To drain or not to drain following thyroidectomy.: A prospective, randomized study.

OBJECTIVES: To ascertain the use of draining the thyroid bed following surgery. METHODS: Fifty four patients who underwent total thyroidectomy were enrolled in the study between March 2021 and July 2022 and randomly allocated into 2 groups - a drain group and a no drain group. The hospital stay, operating time, post operative pain, post operative complications, cosmesis, and patient's perspectives were compared. RESULTS: The mean duration of hospitalization was significantly shorter in the no drain group as compared to the drain group. The post operative pain, as assessed by the Mankoski Pain Scale (MPS) was significantly higher in the drain group than in the no drain group. The cosmetic evaluation undertaken using the Hollander Wound Evaluation Scale, noted that there was a statistically significant difference in scarring between the 2 groups. There was no statistically significant difference in the duration of surgery and post operative complications between the two groups. Patient satisfaction was also noted to be superlative in the no drain group. CONCLUSION: The routine drain placement following thyroidectomy places the patient at a disadvantage in terms of longer hospitalisation, increased post operative pain and poor cosmetic outcome.

An Interesting Case of Hydatid Cyst of Liver Concomitant with Hydatid Cyst of Broad Ligament: A Case Report.

Hydatid cyst is an anthropozoonotic disease caused by Echinococcus for which man is an accidental intermediate host. The hydatid disease commonly involves the liver and lungs. Involvement of extrahepaticopulmonary sites is extremely rare and only a few isolated cases have been reported. In 2022, a 49 year old female from the southern part of Indian subcontinent presented to us with recurrent hydatid cyst of liver co-existing with hydatid cyst of the left broad ligament, twenty years following the initial procedure. She underwent exploratorylaparotomy and cystectomy and was then managed by ERCP and stenting following which she is asymptomatic till date. Though there are no hard and fast rules, the management of such cases mandate proper exploration to avoid any recurrence. Tailored surgical approaches maybe required according to the patient condition for effective, safe and recurrence free treatment of hepatic hydatidosis.

An interesting case of laparoscopic management of traumatic diaphragmatic rupture in an acute setting.

Traumatic rupture of the diaphragm is an uncommon injury, often diagnosed late as it is associated with concurrent abdominal and thoracic visceral injuries which are the main cause of morbidity and mortality. Diaphragmatic rupture has been reported in 1-7 % of the patients following major blunt thoracoabdominal trauma and 10-15 % of the patients following penetrating trauma. In an emergency scenario, open approach remains the mainstay of management; however the laparoscopic approach has been steadily gaining acceptance. We report the case of a 35 year old male who was diagnosed with diaphragmatic rupture following blunt trauma to the chest and abdomen. The patient underwent emergency laparoscopic reduction of contents with anatomical repair of the ruptured diaphragm.

An interesting case report of cutaneous tuberculosis of the foot.

INTRODUCTION AND IMPORTANCE: Tuberculosis is an age old disease caused by Mycobacterium tuberculosis which has been a menace to public health and thwarting economic growth. Pulmonary tuberculosis being the most common type, extra pulmonary tuberculosis has a greater association with HIV and multidrug resistant tuberculosis. Cutaneous tuberculosis accounts for 1-1.5 % of extra pulmonary tuberculosis. CASE PRESENTATION: A 32 year old female presented to the outpatient department with a two month history of ulcer over the sole of the foot with multiple discharging sinuses and surrounding induration. Laboratory tests reported elevated total leukocyte counts. Magnetic Resonance Imaging of the foot showed diffuse intermuscular edema with an interconnecting sinus tract draining to the sole of the foot. Regular wound dressings and antibiotics showed no resolution. Patient eventually underwent near complete excision of the ulcer. The biopsy was suggestive of tuberculous etiology. She achieved complete resolution with antituberculous drugs by three months. CLINICAL DISCUSSION: Cutaneous tuberculosis is often misdiagnosed as it can masquerade as many other commonly encountered dermatological conditions. Microbiological diagnosis plays a crucial role in the accurate diagnosis of cutaneous tuberculosis. These lesions are highly responsive to antituberculous drugs. CONCLUSION: Cutaneous tuberculosis is a rare disease that should be considered in the differential diagnosis of patients with chronic non-healing wounds that are poorly responsive to conventional treatment methods.

Diagnostic difficulties in obturator hernia: a rare case presentation and review of literature.

Hernia arising from obturator canal is rare and it contributes to about less than 1% of incidence of all hernias. Diagnosing an obturator hernia clinically is a challenging one and nearly impossible. These hernias usually present as an intestinal obstruction as more than 50% of obturator hernias goes in for strangulation. Here, we report an unusual presentation of an obturator hernia in a 70-year-old woman who presented to emergency room with acute abdomen and uncomplicated reducible inguinal hernia. Radiological imaging showed obstructed inguinal hernia while on diagnostic laparoscopy, a strangulated and perforated obturator hernia of Richter's type was seen in addition to an uncomplicated inguinal hernia. Obturator hernia, although very rare, is associated with high morbidity and mortality as it is often underdiagnosed as in our case. Laparoscopy bailed us out from missing out a perforation from an occult obturator hernia.