Renal artery aneurysm misdiagnosed as renal cell carcinoma

Renal tumors are best diagnosed by contrast-enhanced computed tomography (CECT) abdomen along with history and physical examination. In case of suspicious lesions in respect to location like lesion arising from the bifurcation of renal artery and close to major vessels with all features suggesting of tumor with absent contrast enhancement and absent color flow on Doppler study should be further investigated keeping other possibility of Renal artery aneurysm with thrombus mimicking as renal tumor. CT angiography should be done in every case of suspicious lesion because this will change the further management protocol from Nephrectomy in case of renal tumor to kidney preserving minimally invasive procedure for renal artery aneurysm. Like in this case diagnosis of Renal cell carcinoma was made on the basis of CECT abdomen findings and managed further as per the management protocol for renal tumor but intraoperatively found renal artery aneurysm. On conclusion every suspicious lesion of kidney should be further investigated for renal artery aneurysm so that kidney preserving procedure could be planned preoperatively.

Management of Hemorrhoids.

This article discusses the pathophysiology, risk factors, classification, clinical evaluation and current nonoperative and operative treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoids. It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development, and could be a potential target for medical treatment. In most instances, hemorrhoids are treated conservatively, using many methods such as lifestyle modification, fiber supplement, suppository-delivered anti-inflammatory drugs and administration of venotonic drugs. Nonoperative approaches include sclerotherapy and, preferably, rubber band ligation. An operation is indicated when nonoperative approaches have failed or complications have occurred. Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy, but postoperative pain is invariable. Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence. The applications and outcomes of each treatment are discussed.

Subcutaneous angiolipomas: a clinicopathological study of 12 cases.

A total of 12 cases of angiolipomas were received over a period of 2 years and comprised 13% of all lipomatous tumors. There were eleven males and one female. Pain/tenderness was the presenting feature in 11 of the cases and in all the cases, the tumors were located on upper extremities or trunk. Grossly, the tumors were encapsulated and histologic examination revealed fibrin thrombi in many capillaries, in all cases. None of these tumors were infiltrating into the surrounding skeletal muscle or soft tissue.

Non-biliary mishaps during laparoscopic cholecystectomy.

BACKGROUND: The most important complications of laparoscopic cholecystectomy (LC) are biliary tract injuries. Non-biliary complications can be equally devastating, but have received less attention in literature. METHODS: The case files of 1748 patients who underwent LC over a period of seven years (1997-2003) in our department were retrospectively reviewed to identify non-biliary complications and their management. RESULTS: Nine patients (0.5%) sustained significant non-biliary injury while undergoing LC. The commonest was duodenal perforation during dissection of the Calot's triangle (3 cases). Other complications included diaphragmatic injury (2 cases), and small bowel injury while inserting the umbilical port, right external iliac artery injury during insertion of Veress needle, portal vein injury during dissection, and liver laceration while using a delivery system to extract the gall bladder (1 each). All these complications were detected and managed intra-operatively. During the same period, 10 patients sustained biliary injury. CONCLUSION: Intra-operative non-biliary injuries during LC occur as frequently as biliary injuries, and can be life-threatening and difficult to manage.