A composite seton for the management of fistula in ano

Treatment of fistula in ano by seton has become less in vogue due to the complications and disadvantages associated with its use. In its place, more technically demanding and expensive procedures, with less morbidity but more recurrence, such as endorectal advancement flaps and laser, are being employed more commonly. To overcome some of the limitations of conventional seton, we have designed a composite seton. In the present study, we evaluated our experience with a composite seton made from two silastic vessel loops sutured together with 5-0 polypropylene. The composite seton was found to not present many of the disadvantages of the conventional seton. The use of the composite seton resulted in low incontinence and recurrence rates, less pain, and high quality of life. This technically simple and cheaper material may have a wider applicability. (AU)

Sporadic Duodenal Gastrinoma causing Zollinger Ellison Syndrome – A Rare Case Report

Introduction: Gastrinoma is a rare gastrin secretingneuroendocrine tumor. Clinical manifestations are nonspecificgastrointestinal (GI) symptoms or as Zollinger EllisonSyndrome(ZES) which often delays the diagnosis in majorityof patients. Hence a high clinical index of suspicion iswarranted in patients who present with nonspecific GIsymptoms to rule out gastrinoma.Case report: We report a case of 55 year old female whopresented with long standing dyspepsia and chronic diarrhoeaand was diagnosed with Sporadic Duodenal Gastrinomaon detailed evaluation. She was treated with surgicalresection and pathologically diagnosed as well differentiatedneuroendocrine tumor, Gastrinoma – grade I after IHCanalysis. Patient was relieved of her symptoms and becameeugastrinemic after surgery.Conclusion: Any patient with refractory dyspepsia associatedwith long standing non specific abdominal symptoms shouldbe evaluated for Gastrinoma and treated accordingly to avoidmisdiagnosis and complications in the long run.

Reversal of nail changes after liver transplantation in a child.

We report a 6-year-old girl who received a left-lobe live-related liver transplant for decompensated liver disease after a failed Kasai’s surgery for biliary atresia. Preoperatively, her nails were white, dystrophic, brittle with severe onycholysis, clubbing and watch-glass deformities. Nail scrapings were negative for fungus. Five months after transplantation, her nails had become near normal. There is only one such documented case in literature on reversal of nail changes in an adult.