Abdominoscrotal Haematocele in an Adult and Its Successful Treatment.

Abdominoscrotal hydrocele (ASH) is a variant of hydrocele that rarely occurs in adults. ASH has two sacs, one in the scrotum and one in the abdomen connected through the inguinal canal. Abdominoscrotal haematocele is a rare complication of ASH. We report a 57-year-old male patient who presented to a tertiary care hospital in Puducherry, India, in 2019 with complaints of swelling in the scrotum for 15 years and abdominal pain for two months. Both the swellings were soft and cross fluctuation was present. Imaging confirmed the diagnosis of ASH. During a diagnostic laparoscopy, the abdominal sac was decompressed and found to have thick brownish fluid suggestive of haematocele. It was demonstrated that both sacs were connected. Due to difficulty in the dissection of the sac, the procedure was converted to an open procedure. Both the sacs were excised and Lytle's repair was done for the dilated internal ring. The patient recovered and no recurrence of any swelling in the abdomen or scrotum was found at the end of a one-year follow-up.

Diagnostic accuracy of Alvarado, RIPASA and Tzanakis scoring system in acute appendicitis: A prospective observational study.

Our prospective observational study, enrolling 167 patients undergoing emergency appendicectomy, served to evaluate the Alvarado, Tzanakis and RIPASA diagnostic scores. The latter was found to be a better scoring system because of its higher diagnostic accuracy. At centres with limited expertise in ultrasonography, RIPASA outperforms the Tzanakis score. Although easy to use, the Alvarado score was useful only to 'rule in' cases with AA with significant accuracy but at the cost of low sensitivity. It cannot be effectively used in triaging.

Gasless single incision trans-axillary thyroidectomy: The feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique.

INTRODUCTION: A range of minimally invasive endoscopic techniques (gas dependent and gasless) have been attempted for thyroidectomy in the past two decades. In this context, we evaluated the feasibility and safety of our technique of a gasless trans-axillary thyroidectomy. MATERIAL AND METHODS: This retrospective study from the Department of Endocrine and metabolic surgery in Southern India included 15 cases. The details of operative technique, intra and postoperative data were documented in all the cases. Only cases with benign thyroid nodules were included. Exclusion criteria were diffuse toxic goiters (Graves' disease), thyroid cancer, > 6 cm nodules, recurrent goitres and patients with shoulder joint pathology. Statistical analysis was done with SPSS software 12.0 version. RESULTS: F:M -14:2. Mean age of the patient group was 26.4 years (15-52). Mean operative time was 123.4 (82-206) minutes. The only specific complications were induration in the infraclavicular area between axillary incision and thyroid region, prolonged wound drainage and stiffness in lower 3(rd) of sternocleidomastoid. Wound drainage lasted for 5.4 days (4 -8). There was no significant operative morbidity. CONCLUSION: This gasless trans-axillary technique for nodular goitres is safe and effective in the hands of an experienced thyroid surgeon.

A simplified protocol of combined thoracoscopy and laparoscopic excision for large subdiaphragmatic hepatic hydatid cysts.

Human hydatid disease caused by echinococcus granulosus is one of the commonest zoonosis and it primarily affects the liver. Amongst, the various treatment options, surgical management with removal of its contents and pericystectomy under the cover of anti-helminthic is the treatment of choice. Large hydatid cysts located in the posterosuperior aspect of liver often require thoracic approach. In this context, we describe an innovative combined thoraco-laparoscopic technique for the surgical treatment of large subdiaphragmatic hepatic hydatid cyst.