Search

Post-liver transplant (LT) hepatic artery vasospasm is a vascular complication that is not well recognized and its incidence is not known. As a possible sequela to vasospasm, hepatic artery thrombosis is the second major cause of allograft failure after primary nonfunction and its reported incidence is 2.9% in adults and 8.3% in pediatric LT. Lacuna in knowledge regarding early hepatic artery vasospasm post-LT makes it a difficult condition to diagnose and treat, as the initial ischemic insult on graft can have devastating consequences. We report a case of pediatric progressive familial intrahepatic cholestasis type 3-related chronic liver disease who underwent cadaveric orthotopic LT and postoperatively developed fever, worsening hypotension, and elevated liver enzymes with an absence of arterial flow in intrahepatic branches on Doppler ultrasound. Suspecting early hepatic artery thrombosis, the patient was re-explored and the graft hepatic artery was found to be in a state of vasospasm. Following the infusion of intra-arterial papaverine, urokinase, and intravenous nicorandil, there was an improvement in blood flow. The patient responded well and was discharged on postoperative day 23 with normal liver enzymes.

Although abdominal aortic aneurysm (AAA) is common in the atherosclerotic aorta in the elderly, isolated AAA (IAAA) is a rare entity. Only few case reports of IAAA associated with concomitant dissection are reported in the literature. Here, we present a case of a middle-aged male who presented with abdominal pain with stable hemodynamics. Abdominal examination revealed a pulsatile mass in the left paraumbilical region. CT angiography of the abdomen revealed an isolated infrarenal AAA with dissection extending into the bilateral common iliac arteries and an eccentric partial thrombosis of the false lumen. The patient underwent successful open aneurysmorrhaphy with PTFE graft. Postoperative course was uneventful, and the patient was discharged to follow up in clinics.

COVID-19 pandemic has affected everyone globally in every walk of life. A rise in the number of patients afflicted with thromboembolic complications of COVID-19 is being reported, both venous and arterial. Elective vascular surgery has been stopped entirely at our institute. However, both COVID-19-positive and negative patients continued to require emergent vascular surgery even during the pandemic. We are reporting a case of COVID-positive, ruptured abdominal aortic aneurysm (AAA) who was successfully managed at our hospital. The principles of open repair of ruptured AAA remained same, with a few special considerations. We did not find any report on open repair of ruptured AAA in COVID-19-positive patient. On search at Medline, we found two cases of ruptured AAA, which were successfully managed with endovascular aneurysm repair (EVAR).

Meckel’s diverticulum can manifest with various complications such as obstruction, intussusception, inflammation or diverticulitis, perforation, haemorrhage and fistula, and commonly manifests in children. Adult intussusception due to inverted Meckel’s diverticulum is an uncommon aetiology of intestinal obstruction but should be suspected in individuals. Imaging such as contrast-enhanced computed tomography aids in the diagnosis but it is not confirmatory to diagnose inverted Meckel’s diverticulum as a leading point. Resection of the intussusception segment is the definitive treatment. We present the case of a young man who presented in emergency with complaints of intestinal obstruction and ileo-ileal intussusception was the aetiology of for the same diagnosed on contrast-enhanced computed tomography of the abdomen. On exploration we discovered an inverted Meckel’s diverticulum to be the leading point for intussusception.

Background and Objectives: Anaerobic infections are usually caused by the host’s endogenous flora due to a breach in the anatomical barriers and Bacteroides spp. are the most notorious organisms associated with anaerobic infections. The identification of anaerobes has been a challenge since times. MALDI-TOF-MS is a boon for aiding the rapid detection of anaerobic organisms and has helped us to enlist the distribution of various anaerobic pathogens. Materials and Methods: This retrospective analysis (January 2018 to December 2019) was carried out in a tertiary care hospital in North India, in which the anaerobic microbiological profile of all patients admitted to surgical wards, ICU, and OPD of various departments (Orthopedics, Surgery, Gynecology, and Obstetrics) was reviewed. Samples received were immediately processed aerobically (5% sheep blood agar and Mac Conkeyagar) as well as anaerobically (RCM and freshly prepared sheep blood agar) as per the laboratory protocols. Results: Bacteroides fragilis (19.12%) was the most common anaerobe whereas among aerobes Escherichia coli (30.2%) followed by Klebsiella pneumoniae (10.34%) were most commonly isolated. The majority of patients were males (56%) and the most common presentation was with abscesses (21.4%). Polymicrobial infections (69.51%) outnumbered monomicrobial ones (30.48%). Conclusion: There is a paucity of literature on anaerobe isolation from surgical infections from our country which motivated us to study anaerobic infections and the high sample size in our institute enabled us to study surgical infections from an anaerobic perspective. This will add to the knowledge of microbiologists and clinicians. MALDI-TOF MS helped in rapid and accurate identification and hence we could report a wider spectrum of organisms in our study.

Abstract Duplication of the inferior vena cava is a rare congenital anomaly, with an incidence of 0.2-3%. Despite being asymptomatic, anomalies of IVC are important in aortoiliac and retroperitoneal surgeries. Preoperative CT imaging is essential to identify any IVC anomaly and to prevent unexpected hemorrhage during surgery. Here, we report a case of a juxtarenal abdominal aortic aneurysm in which we encountered a type I IVC duplication anomaly intraoperatively while performing transperitoneal aneurysmorrhaphy and took precautions to avoid any iatrogenic injuries to either of the two trunks or the pre-aortic trunk of the anomalous duplicate IVC.

Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.