Laparoscopic excision of mesenteric cyst of sigmoid mesocolon.

Mesenteric cysts are rare abdominal tumours. They are found in the mesentery of small bowel (66%) and mesentery of large intestine (33%), usually in the right colon. Very few cases have been reported of tumours found in mesentery of descending colon, sigmoid or rectum. Mesenteric cysts do not show classical clinical findings and are detected incidentally during imaging due to absent or non-specific clinical presentation or during management of one of their complications. Ultrasonography (USG)/computed tomography (CT)/ magnetic resonance imaging (MRI) are used in diagnosing mesenteric cyst but they cannot determine the origin of cyst. Laparoscopy not only helps in diagnosing the site and origin of the mesenteric cyst but also has a therapeutic role. Laparoscopic treatment of mesenteric cyst is a safe, preferred method of treatment and is a less-invasive surgical technique. Here, we present an unusual case of mesenteric cyst arising from the sigmoid mesocolon treated by laparoscopic excision.

Primary neuroendocrine tumor of the left hepatic duct: a case report with review of the literature.

Primary Biliary Tract Neuroendocrine tumors (NET) are extremely rare tumors with only 77 cases been reported in the literature till now. We describe a case of a left hepatic duct NET and review the literature for this rare malignancy. To the best of our knowledge the present case is the first reported case of a left hepatic duct NET in the literature. In spite of availability of advanced diagnostic tools like Computerized Tomography (CT) Scan and Endoscopic Retrograde Cholangio Pancreaticography (ERCP) a definitive diagnosis of these tumors is possible only after an accurate histopathologic diagnosis of operative specimens with immunohistochemistry and electron microscopy. Though surgical excision remains the gold standard treatment for such tumors, patients with unresectable tumors have good survival with newer biologic agents like Octreotride.

Anterior mandibular ameloblastoma.

Ameloblastoma is a benign odontogenic tumor. These are usually asymptomatic until a large size is attained. Ameloblastoma has tendency to spread locally and has a high recurrence rate. Majority of ameloblastomas (80%) arise from the mandible. Ameloblastoma arising from anterior mandibular region (symphysis-menti) is rare. Very few cases of midline anterior ameloblastomas are reported in the literature. They often require wide local excision. Reconstruction of mandible in these cases is challenging. We present a case of mandibular ameloblastoma arising from symphysis-menti. Patient underwent wide surgical excision of the tumor followed by immediate reconstruction using free fibular vascular flap, stabilized with titanium reconstructive plates. A brief case report ands review of literature is presented.

Primary hepatic choriocarcinoma: a rare cause of spontaneous haemoperitoneum in an adult.

Choricarcinoma is a beta human chorionic gonadotrophin secreting neoplasm pertinent to uterus and pregnancy mostly. It occurs primarily in gonads but rarely in extragonadal sites. Primary hepatic choriocarcinoma is an extremely rare tumor. Most of the reported cases are seen in infants representing metastasis from an occult placental choriocarcinoma. Till date, only 7 cases of primary hepatic choriocarcinoma in adults have been reported in literature. We present a case of a 40-yearold male presenting as haemoperitoneum due to ruptured hepatic tumor. He underwent emergency left lateral segmentectomy. He died on 10(th) postoperative day. The surgical specimen and autopsy findings confirmed it to be primary hepatic choriocarcinoma. This is the first case report from Indian Subcontinent. A brief case report and review of literature is presented.

Giant recurrent retroperitoneal liposarcoma presenting as a recurrent inguinal hernia.

Retroperitoneal liposarcoma presenting as an inguinal hernia is a rare entity. We present the first case of Giant recurrent liposarcoma presenting as a recurrent inguinal hernia in a 40-year-old male. Physical examination showed an irreducible lump in the right inguinal region and a scar in the right lumbar and right inguinal region. Computed tomography (CT) scan of abdomen revealed it to be a retro peritoneal mass extending into the right inguinal region along and involving the cord structures. Wide local excision of the tumour with right orchidectomy and inguinal hernioplasty was performed. Histo-pathology confirmed it to be a liposarcoma. Patient received postoperative radio therapy. Follow up of two years has shown him to be disease free. Retroperitoneal liposarcoma can grow along cord structures into the inguinal canal and mimic an irreducible indirect inguinal hernia.

Right posterior branch draining into intra-pancreatic common duct: the triple duct sign.

Simultaneous dilatation of pancreatic duct (PD) and common bile duct (CBD) is often seen on radio imaging in pancreatic head malignancy or chronic pancreatitis. This is called double duct sign. However, dilatation of aberrant bile duct along with PD and CBD resulting in triple duct sign on radio imaging has not been reported in literature till date. We report a case of 45 years old male with surgical jaundice due to pancreatic head mass. Computed tomography (CT) scan revealed three dilated ducts in the head of pancreas. Besides PD and biliary duct, the third duct was pre-operatively thought to be long cystic duct with low insertion in common hepatic duct (CHD). Intra-operative findings revealed an unusually long and dilated aberrant right posterior sectoral duct with low insertion into intra-pancreatic CHD. Patient underwent Whipple's procedure with two separate biliary anastomosis besides pancreaticojejunostomy. Histopathology of specimen revealed chronic pancreatitis. Retrospective analysis shows that Magnetic Resonance Cholangiopancreatogram (MRCP) should have been done for correct pre-operative delineation of this anatomical anomaly. In conclusion, pre-operative detection of triple duct dilatation on CT scan should be further investigated with MRCP for anatomical variations of the biliary tract. This can guide operative planning and prevent inadvertent biliary injuries.