Necrotizing sialometaplasia of parotid gland

A case of Necrotizing Sialometaplasia of parotid gland is reported. Clinical picture: This patient was initially diagnosed as a case of parotitis and treated by intravenous antibiotic for three days without improvement. Ultrasonography revealed fluid collection in the substance of the gland and needle aspiration revealed only blood. Fine needle aspiration was done and cytological examination revealed only blood cells without any glandular tissue. Incision and drainage of haematoma with incisional biopsy was done and histopathological examination confirmed the diagnosis of necrotizing sialometaplasia. After three weeks of conservative therapy without improvement superficial parotidectomy was done without any significant morbidity. Severe form of necrotizing sialoametaplasia affecting major salivary gland can be treated safely and effectively by sialoadenectomy

Gastric carcinoma presenting with skin metastasis

A case of gastric carcinoma presenting with skin nodule is reported. Clinical picture: This patient was diagnosed as sealed perforation in a duodenal ulcer. Two days after lap exploration histopathology report of skin nodule [excised 3days before the operation in plastic surgery day care unit] suggested gastrointestinal origin of this skin metastasis. Esophago-gastroscopy revealed a gastric mass in the body of the stomach and histopathology examination of biopsies taken from the gastric mass confirmed the diagnosis of gastric carcinoma of signet ring cell type. Neoadjuvant chemotherapy started for tumor down staging, then abdominal exploration was done but unfortunately the tumor was unresectable. Gastric carcinoma can rarely present with skin metastasis away from the umbilicus. Gastric carcinoma in very rare occasions may metastitize to the skin without liver or lymph nodes metastasis

10 kilogram breast lump-case report

A case of giant fibro-adenoma which weight 10 Kg is reported. Clinical picture: A 34 years old nullipara Sudanese female patient was presented to the surgical out patient clinic by huge right breast mass. Clinical examination, mammogram and FNA suggested phylloids tumor. Simple mastectomy was done and histopathological examination diagnosed it as benign phylloids tumor in a background of giant fibroadenoma. postoperative course was uneventful and the patient is fine one year after surgery. Breast reconstruction is planed with plastic surgery department. Giant fibroadenomas have to be differentiated from phylloid cystosarcoma and from the breast hamartoma and asymmetric breast hypertrophy in girls by the lack of mammary lobules. Giant fibroadenoma should take its due place in the diagnostic algorithm of the breast tumors

Splenic salvage in adult splenic injury: a 12-year experience

Descriptive study of splenic salvage in adult blunt splenic injury over a twelve years period. A retrospective analysis of the medical records of adult patients admitted in the period between April 1, 1993 and March 31, 2005 with a diagnosis of blunt splenic injury. Patients were sorted according to whether they were treated conservatively or surgically. In the surgically treated patients the patient were subdivided according to the type of surgery done. The results of every six years were grouped together and compared to each other as regard incidence and type of operative intervention, incidence of conservative management and outcomes. Four hundred sixty eight patients with splenic injuries were included in this study-One hundred thirty seven patients [29.3%] underwent total splenectomy [group I], surgical salvage [group II] were done in 112 cases [23.9%], and 219[46.8%] were observed [group III]. In the last six years the rate of splenectomy and surgical salvage decline from 38.7% to 20.7% and 28.8% to 19.5% respectively. The rate of non-operative management increased from 32.4% in the first 6 years to 59.7% in the last 6 years. Total splenectomy is not the ideal treatment for every patient with splenic injury due to blunt trauma. Surgical techniques which preserve splenic tissue mass are often successful. Moreover, nonoperative management of blunt splenic injury has become increasingly popular and successful

An unusual common bile duct foreign body

A 35-year-old man developed obstructive jaundice ten months after laparoscopic cholecystectomy. Endoscopic retrograde cholangiography extracted a foreign body from the common bile duct. Histopathological examination revealed that the extracted foreign body was the remnant of vicryl endoloop with calcification around. Since laparoscopic surgery has become a very common procedure, endoclips and endoloops are used more frequently. It is emphasized that careful surveillance and strict follow-up are necessary to avoid similar complications