Adult necrotising enterocolitis: a rare entity.

A case of Adult Necrotising Enterocolitis in an adult female whom diagnosed with intestinal obstruction was reported. On exploratory laparotomy, the mechanical caused was not found although major part of small bowel, caecum and proximal ascending colon were gangrenous along with intervening normal parts. Resection of affected bowel was performed followed by jejunostomy and transverse colostomy. Unfortunately, the patient not survive in the postoperative periods. Adult Necrotising Enterocolitis may mimic intestinal obstruction clinically or radiologically and prompt medical and surgical intervention is indicated in doubtful cases although it carries a poor prognosis.

A rare clinicopathological presentation of the breast carcinoma; implications and outcome.

In females, the most common cancer is breast carcinoma in which squamous cell carcinoma (SCC) is a rare type of malignancy. Histologically, infiltrating ductal carcinoma is the most common type and lobular, mucinous, and medullary types have lower incidence. Pure SCC of the breast can originate from the skin, nipple, or epithelium of a deep-seated dermoid cyst or squamous metaplasia on chronic inflammation background. We are reporting a rare case of primary SCC of the breast in a 45-year-old female. In follow-up of 8 months, patient is doing well. We discussed our approach for treatment with review of the literature. We have treated this patient successfully with surgical and adjuvant chemotherapy.

Peroral extrusion of the peritoneal catheter in an infant.

Peroral extrusion of the distal end of a ventriculo-peritoneal shunt tube is the potentially hazardous end result of a bowel perforation with only few case reports in the literature. The distal end of the peritoneal catheter got fractured in a 4-year-old child and it protruded out through the mouth. The cranial incision was opened and the shunt divided below the chamber. The ventricular end and the chamber and distal end were removed through this incision. In the present successfully managed case we review the current strategies in the management of such a rare complication and discuss the possible pathogenesis of this entity.

Appendico-cutaneous fistula presenting as a large wound: a rare phenomenon-brief review.

Appendicular inflammation can present as a discharging fistula on the abdominal wall. We are reporting a rare case of appendico - cutaneous fistula presenting as a large wound over the right iliac region. A 60 year old female reported to the emergency with a large wound and slough on right side of the abdomen. The thin shinning serous discharge from the wound revealed actinomycosis on microbiology. Patient was successfully treated conservatively with the help of percutaneous drainage and antibiotics. On follow-up of 3 months, patient is doing well and is asymptomatic. Acute appendicitis is considered one of the elementals of general surgical disease processes, yet its presentation often confounds its diagnosis by most surgeons. Its presentation as abscess in the abdominal wall and groin is a rare clinical entity. Because of insidious onset and subtle clinical signs of resulting abscess, the diagnosis of such cases is often delayed. USG and Contrast enhanced computed tomography are important part of investigations to make diagnose and helps in the treatment.

Xanthogranulomatous pyelonephritis: A rare entity.

CONTEXT: Xanthogranulomatous pyelonephritis is an extremely rare but known entity resulting from prolonged suppuration of the kidney. The disease may be focal or diffuse and may pose considerable diagnostic dilemma at times. Surgery is curable and remains optimal treatment of choice. Owing to its rarity and clinical curiosity we report such a rare case encountered in our clinical practice. CASE REPORT: We report a case of non-functioning kidney suggestive of either Tuberculosis or xanthogranulomatous pyelonephritis in the pre-operative period depending upon the clinical aqumen and investigations available and nephrectomy was done. It was confirmed as xanthogranulomatous pyelonephritis histopathologically. CONCLUSION: Preoperative diagnosis of xanthogranulomatous pyelonephritis may pose difficulty and nephrectomy remains the treatment of choice especially in diffuse cases of xanthogranulomatous pyelonephritis.

Crohn's disease presenting as acute abdomen: Report of two cases.

CONTEXT: Crohn's Disease may involve any part of GI tract leading to inflammation of all the layers of the affected bowel. The symptoms may mimc other intestinal pathologies and at times diagnosis remains a dilemma. Mostly medical therapy remains the mainstay of treatment. However surgical intervention is warranted in cases presenting with acute abdomen. CASE REPORT: We present two such cases of acute abdomen admitted in our hospital and diagnosed as case of intestinal obstruction. Exploratory laparotomy was performed in both cases and diseased resected segments were confirmed as Crohn's Disease on histopathology. CONCLUSION: Crohn's Disease should be kept as a differential diagnosis in patients presenting with acute abdomen especially with a long history of vague abdominal complaints.

Chronic intussuception due to ileocaecal tuberculosis in a young adult with severe anemia: Case report with literature review.

CONTEXT: Intestinal intussuception in an adult is a rare entity that differs in etiology from its pediatric counterpart owing to underlying pathologic lead points in adults, mostly neoplasms. The main clinical presentation in chronic intussuception in adults remains dull abdominal pain, and acute intussuception is uncommon. Computed tomography (CT) remains the diagnostic modality of choice and surgical resection is the optimal treatment. CASE REPORT: We report a case of chronic intussuception in a young adult presenting with severe anemia and chronic abdominal pain in right hypochondrium and lumbar region. Pre operative diagnosis of chronic ileocolocolic intussuception was made on the basis of ultrasound, barium and CT scan findings. Exploratory laparotomy was done and right hemicolectomy with end to end anastomosis was performed. Histopathological examination of resected specimen revealed presence of tuberculosis in the mass along with mesenteric lymph nodes involvement. Postoperative recovery was uneventful and he was put on antitubercular drugs. In follow-up the patient is asymptomatic. CONCLUSION: Chronic ileocolocolic intussuception due to tuberculosis should be considered as a possible cause of intestinal obstruction in young patients presenting with vague abdominal pain and severe anemia even in the absence of any specific medical history.

Gallstone ileus and jejunal perforation along with gangrenous bowel in a young patient: A case report.

CONTEXT: Gallstone ileus is an uncommon condition with potentially serious complications including perforation and gangrene of the small bowel. Its diagnosis is difficult and surgery remains the mainstay of treatment. Here we are reporting the complications of this condition along with brief review of literature. CASE REPORT: We report a case of intestinal obstruction due to gallstone in the small gut which was diagnosed preoperatively on ultrasonography and confirmed on exploratory laparotomy. Postoperative period was uneventful. CONCLUSION: Gallstone ileus is a rare cause of intestinal obstruction and it should be considered in patients who are suffering from gallstone disease and presenting with intestinal obstruction especially when no other obvious cause is seen.

A large retroperitoneal tumor with psoas infiltration: A rare case report.

CONTEXT: Retroperitoneal sarcomas are rare neoplasms. Computed Tomography or Magnetic Resonance Imaging is performed in patients with these tumors to detect local extent and distant metastases of the tumor and for preoperative surgical planning. However the evaluation and treatment of retroperitoneal sarcomas are challenging because of its rarity and frequent presentation with advanced disease in an anatomically complex location. CASE REPORT: We report a case of large retroperitoneal tumor in a female on the right flank. Ultrasound and Computed tomography scan of the abdomen revealed infiltration into the psoas muscle on the same side along with displacement of adjacent structures. Ultrasound guided fine needle aspiration cytology was suggested of liposarcoma. Surgical resection of the tumor was done. In follow up six months, patient was asymptomatic. CONCLUSIONS: In case of retroperitoneal tumors CT scan remains the diagnostic modality of choice and the inefficiency of adjuvant therapy; high recurrence rate and the very low chance of curing the patient after recurrence make the prognosis of these patients poor. However surgical resection remains the optimum treatment in all cases of retroperitoneal tumors.