recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Annular pancreas in adults: single unit experience from a tertiary care centre of Northern India

Annular pancreas is a rare congenital anomaly which usually presents with gastrointestinal symptoms early in life. In adults mostly it remains asymptomatic or may present with abdominal or features of duodenal obstruction the increased diagnosis of which is attributed to the improved imaging modalities. We hereby report our experience of adult annular pancreas in whom clinical presentation initially mimicked gastric or duodenal outlet obstruction. Adult annular pancreas was diagnosed with the aid of computed tomography of the abdomen and treated successfully with Roux-en-Y isoperistaltic gastrojejunostomy.

Fallopian tube as a cause of intestinal obstruction: a rare case report with review of literature

Adhesive Intestinal obstruction is the most common cause of intestinal obstruction in post-operative period. Diagnosis is based on history, clinical examination, plain X-ray abdomen. Authors here report an interesting case of intestinal obstruction after surgery for chronic calcific pancreatitis with pancreatic duct stone with intractable pain. In post-operative period patient developed features of intestinal obstruction, patient was planned for re- exploration and it was found that band was formed by left fallopian tube with transition point at terminal ileum and treated successfully with left Salpingectomy. Very few cases of fallopian tube as cause of intestinal obstruction have been reported in literature and it should be considered as one of the cause of intestinal obstruction in females presenting with acute abdomen.

Diagnostic Value Of Plain Abdominal Radiograph In Non Traumatic Causes Of Acute Abdomen

BACKGROUND : Abdominal pain is a common presentation to emergency department. Preoperative diagnosis of acute abdomen is crucial to minimize the morbidity and mortality where the diagnostic facilities are limited. Plain abdominal films are usually recommended for conditions like perforation of GI tract, intestinal obstruction & ureteric calculus on clinical assessment.In India, where availability of MRI & CT in remote areas & affordability of these investigations by poor patients become hindrance to achieve early diagnosis in acute abdominal conditions.•METHODS :A total of 336 cases of clinically suspected acute abdomen ( non-traumatic ) underwent routine plain x-ray abdomen. Study was performed between August to October 2018. X-rays were carried out on Allengers 350mA, 500mA & 800 mA machine. •RESULTS :Our study showed that among 336 clinicaly suspected cases of acute abdomen , PAR was positive in 63.4 % cases. It was normal or inconclusive in rest 36.6 % cases of clinically suspected acute abdomen. In our study, from total 136 cases of clinically suspected renal or uretreic calculi, 120 (88%) had positive x-ray findings. Further evaluation like ultrasound or CT scan was done of these patients & x ray were true positive in about 90 cases(77%) . In clinically suspected 45 cases of intestinal obstruction , 40 cases (88%) had x ray findings to suggest intestinal obstruction. In follow up of these patients, from 40, 38 patients (95%) were true positive for intestinal obstruction on CT scan. In our study, x rays were 100 % confirmatory for perforation. But , in clinically suspected cases like pancreatitis & cholecystitis only 13% & 23% respectively had positive findings on x-rays.Thus, this study shows that x-rays are confirmatory for cases of perforation. Though , it is reliable for intestinal obstruction & renal stones, it is not confirmatory. Other imaging modalities are necessary to confirm the diagnosis.•CONCLUSION : Plain abdominal radiographs(PAR) in cases of acute abdomen are most widely used first imaging modality. It is noninvasive, low cost first line modality & easy to perform imaging modality that can be used in every patients presenting to casuality. PAR are most useful in cases with perforation , intestinal obstruction.

A Compartive Study Of Usg And Ct Scan Evaulation Of Patient Of Acute And Chronic Pancreatitis

Background: Pancreatitis is a condition of inflammation of pancreas with high rate of morbidity and mortality. USG is useful in the initial radiological assessment of the pancreas, extent of involvement and to evaluate other abdominal organs affected by it. CT scan provides a cross-sectional anatomy of the organ, its internal structure, focal or diffuse involvement and involvement of adjacent structures. This study is done to evaluate the role of USG and CT scan in patients of pancreatitis admitted to L.G. hospital,AMC MET medical college,ahmedabad, Gujarat, India. Aim was to understand the role of CT and USG in determination of diagnosis of pancreatitis and to highlight and evaluate the cases in which USG failed to diagnose the cases which were helped through by CT. Methods: This study was done in department of radio diagnosis at L.G hospital, AMC MET medical college, Ahmedabad, Gujarat, India, over a period from may 2018 to september 2018. Each patient was studied taking into consideration relevant clinical and laboratory reports. USG of patients was done using LOQIC P5 machine. CT scan was done using PHILIPS 16 Slice CT scan machine. Results: Advantages ofUltrasound are non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes in organ is first investigation of choice in pancreatitis. However,limitations of USG are fails imaging in conditions with excess of bowel gas or fatty patient. Detailed characterization of the inflammatory process and peroper extent of necrosis of the gland is not properly evaluated by USG.. CT is superior to ultrasound for precise detection of size, parenchymal involement, main pancreatic duct, calcification, pseudocyst, ascites, pleural effusion, necrosis and peri pancreatic region and hence helps to determine exact extent of inflammation of the organ, multi-system involvement and prognosis. Conclusions: Ultrasound by non-invasiveness, easy availability, cost parameters, lack of radiation hazard and by ability to demonstrate structural changes in organ is first investigation of choice in pancreatitis. However, ultrasonography lacks in detailed characterization of the extent of involvement of the organ and adjacent structures. CT is superior to ultrasound for precise detection and extension of the pancreatitis and it has better sensitivity and specificity than ultrasonography.

A Rare Case Report Of Yolk Sac Tumor

Yolk sac tumor also known as endodermal sinus tumor is a rare malignant tumor that usually occurs insecond decade of life. We report a case of yolk sac tumor which occurred in 13 year old girl. She presented with lower abdominal pain for about one month. Ultrasound findings revealed a large multilocular mixed solid cystic mass lesion with internal septations .doppler study reveals internalvascularity in mass lesion.CECT scan of abdomen and pelvis revealed large mixed density enhancing mass lesion arising from pelvis. Her pathology report revealed yolk sac tumor of the ovary.