Adult idiopathic hypertrophic pyloric stenosis: an infrequent cause of gastric outlet obstruction

Hypertrophic pyloric stenosis is a congenital disease, presenting within two weeks of birth. However adult idiopathic hypertrophic pyloric stenosis (AIHPS) presents in middle age, predominantly in males and usually without any antecedent cause. Secondary variant may be due to intra gastric causes or extra gastric post-operative adhesions. Patient presents with symptoms of gastric outlet obstruction. Diagnosis depends on clinical, radiological and endoscopic findings. Treatment is subtotal gastrectomy. Pyloroplasty and endoscopic dilatation may be tried in debilitated patients. We present a case of AIHPS presenting as gastric outlet obstruction in a 16 year old female, that was surgically managed with an antrectomy.

Trichobezoars: a hairy cause of intestinal obstruction

Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children. Authors report 3 cases of Rapunzel syndrome with a large bezoar in paediatric age group that presented with features of acute intestinal obstruction. They were managed with surgical exploration.

Hydatid cyst of broad ligament: a rare case report

Hydatid cyst is a parasitic disease caused by tapeworm Echinococcus. It affects the liver and lung most commonly, but may rarely affect fallopian tube, broad ligament and other structures. One such peculiar case is where a 17 years old female presented with a rapidly growing cystic mass in lower abdomen, clinically suspicious of ovarian mass or mesentric cyst. Investigations failed to identify the nature. On laparotomy, excision of the mass was done. Suprisingly histopathological examination identified the lesion as hydatid cyst arising from the broad ligament. Patient responded well to surgical excision followed by albendazole administration. Female genital tract hydatidosis is a rare entity and in most cases the involvement is secondary. Primary hydatid disease of female genital tract is even very rarer and generates considerable diagnostic difficulty.

Actinomycosis of male breast: a rare case report

Actinomyces is a commensal of gastrointestinal and genital tract that may cause subacute or chronic granulomatous inflammation. Primary actinomycosis of breast is an extremely rare disease. It may present as a mass or as discharging fistulae. It is often diagnosed after biopsy. It may mimic inflammatory carcinoma or mastitis. Treatment is with a prolonged course of antibiotic. Authors present a case of a 70-year-old male with a palpable breast lump, that was suspected to be malignant. Wide local excision was performed, histopathology confirmed the diagnosis of actinomycoses breast. Patient was given antibiotics post operatively.

Limberg flap for reconstruction after excision of multiple conglomerate epidermoid cysts

Epidermoid cysts are common, subepidermal, keratin containing nodules, found anywhere on the body in 3rd and 4th decade of life. Surgical treatment is by complete excision with wall of cyst intact. Author presents a 40-year-old male with multiple sebaceous cysts in close proximity to one another on his left thigh. Individual cyst excision would have lead to a difficult primary closure, need for multiple incisions, with contracture and poor cosmesis due to the close proximity of the cysts. instead, the cysts were excised in mass and limberg flap was used for reconstruction and primary closure. Patient was followed up for 6 months. The objective of this study was to prove that limberg flap yields superior cosmesis and healing by primary intention in reconstruction after excision of multiple epidermoid cysts.