Aggressive angiomyxoma of scrotum presenting as an Inguinal Hernia

Aggressive Angiomyxoma [AAM] is a rare mesenchymal tumor with a locally aggressive course. The most common location is in the pelviperineal region and occurs mostly in females of childbearing age. In males, it is extremely rare and thus is apt to be mistakenly diagnosed as an inguinal hernia or hydrocele. We report a case of 45 year old man who had right sided scrotal swelling for about four years. It was diagnosed as an inguinal hernia clinically. On further investigations, it was found to be a soft tissue tumor of the scrotum. The patient underwent scrotal exploration. At surgery, a huge lobulated gelatinous mass surrounding the right testicle was found. The mass was excised including the testicle and sent for histopathological analysis. Histologic examination of the excised mass revealed a nonencapsulated lesion composed of sparse spindle-shaped cells and a myxoid stroma with a prominent vascular component. The cells showed focal and weak positivity for desmin. The findings were thus consistent with aggressive angiomyxoma of the scrotum. The margins of the specimen were clear. The patient we report has so far done well with no evidence of recurrence

Inferior lumbar hernia of petit in a patient with neurofibromatosis type-1

Lumbar hernias are rare lesions that account for less than 1.5% of total hernia incidence. Only 250-300 cases have been reported in literature. Diagnosis may be difficult because they are either asymptomatic or may present with vague complaints. Differential diagnosis includes a lipoma, a fibroma, a retroperitoneal or intra-cavitary tumor, hematoma or a chronic abscess. They may occur in association with defects of the musculoskeletal system including some syndromes. Lumbar hernia in patients with neurofibromatosis has been reported in a very few number of cases. We report a case of 40 year old female with type 1 neurofibromatosis who presented with left lumbar hernia of Petit

Outcome of mesh repair for incisional hernia

To determine the results of incisional hernia repair with prosthetic mesh. It is a retrospective descriptive study, conducted at Surgical "D" ward Khyber Teaching Hospital, Peshawar from January, 2002 to October, 2006. A total of 121 patients were included in this study. Those patients with incisional hernia, who were repaired with mesh and completed the minimum of 9 months of follow up, were included. Patients who were clinically diagnosed to have incisional hernia were admitted and after necessary preparation, were operated and defect in the abdominal wall was closed by a synthetic mesh. During the early post operative and follow up period, patients were looked for complications like seroma, infection, chronic discharging sinus formation and recurrence. Out of 121 patients, 73 were female and 48 were male. In most of the patients the incisional hernia resulted from emergency procedures. In 35 [28.9%] patients, there was post operative seroma formation, 17 [14%] patients had wound infection. one [0.8%] patient developed subcutaneous heamatoma due to unidentified bleeding which later on required evacuation under general anesthesia. Eight [6.6%] developed recurrence of hernia out of which some patients were treated by repeat Mesh repair. In 12 [9.9%] patients there was mild to moderate skin margin necrosis and in these cases debridement was a proof of successful treatment. Partial wound dehiscence was found in 3.3% of patients. Incisional hernia is more common in midline laparotomy wounds specially performed in emergency conditions and onlay mesh repair procedure has high acceptable outcomes

Sensitivity patterns in patients of acute secondary bacterial peritonitis, and suggested empirical treatment

The objective of this study was to determine the common pathogens in acute secondary bacterial peritonitis patients in tertiary care hospitals and their sensitivity to the antibiotics commonly prescribed for acute bacterial peritonitis. We conducted culture sensitivity studies on 25 consecutive laprotoniies for secondary peritonitis presented to our Surgical-A ward through Accident and Emergency Department without any advance knowledge of their prior antibiotic therapy or culture sensitivity of the pathogens involved. We were able to get the results for 19 out of 25 cases. They yielded mixed cultures of Gram negative rods and staphylococci. There were three cases of MRSA. They were tested against various antibiotics. Resistance of the Gram negative rods to various antibiotics was also high. Our study revealed a very disturbing trend of occurrence of high resistance strains in patient coming directly from the community. We suggest empirical therapies in view of our results and current medical literature. The high bacterial resistance encounteted necessitates use of broad-spectrum and expensive antibiotics