Solitary intratracheal neurofibroma: a rare tracheal tumor

Intratracheal neurofibromas are rare benign tumors with a tendency to transform into malignant form. Intratracheal neurofibroma remain asymptomatic and are incidentally found during routine radiography or may present with wheeze, cough and lower respiratory tract infection. We recently operated a 38 year old gentleman, who presented with progressive shortness of breath and chronic cough for two years. Examination was normal. CT identified a supracarinal, intratracheal mass. Rigid bronchoscopy revealed a hyper vascular mass, attached to membranous trachea. We performed resection anastomosis via right posterolateral thoracotomy. Histopathology revealed neurofibroma. Patient recovered well and was discharged after eight days.

Surgical management and post-operative complications in abdominal tuberculosis patients

Background: Abdominal tuberculosis is a diagnostic and therapeutic challenge in resource limited countries. The vague clinical presentation is a barrier to early diagnosis. Aim of the study was to highlight the role of operative procedures and post-operative complications in patients suffering from abdominal tuberculosis.Methods: This is a descriptive study of abdominal tuberculosis cases, which were operated in the Department of Surgery, Lal Lajpath Rai hospital Kanpur, Uttar Pradesh, India, and associated hospitals. Informed and written consent was obtained from each patient prior to commencement of the study. Detailed data of each patient was entered on a Microsoft excel. Data were presented in number and percentages.Results: Most of the patient’s lumps were present in right ileac fosa, 70.37% followed by lymph node mass. Rolled omentum and appendicular showed minimum percentage of cases. In operative finding on exploratory laparotomy, the most common site of involvement was ileocaecal, and less commonly involved site in abdomen tuberculosis are duodenum and appendix. Surgical procedures, intestinal resection in the form of right hemicolectomy (21 cases), small bowel resection (58 cases). Appendicectomies were done only in 3 cases. Post-operative complications were found in 64 cases. Most of the complication developed in patients those were operated in emergency.Conclusions: Most of the surgeons were preferred conservative surgery rather than extensive resection of the active lesion. Commonest post-operative complication was broncho pulmonary complication.

Ileal duplication cyst: a rare cause of intestinal obstruction in infants

Ileal duplication cyst (IDC) is a rare congenital anomaly where there is an abnormal portion of intestine attached to or intrinsic with the normal bowel. A 6-month-old male child presented with obstipation and bilious vomiting at emergency. X-ray abdomen showed multiple air fluid level suggestive of intestinal obstruction. Laparotomy was performed. Diagnosis of IDC was made and resection with primary anastomosis was done. Post-operative period was uneventful, and patient did well during 3 month follow-up checkup. IDC is a rare cause of intestinal obstruction which can present with different clinical symptoms posing a diagnostic dilemma. Diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment where imaging method is unavailable for exact diagnosis.

Advanced laryngotracheal stenosis patients in a tertiary provincial government hospital: A prospective case series

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the clinical profiles, interventions, and surgical outcomes of patients with advanced (grade III and IV) laryngotracheal stenosis prospectively seen over a 2-year period.  </p><p style="text-align: justify;"><strong>METHODS:</strong></p><p style="text-align: justify;">           <strong>Design:</strong>           Prospective Case Series</p><p style="text-align: justify;">          <strong>Setting:</strong>           Tertiary Provincial Government Hospital</p><p style="text-align: justify;"><strong>          Participants:</strong>  Five (5) patients with advanced laryngotracheal stenosis confirmed by laryngoscopy and/or tracheoscopy.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Five (5) patients (4 males, 1 female), aged 23 to 31years (mean 27-years-old) diagnosed with advanced laryngotracheal stenosis between June 2016 to June 2018 were included in this series. Four resulted from prolonged intubation (14 - 60 days) while one had a prolonged tracheotomy (13 years). Presentations of stenosis included dyspnea on extubation attempt (n=3), failure to extubate (n=1) and failure to decannulate tracheotomy (n=1). Stenosis length was 3 cm in two, and 1.5 cm in three. Of the five (5) patients, three had grade IV stenosis while two had grade III stenosis based on the Cotton-Myer Classification System. Two of those with grade IV stenosis and both patients with grade III stenosis had undergone prolonged intubation. The stenosis involved the subglottis in three, and combined subglottic and tracheal stenosis in two. Prolonged intubation was present in all three with subglottic stenosis, and in one of the two with combined subglottic and tracheal stenosis. Two patients underwent open surgical approaches while three underwent endoscopic dilatation procedures. Four patients were successfully decannulated while one is still on tracheostomy. None of them had post-operative complications.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong>  Advanced laryngotracheal stenosis is a challenging entity that results from heterogenous causes. Categorizing stenosis and measuring stenosis length may help in treatment planning and predicting surgical outcome.</p><p style="text-align: justify;"> </p>

Comparison of one-stage resection and anastomosis of acute complete obstruction of right and left colonic carcinoma / 中国现代普通外科进展

Objective:To compare the short-term result of one-stage resection and anastomosis for patients with acute complete obstruction of the right and left colonic carcinoma.Methods:The clinical data of 80 patients undergoing emergency one-stage resection and anastomosis of acute complete obstruction for left and right colonic carcinoma were retrospectively analyzed.Results:Thirty-seven patients were operated on for obstructive carcinoma of the right colon,the mortality was 5.4%(2/37),the rate of complication was 21.6%(8/37),the mean hospital stay and cost was(31.6?12.8)d and(52794.9?60804.3)Yuan RMB,respectively.Forty-three patients were operated on for obstructive carcinoma of the left colon.the mortality was 2.3%(1/43),the rate of complication was 25.6%(11/43),the mean hospital stay and cost was(29.6?14.8)d and(50 192.8 ?39 727.4) Yuan RMB respectively.There was one case of anastomotic leakage in both groups.There were no significant differences of mortality and the rate of complication of the two groups.Conclusions:One-stage resection and anastomosis of acute complete obstruction of left colonic carcinoma can be performed as safely as in those with acute obstruction of right.Intraoperative decompression should be considered seriously in left colonic obstruction prior to the anastomosis following colonic resection.

One Stage Operation of Colon Perforation

Colon has the highest bacterial concentration in the gastrointestinal tract. When the colon is perforated, the operator has to decide whether to perform primary closure, resection with anastomosis, proximal colostomy, and exteriorizatoion. In this retrospective study, from October, 1993, through July 1998, 56 patient with panperitonitis due to colon perforation were operated at Ewha womans University medical center. The rectal perforation was limited the intraperitoneal portion. Our cases were divided into two groups. Group I included 34 patients who treated with one step operations of primaryrepair or resection anastomosis. Group II included 22 patients who treated with two step operations of proximal colostomy or exteriorization. The one step operations were performed in 34 patients, proximal colostomy in 21 patients, and exteriorization in 1 patient. There was 13.7% in the incidence of motality and 33.3% in the incidence of morbidity. The Chi-square test was used to evaluate the significance of differences between two groups. Independent risk factors for adverse outcomes were compared and used to analyse the probability for adverse outcomes with respect to the mode of treatmen. The mode of treatment was not dependent on the risk factors. These results suggest that one could select positively primary closure or resection with anastomosis for the treatment of patients with panperitonitis due to colon perforation.