ABSTRACT
Meckel's diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from Meckels diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel's diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel's diverticulum and correlation with other radiological imaging
Subject(s)
Humans , Male , Gastrointestinal Hemorrhage/diagnosis , Angiography , Recurrence , Mesentery , AdultABSTRACT
Peutz-Jeghers syndrome [PJS] is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal [GI] tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extra GI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers. We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan [CT] revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening
ABSTRACT
Background: Tongue tumour thickness has been shown to have a correlation with neck nodal metastasis and hence patient survival. Current AJCC guidelines recommend inclusion of tongue tumour thickness measurement in routine radiologic staging. Several studies have attempted to define the accuracy of MRI in measuring tongue tumour thickness. The aim of our study was to compare tongue tumour thickness measured at T2-weighted and STIR sequences with histologic tongue tumour thickness. Methods: Twenty-eight consecutive patients of tongue cancer who had undergone glossectomy were selected retrospectively. Tumours were measured in both STIR axial and T2- weighted coronal images and compared with histologic tumour thickness on resected specimens. Pearson's analysis was performed to determine the degree of correlation. Paired samples t-test was also used for comparison of mean tumour thicknesses measured on MRI with mean histologic tumour thickness. Results: Pearson correlation analysis showed good correlation of tumour thickness measured on MRI with actual histologic tumour thickness [R=0.876]. Conclusion: MRI provides a satisfactory prediction of tongue tumour thickness which in turn can be used to determine the need for elective neck dissection in these patients. Keywords: Lymphatic Metastasis, Magnetic Resonance Imaging/methods, Tongue Neoplasms
ABSTRACT
To review the results of surgical palliation for unresectable pancreatic carcinoma, and to analyze the morbidity and mortality associated with the surgical procedure. The reasons for readmission after discharge from the hospital were also analyzed. A retrospective study from 1995 to 2001 was done on 30 patients with pancreatic cancer operated with palliative intent, or those explored with curative intent but histopathology revealed positive resection margins or lymph node metastasis. Twenty-five [83.25%] patients were above 50 years of age. There were 16 [53.28%] male, and 14 [46.62%] females, 8 [26.64%] had diabetes mellitus, 2 [6.66%] chronic pancreatitis and 4 [13.32%] had smoking as risk factors. Twenty-three [76.59%] patients presented with jaundice, 18 [59.94%] with weight loss, 17 [56.61%] with epigastric pain, 15 [49.95%] with anorexia and 14 [46.62%] with vomiting. Whipple's procedure was performed in 9 [29.97%] patients, triple bypass in 13 [43.29%], choledochojejunostomy and gastrojejunostomy in 3 [9.99%] and gastrojejunostomy alone in 5 [16.65%] patients. Seven [23.31%] patients had preoperative ultrasonography, while CT Scan was done in 24 [79.92%] and ERCP in 8 [26.64%] patients. Histopathology showed positive resection margins in 9 [29.97%] patients and lymph node metastasis in 5 [16.65%] patients. Seventeen [56.61%] patients received less than 2 units of pack cells transfusion. Most of the patients remained admitted in the hospital between 20 to 30 days. Post-operatively, delayed gastric emptying was detected in 6 [19.98%] patients, cholangitis in 2 [6.66%], wound infection in 3 [9.99%], anastomotic leak in 2 [6.66%] and line sepsis in 2 [6.66%] patients. Three [9.99%] patients expired in hospital post operatively. The reasons for re-admission after discharge included abdominal pain in 9 [29.97%] patients, anemia in 3 [9.99%], intestinal obstruction in 3 [9.99%] and urinary tract infection in 2 [6.66%] patients. Follow up record was available for 22 [73.26%] patients. Six [19.98%] patients survived for 5 to 6 months and 9 [29.97%] had a survival between 7 to10 months. A single surgical procedure can palliate all three symptoms associated with unresectable pancreatic carcinoma, and can be carried out with reasonable safety in selected patients. The commonest indication for re-admission is severe abdominal pain associated with advanced malignancy, hence chemical splanchiectomy may also be considered at the time of surgical exploration