Carcinoma cecum presenting as right gluteal abscess through inferior lumbar triangle pathway--report of a rare case.

Gluteal abscess commonly follows intramuscular injections with contaminated needles. Carcinoma cecum is known to present with pericolic abscess due to microperforations and may rupture intraperitoneally. Gluteal abscess secondary to perforated carcinoma cecum with pericolic abscess is extremely uncommon. A 50-year-old woman who was receiving intramuscular iron injections for anemia presented with a 10×10-cm abscess in the right gluteal region and a vague mass in the right iliac fossa. After investigations, a diagnosis of perforated carcinoma cecum with pericolic abscess tracking into the right gluteal region was made, and incision and drainage were done. Fine-needle aspiration cytology from the cecal growth revealed adenocarcinoma. Unfortunately, the patient was not willing to undergo definitive treatment. This case is being reported for its rarity and as an uncommon etiology for a common condition.

Comparison of standard-pressure and low-pressure pneumoperitoneum in laparoscopic cholecystectomy: a double blinded randomized controlled study.

BACKGROUND AND OBJECTIVE: With the safety of laparoscopic cholecystectomy (LC) having been established, the current stress is on reducing the postoperative morbidity associated with this procedure. Hence, this study was undertaken to compare the effect of low-pressure (8 mm Hg) (LPLC) versus standard-pressure (12 mm Hg) (SPLC) pneumoperitoneum on postoperative pain, respiratory and liver functions, the stress response, and the intraoperative surgeon comfort in patients undergoing LC. MATERIALS AND METHODS: Patients undergoing LC (n=43) were randomized into the LPLC (8 mm Hg) group (n=22) and the SPLC (12 mm Hg) group (n=21). Postoperative pain, changes in liver function, peak expiration flow rate, C-reactive protein level, and intraoperative surgeon comfort were assessed. RESULTS: The postoperative pain scores (P=0.003, 0.000, 0.001, and 0.002 at 0, 4, 8, and 24 h), total analgesic requirement (P=0.001), and the number (total and good) of demands for analgesic in the first 24 hours (P=0.002 and 0.001) were lower in the LPLC group. The surgeon comfort in the LPLC group was significantly lesser (P=0.000). The liver function and peak expiration flow rate did not show any significant changes. C-reactive protein levels varied significantly only at 24 hours postoperatively (P=0.001). CONCLUSIONS: The use of low-pressure pneumoperitoneum (8 mm Hg) for LC is associated with a significantly lower postoperative pain. However, the use of this low-pressure pneumoperitoneum can jeopardize the surgeon's comfort.

Intra-abdominal melioidosis masquerading as a tubercular abdomen: report of a rare case and literature review.

BACKGROUND: Melioidosis, caused by Burkholderia pseudomallei, an important human pathogen in tropical regions, has protean multi-system clinical manifestations. METHODS: Case report and review of pertinent English-language literature. RESULTS: A 33-year-old male, who had been treated for pulmonary tuberculosis and multiple splenic abscesses four years previously, presented with a five-day history of acute-onset high-grade fever, abdominal pain and distension, and dyspnea. Laparotomy and drainage was done for paraumbilical abdominal wall abscess. Omentectomy was performed because the omentum was infarcted and studded with tubercles. Pus culture was positive for B. pseudomallei. The patient developed septic shock and succumbed on the fifth day after surgery. CONCLUSION: This report emphasizes an unusual presentation of melioidosis and the diagnostic challenge posed by its clinical similarity to tuberculosis.