Evaluation of Various Surgical Options in Post-irradiation Cancer Cervix with Central Residue or Recurrence.

The standard treatment for post-irradiation cancer cervix with central residue or recurrence is pelvic exenteration. Some of the carefully selected patients with lesions of size less than 2 cm may be treated with radical hysterectomy. Patients treated by radical hysterectomy have less morbidity rates when compared to pelvic exenteration. The parameters for defining a subset of these patients have not been addressed. Given the changing scenario of organ preservation, we have to determine the role of radical hysterectomy after radical or defaulted radiotherapy treatment. Retrospective analysis of patients with post-irradiation cancer cervix with central residue or recurrence who were treated by surgery from 2012 to 2018 was done. The initial stage of the disease, radiation treatment details, recurrence/residue, extent of disease as per imaging, surgical findings, histopathological examination report, post-surgery local recurrence, distant recurrence and 2-year survival rates were analysed. A total of 45 patients were found eligible for the study from the database. Nine (20%) patients, who had tumours that were confined to cervix, size less than 2 cm with preserved planes of resection, underwent radical hysterectomy and the other 36 (80%) patients underwent pelvic exenteration. Among patients who underwent radical hysterectomy, one (11.1%) patient had parametrial involvement and all of them had tumour-free resection margins. Among patients who underwent pelvic exenteration, 11 (30.6%) patients had parametrial involvement and five (13.9%) patients had tumour infiltrated resection margins. Among patients who were treated by radical hysterectomy, the local recurrence rate was high in patients who had a pretreatment FIGO stage of IIIB when compared to stage IIB (33.3% vs. 20%). Out of the nine patients treated by radical hysterectomy, two patients had local recurrence and both of them did not receive brachytherapy preoperatively. In patients with an early stage carcinoma cervix with post-irradiation residue or recurrence, radical hysterectomy can be considered if the patient consents to participate in a trial, willing to be on strict follow-up and understands the postoperative complications. Large-scale studies for radical hysterectomy have to be done on post radical irradiation small volume early stage residue or recurrence, to identify the parameters for safe and comparable oncological outcomes.

Noniatrogenic Colorectal Barotrauma with Extraperitoneal Rectal Injury.

We present the case of a 22-year-old male who presented to us with abdomen discomfort with subcutaneous emphysema in the abdomen and lower chest, following a prank played by his friend who had inserted a nozzle through his anal orifice and pumped high-pressure condensed air through it. Computed tomography showed evidence of air pockets in the ischiorectal fossa and pelvis. Intraoperatively, we found large-bowel and small-bowel distension with large-bowel serosal tears and rectal tears. The tears were primarily sutured and a transverse loop colostomy was fashioned to facilitate healing of rectal wounds and to relieve the distension. The colostomy was closed after 8 weeks. The postoperative period turned out to be uneventful. We intend to present this case to sensitize the readers about the unusual mode of presentation and our management which we hope would help the medical fraternity who might encounter similar scenarios.

An Unusual Cause of Adult Ileoileal Intussusception.

Intestinal intussusception in adults is not considered to be common. Clinical presentations may range from an acute presentation to a chronic one and such wide variations make it challenging to establish the diagnosis on time. Adult intussusceptions usually have an identifiable pathological lead point: commonly a polyp, submucosal lipoma, or other tumors. Our patient, a 42-year-old male, presented to us with features of acute intestinal obstruction. He underwent an emergency laparotomy when intussusception of the ileum was noted; the involved bowel segment was resected. Histopathology showed that the lead point was due to tuberculous lesion. Further investigations showed that the patient had pulmonary tuberculosis (TB), which was not identified till then. The patient was started on antituberculous treatment thereafter and the patient recovered well. We intend to present this case to sensitize the readers to the unusual presentation of intestinal TB as intussusception which should be considered especially in countries with high TB endemicity.