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   2017| May-August  | Volume 5 | Issue 2  
    Online since July 26, 2017

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Primary and secondary omental infarction: A 5-year experience in a tertiary care hospital
Naseer Ahmad Choh, Tahleel Altaf Shera, Shumyla Jabeen, Obaid Ashraf, Azher Maqbool Khan, Feroze Ahmad Shaheen, Ghulam Muhammad Wani, Munir Wani, Mubashir Shah, Tariq Gojwari, Irfan Robbani
May-August 2017, 5(2):77-81
Objective: The aim of this study is to describe the computed tomography (CT) features of primary and secondary omental infarction. Materials and Methods: Five cases of primary and seven cases of secondary omental infarction are described with emphasis on CT features. The etiology and clinical features are described with the ultimate clinical outcome. Results: In this case series of 12 patients, five omental infarcts (42%) were classified as primary. Seven cases (58%) were postoperative with four infarcts following cesarean section, one following a total abdominal hysterectomy, one occurring after a laparoscopic ovarian cystectomy, and one occurring after laparoscopic hemicolectomy. Of the seven secondary omental infarctions, one was associated with secondary thickening of the transverse colon and one patient developed an abscess. Three patients from the secondary group and one patient from the primary group underwent omentectomy. Primary infarcts showed an ill-defined fat attenuation lesion with thin stranding located in the right upper quadrant in three and left lower quadrant in two patients. The postoperative omental infarcts showed more pronounced inflammatory change and soft tissue attenuation foci interspersed with fat density foci. They were located in the right lower quadrant in four patients, in the right upper quadrant in two patients, and in the left lower quadrant in one patient. The patients were followed to clinical resolution. Conclusion: It is possible to distinguish primary and secondary omental infarcts on the basis of CT features. Even though, a nonsurgical cause of acute abdomen, surgical management may become necessary in patients with secondary omental infarction and secondary infection who fail to respond to antibiotics and percutaneous drainage. The majority of the secondary cases followed cesarean section in our series.
  6,199 337 3
Diagnosis and treatment of traumatic liver injuries
Bilal O Al-Jiffry
May-August 2017, 5(2):53-59
Following abdominal trauma, especially the blunt one, the liver is considered the second abdominal organ liable to injury and the first leading cause of death. The most common cause of liver injury is blunt abdominal trauma secondary to motor vehicle accidents and it carries a higher mortality rate than open one. With the recent trends of nonoperative management of the majority of liver trauma patients, the introduction of damage control surgery (DCS) and other therapies such as hepatic artery embolization and liver transplantation is still having a growing role in severe hepatic injuries with hemodynamic instability. The better understanding of hepatic anatomy and pathophysiology, in addition to the advance in diagnostic imaging, resuscitation, intensive care, and the introduction of DCS, has led to marked improvement in the mortality rate following liver injury.
  4,802 404 -
A traumatic lumbar hernia: Case report and review of the literature
Alaa Mohamed Sedik, Ahmad Fathi, Mufeed Maali, Abrar Hussein, Salwa Elhoushy
May-August 2017, 5(2):84-86
Acute lumbar hernia secondary to blunt trauma is a rare injury of the abdominal wall and, when encountered, is a difficult challenge for the trauma surgeon. Traumatic hernias occurred most commonly in the inferior lumbar triangle (70%) and were most frequently a result of a motor vehicle collision (71%). Delayed diagnosis is not uncommon, as nearly a quarter of these are missed at initial presentation. These hernias are best managed by operative intervention; however, there is no well-defined treatment strategy regarding either the timing or the type of repair. Several approaches, including laparoscopy, have been described to repair these defects. We reported a case of traumatic inferior triangle hernia as a result of a motor traffic accident.
  4,584 242 -
Role of computed tomography scoring system in management of small-bowel obstruction
Atul Jain, Tanweer Karim, Subhajeet Dey, Meenu Garg, Shashank Mishra, Prakash Chand Attri
May-August 2017, 5(2):65-70
Context: Patients with a bowel obstruction still represent some of the most difficult and vexing problems that surgeons face with regard to the correct diagnosis, optimal timing of therapy, and appropriate treatment. Aims: The aim of this study was to study the role of computed tomography (CT) in determining the etiology and intervention in intestinal obstruction with specific role of CT scoring system in decision-making. Settings and Design: This prospective study was conducted in the Department of General Surgery of a medical college of North India, for 2 years. Materials and Methods: In this study, we have selected patients with all age group who attended to outpatient department and emergency department at CSSH hospital with history and clinical picture suggestive of intestinal obstruction. Statistical Analysis Used: Positive predictive value, negative predictive value, and accuracy. Results: In our study, CT scoring system helped 81% of time in predicting the requirement of surgery. CT scoring has less sensitivity toward the cases with congenital malformation and those cases should be managed on basis of clinical and other parameters as conservative management in such cases have high rate of recurrence of obstruction and other complications. Conclusions: Clinical sense remains the mainstay of deciding the line of management in cases of intestinal obstruction. CT in these patients can help surgeon to go for surgery early and prevent complications. It also helps in preventing unnecessary surgeries in patient who can be managed conservatively. CT scoring system is less sensitive for congenital malformations and other CT features along with clinical features are mainstay for decision-making in these patients.
  4,228 408 1
Efficacy of intralesional bleomycin as an alternative approach in the management of vascular anomalies
Rajeev Gurunath Redkar, Swathi Chigicherla, Shirin Joshi, Anant Bangar, Shruti Tewari
May-August 2017, 5(2):60-64
Aim: Cystic hygroma and hemangiomas are vascular anomalies which are mostly congenital in origin. The complications are increase in size of the swelling, infection, hemorrhage, dysphagia, respiratory distress, disfigurement, and recurrences. This study was done to assess the results of intralesional bleomycin. Materials and Methods: A retrospective analysis of patient demographics, clinical response, treatment, and complications were recorded in vascular anomalies from 2009 to 2016. Nine children (53%) with hemangiomas and eight children (47%) with cystic hygroma were included in the study. The bleomycin injection was given as 1 mg/kg/dose intralesionally in all except for face lesions where it was given as 0.5 mg/kg/dose and was repeated after 4 weeks in case of nonresolving lesions. Two to six bleomycin injections were required in 14 cases and remaining three resolved after single injection. The lesions were assessed on first follow-up for resolution at 4–6 weeks. Results: Out of the 17 children, 8 (47%) were male, and 9 (53%) were female. Sixteen children (94%) had lesions in the head, neck, and chest region and one had (6%) lesion on the hand. The lesions had completely resolved over 1–years in 14 (6 - hemangiomas and 8 - cystic hygroma) patients (82%) after bleomycin sclerotherapy, and one patient (hemangiomas) had 80% resolution and is on follow-up. Two patients (11%) had recurrence after six injections of bleomycin in chest cystic hygroma (1) and lip hemangiomas (1), and underwent surgical excision subsequently. Conclusion: The bleomycin injection sclerotherapy is effective, safe, and economical.
  3,912 353 2
Retrospective analysis of appendicectomy specimens: A tertiary care center-based study
Suhailur Rehman, Asim Israr Khan, Hena Ayyub Ansari, Feroz Alam, Shaista M Vasenwala, Kiran Alam, M Amanullah Khan
May-August 2017, 5(2):71-75
Introduction: Acute abdominal pain in the right iliac fossa is the most common symptom of acute appendicitis for which appendicectomy is usually done. Histopathological examination of appendicectomy specimen reveals different causes of appendicitis which will decide further course of action. Aims and Objectives: The aim of this study is to record the percentage of various pathologies of appendix, by carrying out a retrospective study of appendices excised in the past 2 years. Materials and Methods: Three hundred and sixteen cases of appendicitis were taken and H and E sections of the specimens were reviewed. Observation and Results: Out of 316 cases, there were 192 (60.8%) cases of acute appendicitis, 56 (17.7%) of periappendicitis, 1 (0.3%) of acute appendicitis with diffuse lymphoid hyperplasia, 7 (2.2%) of subacute appendicitis, 9 (2.8%) of recurrent appendicitis, 10 (3.2%) of obliterative appendicitis including one case of roundworm infestation, 25 (7.9%) of chronic appendicitis, 3 (0.9%) of mucocoele, 2 (0.6%) of mucinous neoplasm, 2 (0.6%) of carcinoid, 1 (0.3%) of adenocarcinoma, and 8 (2.5%) of normal appendix. Conclusion: This study highlights the importance of histopathology as some of the rare malignancies of appendix as mucinous neoplasm, carcinoid, and adenocarcinoma can present with acute abdominal pain. Hence, careful histopathological examination of appendix and regional lymph nodes is mandatory with follow-up and endoscopy of the patient.
  3,421 312 1
Annular pancreas causing duodenal obstruction in two consecutive sisters
Ruzaimie Noor, Zafran Mohamad, S Farhan, Tarmizi Nor
May-August 2017, 5(2):87-88
Congenital duodenal obstruction is a common cause of neonatal intestinal obstructions. The occurrence of duodenal obstructions in family is extremely rare. We operated on two consecutive sisters presented with symptoms of duodenal obstruction. In both of our patients, annular pancreas was identified as a cause of duodenal obstruction. Only less than twenty cases have been published in English literatures. To the author's knowledge, we are the first to report the cases of familial annular pancreas and duodenal stenosis in Malaysia.
  3,240 213 1
Prostatic leiomyosarcoma: A rare and aggressive tumor
Noora Saeed, Sayeedul Hasan Arif, Saima Khan, Suhail Ur Rehman
May-August 2017, 5(2):92-94
Primary prostatic sarcomas of adults are very rare with the most common type being prostatic leiomyosarcoma. They occur in men in their late age with the clinical features similar to that of prostatic carcinoma, so diagnosis can only be made after the resection of prostate and histopathological examination. Histopathologically, they are mitotically active tumors composed of interlacing fascicles and bundles of smooth muscle with areas of necrosis. These tumors have an aggressive clinical course and bad prognosis. Here, we present a case of 58 years male who presented with urinary complaints and lower abdominal pain. After microscopic and immunohistochemical examination of the specimen following transurethral resection of prostate, a final diagnosis of prostatic leiomyosarcoma was made.
  2,993 187 -
Ileo-ovarian knotting in a case of strangulated inguinal hernia in a 46-year-old female: A first case report
Mohammad Atif Khan, Neha Ramesh Mutha
May-August 2017, 5(2):89-91
Ileo-ovarian knotting in a case of strangulated inguinal hernia, reported herein, has never been reported before. We believe this case is of great importance because of its absolute rarity. A 46-year-old female came with right inguinal swelling, vomiting, and abdominal distension for 2 years but aggravated during the last week. She had passed stools 24 h ago and was vomiting since then. The abdomen was distended as well as tenderness and guarding was noted in the lower abdomen. Examination revealed strangulated right inguinal hernia with abdominal X-ray suggestive of acute small bowel obstruction. Abdominal ultrasonography revealed dilated small bowel loops and aperistaltic edematous intestines in the right inguinal region; an urgent surgery was, hence, planned. Exploration revealed ileo-ovarian knotting with one-foot gangrene of small bowel and strangulated right ovary. Resection of the right ovary, bowel resection, and end-to-end anastomosis with hernioplasty were performed. The patient recovered well in the postoperative period.
  2,817 172 -
Meckel's diverticulum in ectopic location: A rare presentation
Supaksh Mahindru, Sumitoj Singh, Mandeep Singh Sandhu, Ashok Kumar
May-August 2017, 5(2):82-83
Meckel's diverticulum is a common congenital anomaly that present with different clinical manifestations. A case of 35 year old male is being reported who presented with acute pain in right iliac fossa. On exploration meckel's diverticulum was found over the lateral surface of the ileum instead of the anti-mesenteric location. Review of the rare ectopic presentations of meckel's diverticulum, their diagnostic characteristics with their possible explanations has been done in this case report.
  2,473 217 1