Pedunculated perianal lipoma: a rare presentation.

Lipomas are ubiquitous lesions. Most of the lipomas have a fibrous capsule and are divided into lobules by delicate septae. On gross examination and histological analysis, lipomas resemble mature fatty tissue. They are more compact on the cut surface than normal adipose tissue and the lobules are smaller on histological analysis. There is undoubtedly some physiologic difference between fat of lipoma and normal fat. Perianal lipomas are rare and may have deeper or interspincteric extensions. Preoperative evaluation to rule it out is a necessary part of the work up for any perianal lipoma. The case report is of a soft swelling on left side in the perianal region, which was investigated to rule out nature of the lesion or deeper and interspincteric extension. Case was managed by complete enucleation of the lipomatous swelling. Gross and microscopic examination of the surgical specimen revealed a perianal pedunculated lipoma.

Sigmoid perforation post laser ablation of fistula in ano.

Laser ablation of fistula tract is a safe, effective, sphincter-preserving therapy that can be successfully performed by surgeons. Various studies and papers have been published advocating the use of lasers. However clinical experience and technical expertise is necessary for the use of lasers. Here we present a case of a 45 year old male presenting with acute abdomen following laser ablation of fistula in ano. The patients X-Ray abdomen showed free gas under the diaphragm and was explored. The exploration revealed a pyoperitoneum and a sigmoid perforation for which closure of perforation and a diverting colostomy was done. The patient was further operated for fistula excision and Seton suturing and is planned for colostomy closure.

Myxoid liposarcoma presenting like a cystic neck swelling.

Soft tissue sarcomas are rare and unusual neoplasm’s, accounting for approximately 1% of adult human cancers and 15% of pediatric malignancies. Most liposarcomas occur in deep soft tissues of the extremities and retroperitoneum; only a very small percentage (as low as 2%) occurs in the head and neck. Here we present a case of a 48yr old male with a painless mass in the neck clinically presenting as a cystic swelling. The CT neck was suggestive of cystic lesion in the neck representing benign cystic lesion. The swelling was excised and sent for histopathology which was suggestive of myxoid liposarcoma. The patient was planned for wide excision of the edges and scar and adjuvant chemo and radio therapy.

A complication of coronary angiography: rare presentation of pseudo aneurysm with groin swelling.

Pseudo aneurysm (PSA) is one of the most common vascular complications of cardiac and peripheral angiographic procedures. In this case we had an old man presenting with a large hard immobile pseudo pulsatile, severe painful swelling in groin region post21 days of coronary angiography.

Giant left ureteric stone.

A 24 year old male presented with acute pain in left loin with burning micturition, investigation revealed minimal functioning of left kidney with left hydronephrosis and hydroureter and a giant ureteric calculus. He underwent open ureterolithotomy. A giant ureteric calculus measuring 10.5 cm and weighing 49 gm was retrieved from the left ureter post-operative recovery was eventful and was discharged after 10 days.

Study of comparison between skin sutures and skin staplers: 400 case studies.

Background: There are various ways the skin approximation whether be it sutures, staplers, glues, sterile tapes all of these have the same purpose of but the one which provides the best scar with least wound infection and consumes least time is the one that should be used. So here we have studied 400 patients over a period of 20 months comparing skin sutures with staplers and their outcome with respect to time consumed and percentage of complication. Methods: A prospective type of study was conducted from January 2013 to August 2014 at Dr. D Y Patil Hospital, Nerul for comparison between skin sutures and skin staplers in terms of effectiveness and complications in 400 patients who underwent various surgical procedures. The patients included in this study were randomly selected from those who underwent various surgical procedures which were either elective or emergency with various incisions. Results: The average time taken for skin closure by staplers is 1.84 min per 10 cm of wound & for skin sutures, it is 6.61 min per 10 cm of wound and complication rate for suturing is 30% & for staplers it is about 12%. Conclusion: Outcome of staplers is cosmetically superior to skin sutures with overall less complication as compared to skin sutures.

Study of diabetic ulcer with surgical complications of diabetes, their outcome and management modalities in 72 cases studied in Navi Mumbai.

Background: Diabetes and its long term major complications include septic, vascular (either micro vascular or macro vascular) and neuropathic lesions which affect the various anatomical regions of the body. Majority of admissions to surgical wards is due to these surgical complications of diabetes. So this is a study of these surgical complications of diabetes, their outcome and management modalities. Methods: This “Clinical study of surgical complications of diabetes” consists of a study of minimum of 50 or more cases admitted to surgical wards of Dr. D Y Patil hospital & research centre, from June 2010 to Oct 2012. A series of 72 cases were compiled for this study during this period. This study is to know more about the mode of presentation, clinical features and outcome of management of surgical complication of diabetes mellitus. Results: In present study, 30 cases were conservatively managed with meticulous debridement. 13 cases underwent incision & drainage and came for regular follow-up. 10 cases underwent disarticulation of toes. Four patients underwent below knee amputations whereas 8 patients underwent above knee amputations and 7 patients needed split skin grafting for covering of raw area. Conclusions: Patients on irregular medication usually from age group 51-60 majorly male who undergo trauma (lower limb >>upper limb) are prone to diabetic ulcer complication. Mortality in these patients is due to complications. Conservative management is the mainstay of this condition followed by I & D and finally amputation.

Study to evaluate the role of laparoscopy in chronic abdominal pain.

Background: Patients with chronic abdominal pain can undergo numerous diagnostic tests with little change in their pain. This study was under taken to assess the efficacy of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 12 weeks. Methods: All patients undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from Nov. 2011 to Oct. 2012. The patient’s demographic data, length of time with pain, diagnostic studies, intraoperative findings, interventions and follow-up were determined. Results: A total of 25 patients (19 women and 6 men) with an average age of 34.64 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 32.96 weeks (range 12-96). 2 cases required conversion to an open procedure and no complications occurred. Findings included abdominal Koch's in 9, appendicitis in 8, cholecystitis in 1, cirrhosis in 1; ovarian cyst in 1, bilateral fimbrial cyst in 1 and 4 patients had no obvious pathology. 82.6% of patients had pain relief at the time of follow up. Conclusion: Laparoscopy has a diagnostic and therapeutic role in patients with chronic pain abdomen.

A rare case of bilateral bifid ribs: a case report.

Bilateral bifid (bifurcation) rib is very rare malformation of thoracic wall. In this case, we observed variation involving right 6th and left 7th rib in 21 year female. The right 6th and 7th rib and its costal cartilage were bifurcated enclosing a small oval additional intercostal space.

Scrotal cystocele presenting with renal failure.

Extensive bladder herniation is rare. We hereby present a case of scrotal cystocele with chronic renal failure. It was managed successfully by initial nephrostomies and then definitive corrective surgery.