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   2018| July-September  | Volume 6 | Issue 3  
    Online since September 10, 2018

 
 
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ORIGINAL ARTICLES
Mesenteric cysts revisited: An ever-intriguing issue
M Ezzedien Rabie, Abdelelah Hummadi, Mohammad Saad Al Skaini, Sayed Agha Ali Shah, Hussein Shamshad, Salim Jamil, Wael Eman Hassan, Mian Tahir Shah
July-September 2018, 6(3):75-84
DOI:10.4103/ssj.ssj_78_17  
Background: Mesenteric cysts continue to intrigue the surgeons and radiologist alike. Patients and Methods: Our records were reviewed to identify mesenteric cysts, diagnosed in the period from February 2014 to September 2016. Results: We identified one male and four females, with a median age of 44 years. Abdominal pain was the presenting feature in all patients. ultrasound was done in four cases, where the cyst was missed in one case, and no clue to its nature was given in the remaining three, while computed tomography suspected the diagnosis in four patients and failed in one. Laparoscopic excision was attempted in only one patient, but eventually, all patients underwent open surgical excision. In four patients, the cyst was removed intact, while in the fifth, a minor wall break occurred, resulting in limited spillage of cyst contents. Histopathological examination showed simple mesothelial cyst in three cases, a pseudocyst in the fourth case and a cystic lymphangioma in the fifth. All patients tolerated surgery well, and up to the time of writing this paper, no recurrence was reported. Conclusion: Mesenteric cysts, with its numerous types, continue to intrigue the concerned physicians. Regardless of the approach, excision of the intact cyst should be the aim, most conveniently by open surgery. Although laparoscopy could be employed, this should be entertained with caution, to avoid cyst rupture or leaving part of the wall behind, thus predisposing to recurrence.
  5,621 401 -
Postoperative ileus: A study on the role of chewing gum to reduce its duration
Ajay Singh Kalyanwat, Manish Jakhar, Sanchit Jain
July-September 2018, 6(3):85-88
DOI:10.4103/ssj.ssj_84_17  
Background: Post operative ileus (POI) is the transient absence of gut motility without any mechanical obstruction, commonly occuring after abdominal surgery. It is reported to occur in 25% patients. Although it may resolve spontaneously with two-three days there have been many studies which have evaluated the role of early feeding in recovery from postoperative ileus. The study was conducted to evaluate the role of chewing gum for early recovery of postoperative ileus. Materials and Methods: This prospective comparative study was conducted from March, 2017 to September, 2017 on patients who underwent exploratory laparotomy and any kind of intestinal anastomosis either during emergency or elective surgeries. The patients were divided into 2 groups each group having 25 patients. Patients in study group (n=25) were asked to chew one stick of chewing gum for 30 min four times a day until passing flatus while the control group (n=25) patients were kept nil per orally until the passage of flatus. A probability value of less than 5% (P < 0.05) was considered significant. The Chi-square test was used to check for differences between proportions. Results: Total male patients were 33 and 17 were female. There was no significant difference in the appearance of bowel sounds, mean time of passage of flatus, stool passage and feeling of hunger between study and control group. In all these variables the mean time was shorter in study group. The patients were discharged early in study group with a statistically significant difference. Conclusion: Based on the results it can be concluded that the chewing gum does not seem to be significant to reduce the duration of post operative ileus. Although it was seen that the duration of overall recovery of bowel movements in form of appearance of bowel sound, passing flatus and motion and feeling of hunger, occurred early in patients chewing gum but was not significant statistically.
  4,273 378 2
CASE REPORTS
Two different presentations of intestinal duplication cyst in pediatric age group
Abdulaziz Neazy, Ameera Almatrfi, Wafa Alharbi, Ahmad Abokrecha
July-September 2018, 6(3):100-103
DOI:10.4103/ssj.ssj_72_17  
Intestinal duplication cyst (IDC) is a rare congenital anomaly where there is an abnormal portion of intestine attached to or intrinsic with the normal bowel. This condition was first reported in 1733 by Calderin followed by Fitz in 1884 and finally popularized by Ladd in 1937. This study described two cases with different presentations of IDC. The first one was a 6-month-old female presented with bleeding per rectum for 2 days. The second one was a 7-year-old boy presented with constipation for 3 years and abdominal swelling in the last 3 months. Both cases were investigated clinically and radiologically and showed different findings. Laparotomy was performed for both cases and the diagnosis of IDC was made, and the management was achieved by resection with primary anastomosis for both cases. The cyst was located at jejunoileal in the first case, and in the second case, it was found in the distal descending and sigmoid colon – both were communicating and tubular type.
  3,133 248 -
ORIGINAL ARTICLES
Cross-sectional descriptive study on the epidemiology of operated female breast tumor cases in a tertiary hospital of Saudi Arabia
Khlood Mohammed Bosaeed, Khandaker Abu Talha, Mohammad Asadullah, Mohamed Abdul Samie Mitkis, Reham Yousef Al-Ghamdi, Abdulelah Saleh Al-Gthami, Albandari Khalid Al-Thubaiti, Sara Mohammed Alshahrani
July-September 2018, 6(3):71-74
DOI:10.4103/ssj.ssj_71_17  
Patient's presentation with breast lump is increasing day by day all over the world. There are different causes of breast lumps. Some of them are benign and others are malignant. Aim of Study: The aim of the study was to find out the breast tumor patients according to their histological types and age groups. Methodology: This is a cross-sectional descriptive study on the operated breast lump patients in a tertiary hospital of Saudi Arabia. All the breast lump cases operated and diagnosed as breast tumor were included in the study. Data were collected from the operation room registrar, patient file, and histopathology report of the participants. The study period was 5 years. Total number of cases was 192. Result: Two-third of the operated cases was benign, and one-third of the cases was malignant. The mean age of presentation of benign cases was 29.52 years, and the same of malignant cases was 47.31 years. The most common histopathological subtype of benign cases was fibroadenoma (100%). The different histopathology of malignant tumors was infiltrating ductal (86%), ductal in situ (9%), and invasive lobular (5%). After comparing the epidemiological variables of this study with those of different parts of the world, it has been revealed that the onset age and histopathological subtypes are different in different geographical locations.
  2,611 294 -
Totally laparoscopic resection rectopexy with transanal extraction of the specimen
JS Rajkumar, R Prabhakaran, S Akbar, Anirudh J Rajkumar, G Venkatesan, Shreya Rajkumar
July-September 2018, 6(3):89-93
DOI:10.4103/ssj.ssj_5_18  
Aim: The aim of this study is to show the functional and technical feasibility of hand-sewn verses stapler resection anastomosis, with transanal extraction of the resected colon in patients presenting with rectal prolapse and constipation. Materials and Methods: From January 2011 to 2016, a number of 16 totally laparoscopic resection rectopexies with intracorporeal anastomosis and transanal removal of specimen was performed in our institution. All patients had complete rectal prolapse with constipation. Of the 16 patients, nine had stapled anastomosis and seven had totally sutured intracorporeal anastomosis. Results: There were no leaks, no notable morbidity, and mortality in both groups. Time taken for hand-sewn anastomosis was longer (±47 min) and the cost was significantly less in this group. Conclusion: Totally laparoscopic resection rectopexy with transanal removal of the resected dolichosigmoid with either hand-sewn or stapled intracorporeal anastomosis, is a technically feasible option with excellent results in patients with constipation, and full thickness rectal prolapse.
  2,519 243 -
A study of type, pattern, and clinical profile of retained musculoskeletal foreign bodies of extremities in a tertiary care hospital of North India
Ganesh Singh Dharmshaktu, Binit Singh, Alamgir Jhan, Aanshu Singhal, Shailendra Singh Bhandari
July-September 2018, 6(3):95-99
DOI:10.4103/ssj.ssj_9_18  
Background: The presence of foreign body in musculoskeletal tissue is a major concern for the patient and treating doctor with regard to its varied presentations and appropriate management. Both metallic and nonmetallic foreign bodies have been studied extensively with special emphasis on its detection by various imaging modalities and unusual presentations of retained foreign ones. An early detection and retrieval is the mainstay of management, leading to an uneventful recovery. It also prevents subsequent complications of neglected, missed, or retained foreign bodies. The increased indulgence in recreational and industrial activities in recent times has increased prevalence and scope of penetrating injuries with various objects. Detailed data regarding patterns and presentations of various foreign body retention of musculoskeletal tissue, both acute and chronic, thus are helpful to format an anticipatory or preventive workup. Furthermore, the knowledge of the types of common foreign bodies in a region helps in drafting investigative and ameliorative public health strategies. Materials and Methods: The current study is a retrospective account of pattern and presentation of non-firearm foreign bodies managed in a tertiary care teaching hospital within a defined period. Besides it, patient characteristics and relevant details of trauma and associated findings were listed with at least 4-month follow-up. Results: Male sex, upper extremity, and left side of body were commonly involved. There was predilection for acral parts such as hand and feet. Agricultural and industrial setup was the common scenario associated with the injuries, and vegetative foreign bodies were mostly found followed by metallic ones among others. Conclusion: The study highlights various aspects of acute or chronic foreign body retention in clinical settings and is helpful to know type, pattern and presentation in a geographical region.
  2,156 226 -
CASE REPORTS
Gastrointestinal stromal tumor presenting as a recurrent mesenteric cyst: A rare and important entity
Chandan Roy Choudhury
July-September 2018, 6(3):104-107
DOI:10.4103/ssj.ssj_11_18  
Gastrointestinal stromal tumors (GISTs) arise from interstitial cells of Cajal identified in 1893 by Santiago Ramon y Cajal and present with a myriad of symptoms including gastrointestinal bleeding, obstruction, and lump. However, cystic presentation of GIST is a rare presentation and few cases have been reported in literature till date. Our patient presented as a recurrent abdominal cyst with provisional diagnosis of the mesenteric cyst. On surgery, a huge cyst adhered to the mesentery was found adhered to a part of the jejunum which required resection and anastomosis. Postoperative biopsy revealed it to be a case of GIST with cystic degeneration due to hemorrhage and necrosis. The author tries to find out whether preoperatively any features are predictive of this rare diagnosis to enable R0resection for good prognosis.
  1,938 176 -
Paratesticular desmoplastic small round cell tumor as an incidental finding during imaging of an obstructed inguinal hernia in an old-age patient
Sadq Ghaleb Kadem, Sarmad Manea Habash
July-September 2018, 6(3):108-110
DOI:10.4103/ssj.ssj_20_18  
Desmoplastic small round cell tumor (DSRCT) is an extremely rare malignancy mainly located in the abdominal and pelvic peritoneal cavity. A few published studies have reported the involvement of testicular/paratesticular region. The present study describes an unusual case of paratesticular DSRCT that was discovered incidentally during imaging of an obstructed inguinal hernia in an old-age patient. After radical orchiectomy, the patient was administered treatment consisting of a multidrug combination chemotherapy and adjuvant radiotherapy and remained disease free during the 24-month followup period, with only one attachment of local tumor recurrence in the right inguinal region.
  1,825 222 1
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