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Colonic bezoars are undigested or partially digested materials that accumulate in the form of a mass in the colon. There are occasional reports of constipation and intestinal obstruction due to geophagia or pica. Bezoars are due to pica, which is commonly associated with iron deficiency anemia and psychiatry disorders. A nine-year old female child presented with complaint of abdominal pain, vomiting and constipation for few months, and lately with features anemia and acute intestinal obstruction. She had history of pica. After evaluation she was treated surgically in two stages. In the first stage exploratory laparotomy with evacuation of lithobezoars with transverse colostomy was done, which was followed by colostomy reversal in the second stage. As a part of multidisciplinary treatment, psychiatric counseling and nutritional support were provided. Colonic lithobezoars presenting with features of chronic constipation and complicated with large bowel obstruction is a rare finding. Diagnostic imaging modalities such as X-ray and CT scan play an important role in confirming the diagnosis. Initial management involves conservative measures for uncomplicated cases with surgical intervention as a definitive option for complications like obstruction or perforation. This case highlights the importance of considering pica with bezoars in children presenting with anemia and features of bowel obstruction. In such case multidisciplinary support and definitive medical and surgical management is done. • Colonic lithobezoars with pica presenting as acute bowel obstruction and anemia is a rare finding. • Patient can present with history of chronic constipation and features of acute abdomen complicated with large bowel obstruction. • Evaluation of patient with radioimaging aids in diagnosis and operative planning. Failure of Conservative management warrants surgical intervention. • Multidisciplinary approach including psychiatric evaluation and nutritional support is required along with the definitive surgical intervention. [ABSTRACT FROM AUTHOR]

Ileal perforation is a rare but serious condition that can arise from accidental ingestion of foreign objects. This report discusses an unusual case of ileal perforation peritonitis caused by ingestion of a chicken bone. A 60-year-old male presented with acute generalized abdominal pain, fever, nausea, and vomiting for three days. A physical examination revealed signs of peritonitis. Imaging results were unremarkable. Emergency laparotomy revealed perforation in the ileum caused by the chicken bone. The perforated segment was resected, and primary anastomosis was performed. Ingestion of foreign bodies, although common, rarely leads to gastrointestinal perforations. Among these foreign bodies, chicken bones are rarely reported, making the diagnosis challenging because of nonspecific symptoms and low clinical suspicion. Prompt surgical intervention is crucial for managing complications such as peritonitis and sepsis. This case highlights the importance of considering foreign body ingestion in the differential diagnosis of acute abdominal pain, particularly in patients without an obvious cause of peritonitis. Early detection and timely surgical intervention are essential to improve patient outcomes. • Ileal perforation caused by the accidental ingestion of chicken bone is an infrequent and challenging diagnosis. • Preoperative diagnosis was challenging in a 60-year-old male due to nonspecific symptoms and unremarkable imaging results. • Prompt resection and primary anastomosis led to successful management of ileal perforation and peritonitis. • This case emphasizes the need to consider foreign body ingestion in the differential diagnosis of acute abdominal pain. [ABSTRACT FROM AUTHOR]

Protein S deficiency resulting in mesenteric vein thrombosis has been reported in previous studies however those causing SMA thrombosis has been rarely reported. Multidisciplinary approach involving general surgeon, a vascular surgeon, an interventional radiologist, and an intensivist are crucial for management of SMA thrombosis. A 39-year-old non-smoker hypertensive female who was diagnosed with partially occlusive thrombus in the superior mesenteric artery via Contrast-enhanced computed tomography (CECT) re-presented after 5 days and CECT revealed a partially occlusive thrombus in the superior mesenteric artery and Protein S deficiency (free protein S:15 %). She was managed by lysis of thrombus with streptokinase by interventional radiology team. The patient is on anticoagulants and without abdominal complaints on follow-up at 24 months. Computed tomography angiography should be done immediately in any patient suspected of AMI since delay in diagnosis accounts for high mortality rates of 30–70 %. The surgical treatment of the condition is well established and consists of revascularization and/or resection of nonviable bowel. Endovascular techniques have emerged as an alternative for occlusion of the SMA. Patients with protein C and/or S deficiency treated for AMI require lifelong anticoagulant/antiplatelet therapy to prevent relapse. Hereditary thrombophilia should be suspected in young people with unusual thrombotic presentations. Earlier diagnosis and aggressive antithrombotic therapy in individuals with hypercoagulable states can improve outcomes. Treatment involving a multidisciplinary approach improves outcomes. • Protein S deficiency causing SMA thrombosis have been rarely reported. • Delay in diagnosis is the dominant factor that accounts for high mortality rates of 30–70 %. • A multidisciplinary approach is crucial in management of AMI with protein S deficiency. [ABSTRACT FROM AUTHOR]

• Prostatic tuberculosis is one of the rarest clinical entities. • Huge prostatic abscess might be one of the complications of granulomatous prostatitis. • Most cases follow the disseminated tuberculosis. • Transurethral loop drainage can be a promising method of treatment. • Category 1 anti-tubercular therapy should be initiated. Prostatic tuberculosis is one of the rarest findings in clinical practice and associated prostatic abscess is even scarce, described in literatures. We present a rare case of prostatic tuberculosis complicated by huge prostatic abscess. A 68-year-old male with no any comorbidity presented with history of increased frequency of micturition along with poor flow, urgency and nocturia for 17 days. He was under medical treatment for benign enlargement of prostate for 2 years. Per rectal examination revealed a boggy cystic swelling anteriorly with enlarged prostate with mild tenderness. Ultrasonography abdomen and pelvis showed massive enlargement of prostate with central avascular necrotic area with moving internal echoes. Contrast enhanced computed tomography (CECT) showed 230 g of prostate with central liquefaction of approximately 101 mm3. Transurethral loop drainage along with resection of prostate was done. Histopathology revealed granulomatous prostatitis highly suggestive of prostatic tuberculosis. Prostatic abscess culture was negative. Patient is currently under category 1 anti-tubercular therapy. Prostatic tuberculosis is a rare clinical finding which is commonly seen in patients with disseminated tuberculosis with immunocompromised status. Prostatic abscess in setting of granulomatous tuberculosis of prostate is even rarer. Transrectal ultrasonography is the investigation of choice for diagnosis of abscess if available. Treatment includes drainage of abscess preferably transurethral, and antitubercular therapy. Trans-urethral loop drainage is a safe treatment modality for patients presenting with prostatic abscess followed by anti-tubercular therapy if histopathology findings are suggestive of granulomatous lesions. [ABSTRACT FROM AUTHOR]

• Splenic abscess is one of the rarer findings which is commonly seen in immunocompromised individuals. • Splenic abscess may present with features of pleural effusion along with empyema if gets infected. • Pleural empyema needs tube drainage. • Splenic entity if unilocular, can be managed with broad spectrum antibiotics along with percutaneous aspiration or drainage. • Open drainage or splenectomy is mandatory in case percutaneous techniques fail. Splenic abscess generally occurs through hematogenous spread and typically follows endocarditis or seeding from contiguous sites of infection. This can be complicated by empyema thoracis. We present a rarer case of chronic alcoholic with splenic abscess along with empyema thoracis. A 39-year old alcoholic male presented with history of pain at left hypochondrium and difficulty breathing for 7 days. Abdominal examination revealed tenderness at left hypochondrium along with enlarged spleen and liver associated with decreased air entry of left chest. Chest X-ray showed complete white out lung field on left side. Contrast enhanced tomography abdomen and pelvis revealed splenic abscess involving lower pole of spleen along with peri splenic extension. Tube thoracostomy drainage on left chest was done followed by ultrasonography guided repeated aspiration of splenic entity. Pus culture sensitivity showed growth of Streptococcus pyogenes while splenic aspirate remained sterile. Patient got discharged on 8th day of admission with full recovery. Splenic abscess is the rare entity which is commonly seen in immunocompromised individuals that might get complicated as empyema thoracis and management includes broad spectrum antibiotics along with tube thoracostomy and percutaneous drainage of splenic abscess if possible, in view of spleen being salvageable. Pleural collection revealed growth of Streptococcus pyogenes in our case which itself is the rare finding. Splenic abscess can be managed with percutaneous aspiration/drainage if lesion is unilocular in the view of salvaging spleen. Complicated empyema can be managed with tube thoracostomy along with broad spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Isolated pancreatic injury following blunt abdominal trauma is rare, and the absence of definite clinical signs and symptoms may delay diagnosis and management. We present the case of a seven-year-old girl with a history of progressive, periumbilical abdominal pain and multiple episodes of non-bilious, non-blood mixed vomiting following a road traffic accident. Computed tomography (CT) imaging revealed an isolated grade three pancreatic injury managed conservatively. The patient usually presents with epigastric tenderness with or without a rise in pancreatic enzyme levels. CT grading of injury correlates with and guides the management approach, and CT abdomen with contrast is the preferred investigation for diagnosis. Management depends on the grade of injury, the hemodynamic status of the children, and the co-existence of other injuries. Isolated pancreatic injury, although rare, can go undiagnosed due to a lack of suspicion from the treating surgeon and may have dire consequences. Conservative management can be a suitable strategy for children with stable hemodynamic status. • Isolated pancreatic injury following blunt abdominal trauma is rare. • Accurate diagnosis relies on clinical features, raised pancreatic enzymes, and imaging. • Contrast-enhanced CT abdomen is the preferred diagnostic method. • Management depends on the injury grade, children's hemodynamic status, and co-existing injuries. • Non-operative management can lead to equivalent outcomes in selected cases. [ABSTRACT FROM AUTHOR]

The mangled hand is a complex and uncommon injury of the upper extremity. It involves injury to multiple structures i.e., bone, soft tissue, and neurovascular bundles of the hand leading to loss of function and viability. These injuries are usually caused due to trauma from high-energy equipment. A 32-year female presented with a crush injury to her right hand by a grass-cutting machine. The right hand was de-vascularised with injury to both radial and ulnar arteries. She had multiple lacerations, fractures of the distal radius and ulna, and multiple fractures of the metacarpals and phalanges. An initial revascularization procedure with a vein graft was done in the ulnar artery, joints were stabilized, and planned for reconstructive surgery at a later date. Initial evaluation includes a decision to salvage or amputate the limb. Early intervention to restore vascularity is key to salvaging a mangled hand. This should be followed by a multidisciplinary team approach. Preference is given to reconstruction procedures rather than amputation and prosthesis procedures. Early intervention, a multispecialty approach, and staged procedures are required for the successful management of a mangled hand. Eventually, physiotherapy has a key role in the restoration of function. • A mangled hand is a complex and uncommon injury of the upper extremity involving injury to multiple structures of the hand. • Early intervention to restore the vascularity is important to salvage the mangled hand. • Management requires multispecialty approach and staged treatment along with effective physiotherapy. [ABSTRACT FROM AUTHOR]

Chyle leak is the leakage of milk-like triglyceride-rich lymphatic fluid from the lymphatic system to the peritoneal cavity. The incidence of chyle leak after radical gastrectomy is very low. A 77-year-old female presented with complaints of decreased appetite and weight loss for six months. Upper gastrointestinal endoscopy showed a polypoidal growth along the greater curvature and the histopathological report of the biopsy taken showed high-grade tubular adenoma with high-grade dysplasia. The patient underwent pylorus-preserving gastrectomy with D1 lymphadenectomy. Postoperatively, after initiation of the oral diet, the abdominal drain started draining milky white fluid, which was rich in triglyceride. The patient was managed conservatively with nil per oral, total parenteral nutrition, and somatostatin analogue. The appearance of milky, nonpurulent fluid in abdominal drain concurrent with the initiation of oral feeding is characteristic of postoperative chyle leak. In our case, we managed the case successfully over a few days with total parenteral nutrition, nil per oral status, and somatostatin analogue. The incidence of chyle leak after gastrectomy is low, if it occurs it prolongs the hospital stay. Higher age, female gender, and early enteral feeding have been seen as the risk factors for chyle leak. Conservative treatment is effective and is the treatment of choice. • Chyloperitoneum is the leakage of milk-like triglyceride-rich lymphatic fluid from lymphatic system to the peritoneal cavity. • Post-operative chyle leak increases with extensive intraoperative dissection • Higher age, female gender and early enteral feeding have been seen as risk factor for chylous ascites. • Total parenteral nutrition, somatostatin analogues, paracentesis along with low fat diet are curable in most of the cases. [ABSTRACT FROM AUTHOR]

Popliteal artery thrombosis a rare but life-threatening complication of Paroxysmal Nocturnal Hemoglobinuria caused due to hemolysis. Complications of further thrombotic event are common after initial management. A 38 years old male, known case of PNH for 2 years, presented with the history of loss of pain sensation, coldness and loss of movement in left lower leg for 5 days and history of multiple blood transfusion. The patient underwent knee amputation because of possible complication of PNH. Intermittent claudication along with paresthesia, lower extremity weakness, stiffness, and cool extremities are seen in patients of Peripheral Artery Disease. Ultrasound color duplex is a sensitive and specific examination for peripheral flow while gold standard techniques like MRI and CT angiogram to detect and diagnose arterial lesions. The risk of thrombo-embolism in a patient of PNH should be considered by a treating doctor while early imaging and management should be done to reduce the complications and risk of amputation. • Popliteal artery thrombosis is a rare life-threatening complication of Paroxysmal nocturnal hemoglobinuria (PNH) • We report a known case of PNH patient diagnosed with acute occlusion of Popliteal artery due to thrombosis. • Complications of further thrombotic event are common after initial management and subsequent above knee amputation was done. [ABSTRACT FROM AUTHOR]

The association between gastrointestinal stromal tumor (GIST), mesenchymal tumor arising from the interstitial cells of cajal and Neurofibromatosis type 1 (NF1), an autosomal dominant disease has been reported in the literature. GIST in NF1 patients are multiple and located in the small intestine. Tumorigenesis in NF1 associated GIST is different to that of sporadic GIST and hence the treatment. Here we report a rare case of an NF1 patient with multiple jejunal GISTs. We here present a rare case of a 57-year-old male diagnosed with NF1 30 years back, presented in our emergency department with complaints of black, tarry stools later diagnosed to have multiple GIST in jejunum. Contrast enhanced computed tomography (CECT) of the abdomen showed a large 10.1 × 7.33 × 6.2 cm heterogeneous, exophytic, solid mass with cystic areas originating from the jejunum. The microscopic examination of the specimen showed spindle shaped tumor cells while immunohistochemistry showed CD117 (c-KIT) and DOG-1 positivity. The primary treatment was complete surgical excision of the tumor. The incidence of GISTs in NF1 patient is around 6–7%; however, concomitant presence of multiple GISTs is rare. CECT of abdomen along with histopathological and immunohistochemistry studies are diagnostic. The management of GIST includes surgical and adjuvant therapy methods based on the tumorigenesis and recurrent risk stratification. Early clinical suspicion and imaging aids in early detection of the tumor in patients with NF1 presenting with gastrointestinal symptoms. Postoperatively, screening for recurrence with radiology is of utmost importance. • An association between Neurofibromatosis 1 (NF1) and gastrointestinal stromal tumors (GIST) has been reported in literature. • Clinical suspicion for GISTs should be made in middle-aged or older NF1 patients presenting with gastrointestinal symptoms. • CECT of the abdomen along with histopathological and immunohistochemistry studies are diagnostic. • The treatment often mandates surgical resection of the tumor and the prognosis of NF1-associated GIST patients is good. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) is a rare haematological disorder affecting infants and young children and has an estimated incidence of 2-5 cases per million people per year. LCH invades the reticuloendothelial system and causes the proliferation of Langerhans cells and mature eosinophils. LCH involving the temporoparietal bone has rarely been reported in the literature. A ten-year-old boy presented to the Neurosurgical outpatient clinic with a swelling on the right temporoparietal region following a fall from his bicycle. Local examination revealed a single, 3 × 3 cm, non-tender, cystic, immobile swelling in the right temporoparietal region. On evaluation for recent head trauma, an incidental finding of eosinophilic granuloma was discovered on a CT scan. The FNAC was suggestive of a histiocytic lesion pertaining to a diagnosis of LCH. The patient underwent wide excision of the mass and cranioplasty. A one-month follow-up CT scan of the head had no evidence of residual or recurrent disease. Eosinophilic granuloma is one of the three variants of LCH and has a relatively better prognosis. Clinical diagnosis can be challenging and mandates tissue sampling for histopathological examination. Treatment modalities including surgery, radiotherapy, chemotherapy, and steroid injection are used alone, or in combination, depending on the extent and severity of the disease. Examining a swelling in the temporoparietal region with no other characteristic symptoms could be a case of LCH. The timely diagnosis and surgical excision with other adjuvant treatment options of this rare pediatric disease would help in a better outcome. • Langerhans cell histiocytosis can present as a mass in the temporal or parietal region with no symptoms otherwise. • The etiology of Langerhans cell histiocytosis is still unknown and diagnosis can be challenging. • The prognosis depends greatly on early identification and prompt surgical treatment. [ABSTRACT FROM AUTHOR]

Choledochal cyst is an important risk factor for cholangiocarcinoma. Concomitant hilar cholangiocarcinoma with choledochal cyst with cholelithiasis is a rare finding. A 52-year-old male presented with non-specific complaints of generalized weakness for 3 months. Transabdominal ultrasound showed dilated common bile duct with hyperechoic mass at hilar region; further evaluation with magnetic resonance cholangiopancreatography and contrast-enhanced computer tomography of abdomen and pelvis revealed concomitant intraductal hilar cholangiocarcinoma (Bismuth Corlette type 1) with Choledochal cyst (type IVa) with cholelithiasis. After optimization patient underwent left hepatectomy with common bile duct excision with cholecystectomy with Roux-en-Y hepaticojejunostomy. Histopathological examination confirmed it to be well-differentiated adenocarcinoma, intestinal type at the hilar confluence. An asymptomatic male patient with the concomitant finding of perihilar cholangiocarcinoma (Bismuth Corlette type I) with choledochal cyst type IVa with cholelithiasis is a rare finding. The patient was managed with surgical excision of the common bile duct with Roux-en-Y hepaticojejunostomy and cholecystectomy. Diagnostic evaluation should be proper not to miss or overlook such a synchronous lesion. Incidental finding of concomitant perihilar cholangiocarcinoma with the choledochal cyst is rare. Proper evaluation of the patient with CECT abdomen and pelvis and MRCP is necessary for the diagnosis. Proper surgical resection with adequate lymph node removal is important for surgical clearance. • Choledochal cyst and cholelithiasis are the risk factors for cholangiocarcinoma. • Concomitant perihilar cholangiocarcinoma with choledochal cyst and cholelithiasis without symptoms is rare. • Proper clinical evaluation along with multimodal imaging is essential for diagnosis and management. • Surgical R0 resection including adequate perihilar and pericholedochal lymph node removal is important for surgical clearance. [ABSTRACT FROM AUTHOR]

• Common Hepatic Artery pseudoaneurysm after total gastrectomy is uncommon and can be devastating. • We report a case of a ruptured common hepatic artery pseudoaneurysm who presented with massive gastrointestinal bleeding. • Early assessment with CT angiography followed by early appropriate treatment is life-saving. Common Hepatic Artery (CHA) Pseudoaneurysm is a rare entity, attributed to infections, trauma, and upper abdominal surgery. Most cases occur after biliary and pancreatic surgery. CHA pseudoaneurysm after total gastrectomy is uncommon and can be devastating. A 58-years male who underwent D2 total gastrectomy for gastric carcinoma ten days ago, presented with hematemesis, epigastric pain, and a history of melaena. After admission, upper gastrointestinal endoscopy showed a clot at the jejunojejunostomy site. Computed tomography with angiography was diagnostic of pseudoaneurysm of CHA located inferiorly. Coil embolization of CHA was done and the patient improved. Pseudoaneurysm of the common hepatic artery is a serious complication after abdominal surgery. Only a few cases have been reported with similar symptoms related to gastrointestinal bleeding following various upper abdominal surgeries. Coil embolization is a gold standard technique with a high success rate. CHA pseudoaneurysm is a dreadful potential complication of abdominal surgery including gastrectomy. Early recognition and emergency management of CHA pseudoaneurysm are crucial for a favorable outcome for patients with bleeding from CHA aneurysm. [ABSTRACT FROM AUTHOR]