Search

Gastrosplenic fistula is an unusual complication of benign as well as malignant gastric and splenic pathologies. This pathology acquires an important clinical significance due to its rare association with life-threatening upper gastrointestinal haemorrhage. The aim of this article is to review the English-language literature in order to gain a better understanding of etiological factors, diagnostic evaluation, and management of gastrosplenic fistula. The systematic search of the literature was performed on PubMed and MEDLINE from January 1950 to September 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We retrieved 44 articles matching our selection criteria from the search. There were 3 case series, 37 case reports, and 4 review of the literature. In our appraisal of articles published in PUBMED, a total of 36 cases of malignant and 10 cases of benign gastrosplenic fistula could be identified. Gastrosplenic fistula is an exceptional complication of malignancies of the gastrointestinal tract. Lymphomas particularly arising from the spleen are the commonest cause. Gastric adenocarcinoma causing GSF is extremely rare. Most cases occur spontaneously, but at times, it can be secondary to tumour necrosis following chemotherapy.

Involvement of esophagus with tuberculous infection is a rare form of extrapulmonary tuberculosis. Secondary esophageal tuberculosis is much more common than primary TB. The most common source of secondary esophageal involvement is tuberculous mediastinal lymphadenitis. Esophageal tuberculosis mimics carcinoma esophagus. Clinical features are same and it is difficult on imaging studies also to differentiate the two pathologies. Misdiagnosis is common. The disease is medically curable; therefore, it is essential to make all efforts to diagnose the pathology with non-surgical diagnostic modalities in suspected cases so as to save patients from the trauma of major surgical resection. Surgical intervention is indicated for failed medical therapy and complications. A total of 133 cases of esophageal TB have been reported till date. The authors encountered 4 cases of esophageal TB between April 2011 and March 2019. The aim of this article is to present our data and to provide comprehensive review of the available literature on this pathology in order to gain a better understanding of diagnostic methods and provide guidelines for the diagnosis and management of esophageal TB.

Congenital diaphragmatic hernia (CDH) is a condition characterized by defect in the diaphragm which leads to protrusion of abdominal contents or viscera into the thoracic cavity interfering with normal development of the lungs. CDH is a developmental defect of diaphragm associated with significant neonatal mortality and morbidity. Incomplete development of diaphragm allows the abdominal content to invade the thoracic cavity resulting in compression of the developing lungs. Most of the CDH diagnosed in the new born or early childhood. Around 1% with CDH have no symptoms and may be detected incidentally. Diaphragmatic hernias can be divided into two broad categories: congenital and acquired. A congenital diaphragmatic hernia (CDH) occurs through embryologic defects in the diaphragm, and most patients present early in life rather than later. However, a subset of adults may present with a smaller CDH that was undetected during childhood. Infants with CDH often present in the neonatal period with severe respiratory distress. Early surgery is mainstay of treatment in newborn as mortality is very high in this condition. Here, we are describing very late presentation of a case of congenital diaphragmatic hernia treated by surgery with good post operative outcome. This case report summarizes how to diagnose and manage a late-presenting congenital diaphragmatic hernia to prevent further complications.

Self-gripping mesh can be difficult to handle during spread to the inguinal floor because it can stick or adhere to the undesired structures because of micro-grips available on its underneath surface. This article aims to describe a new technique; we named it a four-fold technique to spread the self-gripping mesh to avoid this problem. The present study was a prospective comparative study between self-gripping mesh (polyester mesh with polylactic acid grips) and sutured mesh (polypropylene) in open inguinal hernioplasty under spinal anesthesia. This study was conducted from 1 November 2018 to 31 March 2020 in ABVIMS & Dr. R.M.L. Hospital, New Delhi. The potential candidates for the study were patients of 18 years age and above, presenting with a unilateral uncomplicated inguinal hernia that underwent open inguinal hernioplasty under spinal anesthesia. Sixty patients were alternatively allotted to group A (30 patients) and group B (30 patients) for comparison between self-gripping and sutured mesh. We used a 14 × 9-cm-size self-gripping mesh, which has semi-resorbable surface on one side and resorbable micro-grips on the other side to provide immediate fixation. Mesh was folded four times in a specific sequence before placing it, thus hiding the majority of the absorbable micro-grips. In this way, only the lower medial half of the mesh has the micro-grips exposed, and the mesh can now be fixed to the inguinal ligament without fixation to unintended tissues and structures underneath. Once the mesh is placed over the pubic tubercle and medial part of the inguinal ligament, it can be unfolded in the reverse order. The four-fold technique is an excellent method to spread the self-gripping mesh in inguinal hernia surgery to avoid sticking with undesired tissues.

The rare case is reported of advanced hepatocellular carcinoma (HCC) in a 50-year-old male with type 1 neurofibromatosis (NF 1). The patient presented in the surgical outpatient department with a 4-year history of multiple neurofibromas over the trunk and complaints of pain in the right upper abdomen for 4 months, progressive weight loss and loss of appetite. Investigation for both the abdominal complaints and the multiple neurofibromas led to the diagnosis of advanced HCC (according to the Barcelona Clinic Liver Cancer Sstaging and Treatment Strategy) with NF 1, and the patient is being managed on oral Sorafenib as palliative treatment. NF 1 occurs due to mutation in the NF 1 gene located on 17q, which codes for the protein neurofibromin, which has a tumor suppressor function. NF1 presents rarely with malignancy, in which case tumors of the central nervous system are the most common type. To the best of our knowledge this is only the second documented case of NF 1 presenting with HCC.

Aim/Objectives This prospective study aims to assess the efficacy of hyperbaric oxygen therapy in diabetic foot ulcers in relation to standard wound care.

Aim/Objectives This study aims to evaluate the role of laparoscopy in patients presenting with chronic non-specific abdominal pain and also correlate the laparoscopic findings with clinical and radiographic findings in all such patients.

Perforation peritonitis is one of the most common surgical emergencies encountered by general surgeons in India. The spectrum of aetiology of perforation differs from its western counterpart. This prospective study conducted at a tertiary healthcare centre was designed to highlight the spectrum of perforation in terms of aetiology, presentation site of perforation, surgical treatment and postoperative complications so as to improve its outcome in our region. This was a single-centre prospective cohort study conducted by the department of surgery from January 2001 to December 2014. In total, 1908 consecutive cases of perforation peritonitis admitted to surgical unit 6 were recruited in the study. Continuous variables are presented as mean ± SD, and categorical variables are presented as absolute numbers and percentages. The mean age of the patients was 34.42 years (range 18 to 60 years) and the standard deviation was ± 11.10. The majority of patients were male (77.6%). Perforated duodenal ulcer due to acid-peptic disease and small bowel perforation due to typhoid were the most common causes of perforation peritonitis, followed by small bowel tubercular perforations. Postoperative complications included wound infection 18.4%, wound dehiscence 3.9%, respiratory complications 10.5%, septicaemia 5.2%, and abdominal collection 3.9%. Perforation peritonitis is still a dreadful disease. Malignancy is a rare cause in our region. Resuscitation before surgery improves outcome. The formation of only a stoma in bowel perforations and omentopexy in the stomach and duodenum perforations rather than extensive emergency surgery contribute to low mortality.

Aims/Objectives This study aims at comparing the value of BISAP, APACHE II, and CTSI scoring in predicting the outcome of acute pancreatitis and categorization of patients based on these scoring systems.

Tuberculosis of the pancreas is extremely rare and in most of the cases mimics pancreatic carcinoma. There are a number of case reports on pancreatic tuberculosis with various different presentations, but only a few case series have been published, and most of our knowledge about this disease comes from individual case reports. Patients of pancreatic tuberculosis may remain asymptomatic initially and manifest as an abscess or a mass involving local lymph nodes and usually present with non-specific features. Pancreatic tuberculosis may present with a wide range of imaging findings. It is difficult to diagnose tuberculosis of pancreas on imaging studies as they may present with masses, cystic lesions or abscesses and mass lesions in most of the cases mimic pancreatic carcinoma. As it is a rare entity, it cannot be recommended but suggested that pancreatic tuberculosis should be considered in cases with a large space occupying lesions associated with necrotic peripancreatic lymph nodes and constitutional symptoms. Ultrasonography/computed tomography/endosonography-guided biopsy is the recommended diagnostic technique. Most patients achieve complete cure with standard antituberculous therapy. The aims of this study are to review clinical presentation, diagnostic studies, and management of pancreatic tuberculosis and to present our experience of 5 cases of pancreatic tuberculosis.

Injury to the extrahepatic biliary tract occurs frequently due to damage inflicted during upper abdominal operations, cholecystectomy being the commonest situation followed by other upper abdominal surgeries, and less often due to blunt or penetrating abdominal injury. Most traumatic extrahepatic biliary tract injuries are caused by penetrating trauma and are usually discovered during laparotomy. Diagnosis is made by noting the accumulation of bile in the upper quadrant. The gallbladder is the most commonly injured structure. Regardless of the type of biliary injury and/or management, wide and adequate drainage is essential. Any upper abdominal operation can result in biliary tract injuries. Cholecystectomy is the procedure most implicated in biliary tract injuries because it is one of the most common elective surgeries performed worldwide. If not managed properly, bile duct injuries can lead to life-threatening complications. Identification and management of biliary tract injuries demand precise judgement, expertise, timely and appropriate intervention and prevention of complications. This study aims to present detailed information and an update on biliary tract injuries.

Gastrointestinal stromal tumours, the most common mesenchymal tumours of the gastrointestinal tract, are immunohistochemically and ultrastructurally different from other mesenchymal tumours. They can occur anywhere in the GI tract, the commonest site being the stomach. GIST occurrence is not restricted to the bowel but can also involve unusual sites. The diagnosis and treatment of GIST have been revolutionized over the past decade. The mainstay of treatment remains surgical resection with adequate margins. Though these tumours are refractory to conventional chemotherapy or radiotherapy, they show a good response to molecularly targeted therapy with tyrosine kinase inhibitor. Hence, in cases where a tumour shows malignant potential, adjuvant treatment with tyrosine kinase inhibitor may prevent or delay relapse. This review summarises the current clinical and immunohistochemical knowledge of GISTs and their treatment.

Mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. Because of rarity, these tumors pose a diagnostic and therapeutic challenge. These tumors may remain asymptomatic, but commonly present as a painless mass. There are no clear treatment guidelines. Surgical excision with wide margin is the preferred modality of treatment. Medical therapy is indicated for inoperable and recurrent tumors. There are several isolated case reports on mesenteric fibromatosis with different and unusual presentations and its complications. Though several studies have been published on extra-abdominal fibromatosis as well as on extramesenteric abdominal fibromatosis, but extensive research studies are still lacking on mesenteric fibromatosis. The aim of this article is to present current knowledge on mesenteric fibromatosis, our experience of four cases, and comprehensive review of available literature.

Aims/Objectives To evaluate the sequential organ failure assessment (SOFA) score pertaining to the severity and outcome in acute pancreatitis, and compare its outcome with the APACHE II score in terms of accuracy and ease of operation with a view to establishing whether the SOFA scoring system can replace APACHE II in predicting severity and outcome of acute pancreatitis.

Pancreatic acinar cell carcinoma is a rare tumour, accounting for only about 1 % of all pancreatic tumours. The long-term survival for patients with acinar cell carcinoma is significantly better than the long-term survival of patients with pancreatic adenocarcinoma. As no large series of patients with acinar cell carcinomas exist, our understanding of this disease comes mainly from small case series and case reports. Aggressive surgical resection with negative margins is associated with long-term survival in these more favourable pancreatic cancers. There are no clear treatment guidelines for patients in whom complete surgical resection with curative intent is not possible. Acinar cell carcinomas are chemoresponsive to agents that have activity against pancreatic adenocarcinomas and colorectal carcinomas because of the shared genetic alterations between these cancers. The role of neoadjuvant or adjuvant chemoradiotherapy remains unproven. The aim of this article is to present current knowledge on acinar cell carcinoma and comprehensive review of available literature.

Background To compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging-magnetic resonance cholangiopancreatography (MRI-MRCP) in assessing the level and cause of obstruction in patients with obstructive jaundice, and to corroborate the preoperative diagnostic accuracy of MRI-MRCP and CT with operative findings.