbidity.

Rare case of adenocarcinoma of sigmoid colon with gastrointestinal stromal tumors

Rohan Maydeo, Pravin Suryawanshi — Thu, 25 Sep 2025 00:00:00 +0530

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract but account for only about 1% of gastrointestinal neoplasms. They usually occur as solitary lesions, and their synchronous occurrence with other primary malignancies is extremely rare. We report a 35-year-old female who presented with per rectal bleeding and lower abdominal pain. Imaging and endoscopy revealed an obstructive sigmoid colon mass and an incidental gastric lesion. Biopsy confirmed moderately differentiated adenocarcinoma of the sigmoid colon, while upper gastrointestinal endoscopy suggested a gastric submucosal tumor. The patient underwent laparoscopic-assisted sigmoid colectomy with partial gastrectomy in the same session. Histopathology confirmed adenocarcinoma of the sigmoid colon with mucinous features and a synchronous gastric GIST. The coexistence of GIST with colorectal adenocarcinoma is rare and can complicate diagnosis and management. Careful radiological and endoscopic evaluation is important for detecting concurrent lesions. Surgical resection remains the mainstay of treatment, and recognition of synchronous tumors is essential for optimizing outcomes.

A case report of sacral chordoma post-radiotherepy

Nabajyoti Paul, Siddharth Hazarika — Thu, 25 Sep 2025 00:00:00 +0530

Sacral chordoma is a tumor which is not commonly encountered even in experience of busy operating surgeon making it relatively rare tumor. This tumor being indolent in nature in early phase causes relatively no symptoms until advance stages. This case report presents a case of sacral chordoma in a 65 years old female coming with us for a swelling over buttocks and pain while sitting. Chordoma was confirmed on tissue biopsy and patient was planned for surgery. Debulking surgery of tumor was done and patient was discharged on post-operative day (POD) 8 with complete relief of symptoms.

The disguised testis: a rare case of intra-abdominal seminoma presenting as a lower abdominal mass

Hansraj Ranga, Vaishnavi, Luv Sharma, Rajveer Singla, Dushyant Kumar Yadav — Thu, 25 Sep 2025 00:00:00 +0530

Intra-abdominal undescended testes in adults are rare and often present as abdominal or pelvic masses, leading to diagnostic confusion with neoplasms such as gastrointestinal stromal tumors (GIST). Unrecognized cryptorchidism carries a significant risk of malignant transformation, particularly into germ cell tumors. Thorough clinical assessment, including genital examination, remains essential in such cases. A 55 years old male presented with progressive lower abdominal pain and a firm, non-tender mass in the left iliac fossa. There was no prior history of undescended testis or related surgery. Imaging studies, including contrast-enhanced CT, suggested a well-defined mass near the sigmoid colon, initially suspected to be a GIST. The patient underwent exploratory laparotomy for definitive diagnosis and management. Intraoperatively, a well-encapsulated, 6 cm mass was identified adjacent to the sigmoid colon. The lesion was excised completely without bowel involvement. Histopathological analysis revealed atrophic testicular tissue with intratubular germ cell neoplasia (ITGCN), confirming the mass as an intra-abdominal undescended testis with pre-malignant changes. This case highlights the diagnostic challenge posed by intra-abdominal undescended testes in adults. Awareness of this rare presentation, combined with careful genital examination, is crucial to avoid misdiagnosis and unnecessary extensive resections. Cryptorchidism should always be considered in the differential diagnosis of unexplained abdominal masses in males, regardless of age.

Robotic-assisted video-assisted thoracic surgery decortication using the Cambridge medical robotics versius system in a chronic kidney disease patient

Ved Prakash, Anirudh Agrawal, Ashutosh Pandey, Shivangi — Thu, 25 Sep 2025 00:00:00 +0530

Empyema thoracis in patients with chronic kidney disease (CKD) presents a unique therapeutic challenge due to increased bleeding risk and impaired host immunity. This report presents a case of a 45-year-old male on hemodialysis with right-sided multiloculated empyema who underwent robotic-assisted video-assisted thoracic surgery (VATS) decortication using the Cambridge medical robotics (CMR) versius system. The procedure was successfully completed with minimal blood loss, no intraoperative complications, and favorable postoperative recovery. The patient was re-listed for renal transplant after recovery. Robotic-assisted decortication using the CMR versius platform proved to be a safe and effective modality for complex thoracic interventions in high-risk patients.

Clear cell myoepithelioma of the palate: a case report and comprehensive review

Venkatesh Anehosur, Divya B. Kotian, Jawahar Anand, Kiran Kumar, Niranjan Kumar — Thu, 25 Sep 2025 00:00:00 +0530

Myoepitheliomas are a group of rare tumors of the salivary glands, primarily affecting the parotid gland. It accounts for less than 1% of all salivary gland tumors. The diagnosis of tumors of myoepithelial origin relies on evaluating the histologic features and is confirmed using immunohistochemical analysis. Vimentin and S-100 are non-specific but sensitive immunohistochemical markers of neoplastic myoepithelium. This is a unique case of a clear cell myoepithelioma of the hard palate. Diagnosis involved thorough histological examination and immunohistochemical confirmation, utilizing standard protocols. Our case showcases a rare occurrence of myoepithelioma, specifically the clear cell variant, in the hard palate. Histological analysis revealed large polyhedral cells with eosinophilic and clear cytoplasm and round to oval vesicular nucleus with small nucleoli. The cystic/ pseudo glandular spaces were filled with mucinous material. The results were further validated by immunohistochemical tests using Vimentin and S-100. This case highlights unusual presentation of myoepithelioma outside the parotid gland, emphasizing the importance of considering these tumors as differential diagnosis. Awareness of these atypical manifestations is crucial for accurate diagnosis and optimal patient management.

An uncommon case of transverse testicular ectopia presented as unilateral inguinal hernia: uncover impact of laparoscopy and management options

Nitin Jain, Simmi K. Ratan — Thu, 25 Sep 2025 00:00:00 +0530

Transverse testicular ectopia (TTE) is an extremely rare congenital anomaly in which both testes descend through the same inguinal canal. Patients with this condition often present with an inguinal hernia and an impalpable contralateral testis. This condition is not usually diagnosed preoperatively and the ectopic testis is usually discovered incidentally during herniotomy or findings are noted at the time of diagnostic laparoscopy. Sometimes but not commonly, TTE cases associated with intersex conditions like persistent Mullerian syndrome, which may prevent normal testicular decent. Here, we report a four year old male child presented with impalpable left undescended testis and right inguinal hernia. Diagnostic laparoscopy revealed closed left internal ring with absence of vas deferens and testicular vessels. While on the right side, vas and vessels found to be entering the wide open internal ring and left testis was located just inside the ring with its own vas and vessels supply. Consequently, trans-septal contralateral orchidopexy involving fixing the right testis in left hemiscrotum as right testis had adequate cord length and left testis was fixed in the right hemiscrotum due to its short cord length was done.

Three CBD stents removed: a rare case of obstructive jaundice

Jaspreet S. Bajwa, Rahul Chaudhary, Anjali Singh — Thu, 25 Sep 2025 00:00:00 +0530

Retained biliary stents are a rare but important cause of obstructive jaundice and cholangitis. Authors reported a unique case of a 28-year-old female with three retained common bile duct (CBD) stents, presenting with recurrent jaundice and undergoing successful open CBD exploration and Roux-en-Y hepaticojejunostomy. This report highlights the importance of follow-up after biliary stenting and the surgical challenges associated with retained stents.

Duodenal gastrointestinal stromal tumor: a rare disease in a young male patient presenting with life-threatening hemorrhage

Neel B. Patel, Jagdish Patel — Thu, 25 Sep 2025 00:00:00 +0530

Gastrointestinal stromal tumors (GISTs) are rare in the duodenum and can pose significant diagnostic and therapeutic challenges, particularly when presenting with acute gastrointestinal bleeding. A 33 years old male presented with multiple episodes of hematemesis, melena and severe anemia. Upper endoscopy revealed a duodenal nodule with overlying ulceration. CT angiography suggested a submucosal lesion consistent with a gastrointestinal stromal tumor. After stabilization, the patient underwent exploratory laparotomy with local tumor excision and omentoplasty. Postoperative recovery was uneventful. Histopathological evaluation confirmed the diagnosis of a low-grade spindle-cell type GIST. The tumor was submucosal, unifocal and fully resected with clear margins. The surgical approach was tailored to preserve duodenal integrity, given the patient's young age and tumor location. This case emphasizes the importance of recognizing duodenal GIST as a potential cause of upper gastrointestinal bleeding, even in younger adults. Prompt diagnosis and appropriate surgical intervention can lead to favorable outcomes.

Ischiorectal abscess with retroperitoneal extension: masquerading as an appendicular abscess

Kalyani Dnyaneshwar Aher, Minakshi Gadhire, Naman Jain, Prafulla Salunkhe — Thu, 25 Sep 2025 00:00:00 +0530

The occurrence of a retroperitoneal abscess as an extension of ischiorectal abscess is exceedingly rare. It’s presentation may be late or atypical. Here, we present a case report of a 27-year-old male who developed an ischiorectal abscess with late symptoms of retroperitoneal spread. Retroperitoneal extension was diagnosed radiologically following complaints of right iliac fossa pain and loose motions. Early surgical management was performed successfully.