Intestinal endometriosis: a diagnostic dilemma

Background: Endometriosis is a benign gynaecological condition that causes significant morbidity to women of reproductive age group. It uncommonly affects the gastrointestinal tract and acute bowel obstruction is a rare manifestation.Methods: A retrospective observational study was conducted on eight patients.Results: In three patients (37.5%), small intestinal involvement was seen, and colon was involved in five patients (62.5%). One (12.5%) patient presented with complete bowel obstruction while in others partial obstruction of the intestine was seen.Conclusions: Intestinal endometriosis is a diagnostic challenge and should be considered in young menstruating women with gastrointestinal symptoms. Intestinal endometriosis is the most common extra-pelvic site and it is found in 12% of women with endometriosis. The true incidence of endometriosis causing bowel obstruction is unknown. Pre or intraoperative sigmoidoscopy may prove helpful in ruling out malignancy. The gold standard for diagnosis is laparoscopy and biopsy, which allows a full assessment of the pelvis as well as surgical resection if required. The management of endometriosis is an integrated approach of both medical and surgical therapy. Bowel resection is usually undertaken if there are features of obstruction or bleeding, and if there is suspicion of malignancy.

Clinical profile and outcome of severe acute pancreatitis.

Background and Objectives: Around 20% of the patients of acute pancreatitis develop acute severe pancreatitis in the form of extensive pancreatic or peripancreatic fat tissue necrosis with associated peripancreatic collections. These patients run a protracted clinical course, multiorgan failure, high morbidity and mortality. Methods: Clinically and radiologically diagnosed 30 patients of acute severe necrotizing pancreatitis were prospectively evaluated for the clinical outcome with respect to extent of pancreatic necrosis and severity in terms of CTSI. Results: 18 patients had pancreatic necrosis between 30-50% (Group A) whereas 12 patients had necrosis more than 50% (Group B). The rate of organ dysfunction and mortality (11.11% versus 50.50%) the rate of was significantly higher in the group B. Multiorgan failure (MOF) was present in 5.56% of group A and 58.33% of group B patients. 66.67% patients were managed conservatively of whom 80% survived and 33.33% patients underwent surgical intervention of whom 60% survived. Conclusion: CECT is the modality of choice to help stage the severity of pancreatic necrosis, depict severity of inflammatory processes and local complications. Patients with pancreatic necrosis with transient end organ dysfunction can be treated conservatively with favorable outcome. The need for intervention should be individualized and based on the clinical condition of patient.

Gastric zygomycosis--an unusual cause of massive upper gastrointestinal bleed.

We report a 62-year-old man with cardiac failure and acute renal failure, who had massive hematemesis. Upper GI endoscopy showed a large gastric lesser curvature ulcer. Billroth II gastrectomy specimen showed fungal invasion. He received amphotericin B postoperatively, and recovered uneventfully.