Giant Ovarian Cyst: A Case Report.

Cystic abdominal tumors are extremely common. Now a day they are diagnosed more frequently and much earlier due to availability of better imaging modalities. Presentation of large ovarian cysts has become rare as most of them are diagnosed and treated early. Still we get reports of patients with large/giant benign abdominal cysts and many of them are serous cyst adenoma of ovary. Mucinous cyst adenomas (MCAs) of the ovary are known for their potential to grow to massive proportions and are often incidentally diagnosed. They are typically benign tumors accounting for 15% of ovarian neoplasm's and up to 80% of all mucinous tumors. Sometimes, it becomes very difficult to identify the source of these cysts and are misdiagnosed as mesenteric cyst. Final diagnosis is only possible at laparotomy. Here we report a case of Giant ovarian cysts in an octogenarian female, weighing 27 kgs.

Meckel's Diverticulum with Mesodiverticular Band (A Rare Cause of Intestinal Strangulation In Elderly ).

We present a 60 year old male who had 3 days history of intestinal obstruction. At the time of presentation there were sings of peritonitis. The patient was operated after proper resuscitation. Per- operative findings were that of distended small bowel with a band (mesodiverticular band ) extending from mesentery across the ileum to Meckel's diverticulum beneath which the herniated loops of ileum were strangulated. Division of the mesodiverticular band, resection of involved gut along with Meckel's diverticulum and end to end anastomosis was done. The patient made an uneventful recovery in the post-operative period.

An Unusual Presentation of Biliary Ascariasis

Ascariasis is one of the most common disease in human being worldwide. Ascariasis is 2nd to gall stone as a cause of biliary symptoms. The invasion of biliary tract by round worms during early post operative period is an infrequent but serious complication. We present 42 years old man operated for cholelithiasis with Choledocholthiasis on whom choledochotomy and T -Tube insertion was done. On 5th postoperative day Ascaris extruded peri-T-Tube and immediate T - Tube cholangiogram done that showed multiple filling defects in Common Bile Duct (CBD). Patient was managed with saline irrigation of CBD via T-Tube and anti-heliminthic was given. In view of its rarity and unusual presentation the case is being reported.

Bilateral Petit’s Triangle Hernia

Lumbar traingle hernia that occurs through lumbar triangles is very rare type of hernia. Only about 300 cases have been reported till date. Bilateral Petit’s triangle hernia find further rarity and the case under reference is probably the first ever reported case of Primary bilateral Petit’s triangle hernia. The present case is of a 46 years old married, multigravida female who presented with 1 year duration of LBA and subsequently notice of swelling both sides of low back. FNAC revealed lipoma and on exploration it turned out to be rarest extra peritoneal bilateral Petit’s triangle hernia, fat as contents.

Extradural Hematoma - An Experience of 300 Cases

Three hundred cases of extradural haematoma seen over a period of nine years from June 1995 to May 2004 in Neurosurgery unit of Postgraduate Department of Surgery, Government Medical College, Jammu were analysed retrospectively for their clinical profile and operative measures. Their clinical presentation varied from intense headache to deep coma and fixed pupil. Two hundred forty five of them were operated and rest managed conservatively. Overall mortality in operated cases was 14%. Cases managed conservatively were monitored closely and serial CT Scans were done to assess progress. In two cases we had to operate as haematoma increased in size.

(A Medial Muscle Retracting Approach)

Mini-cholecystectomy, one of the minimally invasive techniques of gall bladder removal was used on 50 cases of symptomatic gallstones with 4-6 cm transverse incision. The rectus mucle was retracted medially in all the cases starting incision short of midlline. No special retractors were used. Depending upon the availability either liga clips or silk was used for occlusion of the cystic duct and artery. In only one cases the incision had to be extended to complete the operation. The success rate was 98%. Average operation time was 47.7 minutes average hospital stay was 4.82 days and post-operative analgesics required on average were 3.48 does per patient. No specific intra-operative or post-operative complications were noticed which could have incapacitated the patient for a long time. The average time taken to return to work was 14 days. There was negligible morbidity and no mortality. In the follows up period extending from 2 weeks to 3 months, no long term complications were noticed and patient were very well satisfied with outcome of the procedure.