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Background and objective: Chronic pancreatitis is a chronic, fibro-inflammatory condition that damages the pancreas' structural integrity permanently and impairs exocrine and endocrine function. Alcohol is a major part in the multifactorial pathogenesis. Pain in the form of recurrent attacks of pancreatitis or constant and disabling pain is usually the main symptom. Pain management is mainly empirical and involves treatment with potential potent analgesics, and duct drainage by endoscopic or surgical means. Methods: An observational study was conducted at Dr. D.Y. Patil Medical College for a period of two years, from 2020 to 2022. Cases of chronic pancreatitis were chosen for the study after taking informed consent of the patients concerned. This study aims at achieving comprehensive pain management, and seeks to assess the response to different modalities of treatment. Accordingly, a total of 36 patients were studied by commencing a medical line of management, and their responses were documented using the visual analog scale (VAS) on Day 1, Day 3, and Day 5. Pain medications were stepped up in unresponsive cases based on the World Health Organization (WHO) pain relief ladder. Celiac plexus block and surgical intervention (lateral pancreaticojejunostomy) were conducted where the pain could not be subsided by using the medical line of management. Results: Out of 36 cases with chronic pancreatitis, a majority of the cases had moderate pain (VAS score 4-7) at the time of admission, whereas severe pain (VAS > 7) was reported in 11.1% of the cases. Medical management was commenced in all cases by administering a paracetamol injection (1g IV, 8 hourly); however, pain was relieved in only 25% of the cases. In the remainder of cases, the line of treatment had to be stepped up by using a tramadol injection (1 ampule in 100ml NS IV, 8 hourly) in 61.1% (22 out of 27) of the cases, and by using a morphine injection (30mg IV, 8 hourly) in 13.9% (five) of the cases. Furthermore, celiac plexus block was required for managing pain in a total of 9 cases, and recurrence of pain after celiac plexus block was observed in 55% (5 out of 9 cases); these cases underwent lateral pancreaticojejunostomy. Cases that underwent surgical intervention showed satisfactory results with no recurrence of pain in the follow-up period. Conclusion: A majority of the patients responded to various levels of medical analgesia. Only a few required surgical intervention for pain management. Hence, a multidisciplinary approach is required for adequate management of pain to improve the quality of life. [ABSTRACT FROM AUTHOR]

Background: Sacrococcygeal pilonidal sinus (SC-PSD) is an acquired condition usually seen in young adults especially males associated with high recurrence rate after surgery. Many conventional surgical procedures are described for its management with their merits and demerits. The present study aims to evaluate the efficacy and determine effects of the Limberg flap rotation and its feasibility to the patients, their compliance, and outcomes such as wound infection, post- operative pain relief, recurrence rates, and return to work. Methods: 25 consecutive patients underwent Limberg flap reconstruction between January 2021 to may 2022 and were evaluated for various parameters. Results: All patients successfully underwent surgery, with very minimal postoperative pain, average hospital stay for 5 days, returned to work after 2 weeks with 1 patient having seroma, 1 having flap edema, 1 developed wound infection and no recurrences so far. Conclusions: Limberg flap reconstruction after excision of sacrococcygeal pilonidal sinus is an effective and reliable technique, easily performed, with high patient satisfaction, associated with complete cure and low incidence of post-operative complications. [ABSTRACT FROM AUTHOR]

Duodenal NETs (Neuroendocrine Tumours) are rare neoplasms that represent a clinical challenge due to heterogeneity of their biological behaviour, diagnosis and treatment options. They represent 1-3% of all primary duodenal tumours. Our case report aims to increase awareness and highlight some issues related to the diagnosis and management of duodenal Neuroendocrine tumours. We present the case of a 55-year-old man with a large, slowly-growing Neuroendocrine tumour of the duodenum which was incidentally identified after a screening USG of the abdomen. A Whipple's procedure with complete tumour excision was performed. Patient was comfortable on discharge and on regular follow up. The mainstay of treatment of duodenal NET is surgery with the intent to cure. The management protocol is based on ENETs guidelines. Surgical resection of D-NETs should be followed up by CECT of A+P and Chromogranin A levels performed at 6 and 12 months after surgery, and then every year for at least 3 years. [ABSTRACT FROM AUTHOR]

About 75% of abdominal wall hernias are inguinal hernias, with a lifetime risk of 27% for males and 3% for women. Amyand's hernia is an uncommon disorder in which an inguinal hernia sac contains a vermiform appendix. In the paediatric population and in men, it is most often observed. There have only been 228 known cases of the Amyand's hernia since Claudius Amyand's initial case was published in 1736. The clinical appearance, treatment, and complications of the illness are yet unknown because of its rarity. Although Amyand's hernia's appearance can be extremely diverse, it often manifests as an imprisoned or strangulated hernia. We describe a case that looked similar but was actually a right inguinal hernia. [ABSTRACT FROM AUTHOR]