Axillary artery aneurysm

Axillary artery aneurysm is a rare condition. Though mostly asymptomatic, it should be treated early as it can develop thrombosis, distal embolisation, pressure symptoms or rupture. We report here a case of a 24-year woman who presented with neurological deficit in her arm because of pressure by axillary artery aneurysm. Standard treatment of these aneurysms is excision and replacement with an interposition graft. We used reversed saphenous vein as interposition graft between axillary and brachial artery

Teenage jejunoileal diverticulosis

Presentation of jeujunoileal diverticulosis in young age is virtually unknown. It is associated with middle or old age. It is usually asymptomatic but may present with vague abdominal pain and episodic nausea, vomiting or diarrhoea. It can lead to complications like bleeding, perforation and obstruction. We had 3 cases of jejuno-ileal diverticulosis presenting in their teens. They had resection and anastomosis resulting in improved health

Paratesticular leiomyosarcoma

We are reporting the case of a 44-year old patient with paratesticular leiomyosarcoma, which was initially reported to be leiomyoma on testicular biopsy. Due to persistence of symptoms, his orchidectomy was done. On histopathological examination the tumour proved to be leiomyosarcoma arising from tunica albuginea. Operation was followed by adjuvant chemotherapy and the patient is presently asymptomatic

Gall bladder tuberculosis: a case report

An 80-year old man presented with mild right upper quadrant abdominal pain of six months duration. The pain exacerbated off and on. Clinical examination of the patient revealed a mildly tender right hypochondrium. No mass or enlarged viscus was palpable. Ultrasonography of abdomen revealed a contracted gallbladder containing multiple calculi. Chest X-ray was suggestive of chronic obstructive airway disease [COAD]. His hemoglobin was 12.6 gm/dl and total leukocyte count was 5.6x10e9/L. Neutrophils were 65% while lymphocytes were 30%. Blood glucose levels and liver function tests were within normal limits. Hepatitis B surface antigen and anti-HCV antibodies were negative. Peroperatively, gallbladder was seen to be contracted and had thickened walls. Its serosal surface was granular. The greater omentum and mesentery were studded with nodules. No spread was seen into the gallbladder fossa or into the liver. Lymph node of Lund and those in the mesentery were enlarged. Gallbladder contained multiple small calculi. The resected gallbladder and a biopsy of greater omentum were sent for histopathology, which revealed gallbladder tuberculosis with caseating granulomas, as well as tuberculous omentitis. Patient is on anti-tuberculosis therapy and is improving steadily

Skip lesions in intestinal tuberculosis

A young lady of 20 years presented with profuse vomiting and absolute constipation of three days duration. She had history of recurrent abdominal pain with vomiting associated with intermittent constipation, abdominal distension and weight loss for the last one year. Conservative management led to no improvement. There was no past history of diarrhea, bleeding per rectum, cough or hemoptysis. General physical examination showed her to be emaciated, afebrile and moderately dehydrated. Her weight was 38 kg. Abdomen was grossly distended with tinkling bowel sounds. No other general or specific physical abnormality was found. Her ESR was 25 mm at the end of 1st hour [Westergren method]; hemoglobin was 9.3 gm% with a hematocrit of 30%; TLC was 8500/cm with 25% lymphocytes and the plain x-ray abdomen showed multiple air-fluid levels in small intestine confirming the diagnosis of intestinal obstruction. She was prepared for emergency surgery, which revealed seven tight strictures in the jejunum and ileum starting at 6 inches from the duodenojejunal flexure and ending 4 inches from the ileocaecal junction. Although the proximal jejunum was dilated, the intervening segments of intestine between strictures were absolutely normal in shape and thickness of wall, colour and texture varying in length from 7 to 18 inches. Gross examination of the mucosa showed transversely placed fibrous strictures causing stenosis without adjacent ulceration, edema or congestion. Mesenteric lymph nodes were enlarged. The rest of the gut was normal. All strictures were managed by stricturoplasties. A piece of the involved gut and an enlarged lymph node from the mesentery was taken as biopsy. Postoperative recovery was smooth. Considering the history and the gross appearance of the intestinal mucosa, anti-tuberculous [TB] chemotherapy was started. Histopathology revealed caseation and Langhan's type of multinucleate giant cells in both the specimens. Ziehl Nielson [ZN] staining of the intestinal biopsy showed acid-fast bacilli, confirming the clinical diagnosis of tuberculosis. Anti-TB drugs were continued for 9 months. During this period her weight increased to 60 kg and abdominal symptoms disappeared. She was asymptomatic 6 months after cessation of drugs

Xanthogranulomatous pyelonephritis in a child

A case of xanthogranuloma of kidney in a child is presented, which was clinically diagnosed as a case of renal tumor. Nephrectomy with subsequent histopathology revealed Xanthogranulomatous Pyelonephritis