Quiescent Volcano-Chest Wall Hemangioma.

Chest wall hemangiomas are rare tumors that may originate within the soft tissue or from the ribs. Intramuscular hemangioma is infrequent, representing less than 1 % of all hemangiomas, and the localization in the chest wall is even less frequent. They are typically cutaneous in location, large, and poorly circumscribed and can be locally destructive. We present a case of a 34-year-old lady presented with firm lump 3 × 3 cm in left upper and inner quadrant of left breast well defined borders, non-pulsatile and restricted mobility. Sono-mammogram was suggestive of ill-defined lesion at 10 o'clock position. CT chest was conclusive of chest wall hemangioma. The patient underwent excision of the lump. HPE was suggestive of cavernous hemangioma. Cavernous hemangioma typically manifest at birth or before the age of 30 years. CT is more sensitive than plain radiography in detecting phleboliths, which are present in approximately 30 % of cavernous hemangiomas. Surgical excision would be treatment of choice. In this case, the site of the lesion was in the breast clinically mimicking that of a fibroadenoma which warrants hemangioma as a differential diagnosis.

Rare case of ileal perforation.

Ileitis, or inflammation of the ileum, is often caused by Crohn's disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. Eosinophilic enteritis can present as abdominal pain, protein loosing enteropathy, ulcers, intestinal obstruction, intussusception and perforation.Bowel perforation is an uncommon presentation of eosinophilic enteritis. We report a rare case of ileal perforation due to eosinophilic enteritis in a 57 years old female.

A rare cause of jejunojejunal intussusception in an adult.

Jejunojejunal intussusceptions are not common in adults and unlike in children, a lead point is usually found. The clinical presentation in adults tends to be more chronic or intermittent and include abdominal pain, obstructive symptoms, gastrointestinal bleeding or palpable mass. These unspecific symptoms often lead to a late diagnosis. The clinical picture is subtle and diagnosis is therefore elusive. We report a case of jejunojejunal intussusception secondary to gastrointestinal stromal tumor (GIST) in a 50 year old female.

Tuberculous mastitis presenting as breast abscess.

Tuberculous mastitis is a rare clinical entity and usually affects women from the Indian sub-continent and Africa. It often mimics breast carcinoma and pyogenic breast abscess clinically and radiologically, may both co-exist. Routine laboratory investigations are not helpful in its diagnosis. Fine needle aspiration cytology (FNAC) / biopsy are essential for diagnosis and tuberculosis culture when positive may be very useful to guide antimicrobial therapy. Antitubercular drugs in combination with aspiration or surgical drainage are usually associated with an excellent outcome.

Evisceration of the appendix: a rare complication of intraperitoneal drainoge.

Evisceration through intraperitoneal drainage site is a rare complication and till date only five cases of appendicular evisceration have been reported. A similar case of appendicular evisceration in a young male patient who underwent laparotomy for strangulated diaphragmatic hernia has been reported.

Strangulated Richter's Umbilical Hernia - A Case Report.

Richter's hernia is an abdominal hernia in which part of the circumference of bowel entrapped in the hernial sac. The segment of the entrapped bowel is nearly always the distal ileum but any part of gastrointestinal tract from the stomach to the colon may become incarcerated. The most common sites for Richter's hernia are the femoral ring (71%), deep inguinal ring (23%) and ventral or umbilical hernias (6%). The growing popularity of laparoscopic surgery has led to a new possible site for development of Richter's hernia. In most cases as less than two thirds of the circumference of the bowel wall is involved, the lumen of the gut remains free and thus features of intestinal obstruction are often absent. Richter's hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. We report a case of strangulated Richter's umbilical hernia in a 36 years old male.

Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure.

Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The maximum number of patients was encountered in the age group of 20 to 40 years with mean duration of age 34.14 years. In all three groups symptoms like pain, bleeding, constipation and sphincter spasm were present. Sentinel pile was present in 56% of the patients. Common site of fissure was found to be posterior in 94% of patients. Observations with respect to relief of pain, no bleeding and healing were recorded at 2, 6 and 12 weeks of duration. Lateral sphincterotomy remains effective but should be reserved for the patients who fail to respond to initial chemical sphincterotomy or GTN therapy. GTN is good alternative mode of therapy for patients who refuse surgery and prefer medical line of treatment.

Clinical profile and surgical outcome of Meckel's diverticulum.

The aim of the study was to estimate the incidence and analyse the clinical profile and surgical outcome of the Meckel's diverticulum. This prospective study included 632 patients who were operated upon for acute abdomen during August 1999 to July 2004 in a single surgical unit. Pre-operative abdominal ultrasonography and plain x-ray abdomen erect were done depending on the necessity. These patients were subjected to laparotomy/appendicectomy depending on the case. A search for Meckel's diverticulum was done and if found, surgical resection and analysis by histopathological confirmation of the Meckel's diverticulum was performed. This study detected 9 patients (1.42%) with Meckel's diverticulum during the operation. In none of these cases pre-operative diagnosis of Meckel's diverticulitis was made. Out of 9 patients, 6 (66.6%) were males, 3 (33.4%) females. Four cases (44.4%) were symptomatic due to Meckel's diverticulum and 5 (55.6%) were asymptomatic. One patient presented with haematochezia, one with intestinal obstruction due to gangrene of the Meckel's diverticulum and one case of duplication of (double) Meckel's diverticulum. Histopathological examination of these specimens confirmed 2 cases with inflammation, one with gangrene and one ulcerated gastric mucosa in the Meckel's diverticulum. In 2 cases (22.2%) there was heterotopic epithelium (gastric-1, colonic-1). It is recommended that a search for Meckel's diverticulum in every case of appendicectomy, laparotomies for acute abdomen should be conducted and if found, Meckel's diverticulectomy/resection should be performed to avoid secondary complications arising from it.

Spontaneous rupture of incisional hernia-a case report.

Spontaneous rupture of an abdominal hernia is very rare and usually occurs in incisional or recurrent groin hernia. The rupture of abdominal hernia demands emergency surgery, to prevent further obstruction, strangulation of bowel and to cover its contents. The hernial contents can be covered primarily by mesh repair if the general condition of the patient and local condition of the operative site allows or can be covered by skin followed by delayed mesh repair. We report a case of spontaneous rupture of incisional hernia in a 60 years old lady who had developed incisional hernia following tubectomy and managed by mesh repair.

Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated?

BACKGROUND/AIM: The objective of this study was to estimate the incidence of the Meckel's diverticulum (MD) and to study its clinical profile and surgical outcome, as well as to check whether diverticulectomy is indicated for asymptomatic MD in adults. MATERIALS AND METHODS: This is a prospective study of 1332 patients who were operated upon for acute abdomen during the period August 1999 to July 2009 in a single surgical unit. Preoperative abdominal ultrasonography and plain x-ray abdomen (erect) were done depending on the necessity. These patients were subjected to laparotomy/ appendicectomy depending on the case. A search for MD was done, and if found, surgical resection and analysis by histopathological confirmation of the resected MD were performed. RESULTS: During the operation, this study detected 15 (1.13%) patients with MD. In none of these cases, preoperative diagnosis of Meckel's diverticulitis was made. The age of the patients ranged from 18 to 68 years (mean age, 32.9 years). Out of 15 patients, 9 (60%) were males; 6 (40%) were females. Seven (46.7%) cases were symptomatic due to MD and 8 (53.3%) were asymptomatic. One patient presented with hematochezia; 2, with intestinal obstruction due to gangrene of the MD; and 4, with Meckel's diverticulitis. One patient had duplication of (double) Meckel's diverticulum without any inflammation in both the diverticulae. Histopathological examination of these specimens confirmed 4 cases with inflammation; 2, with gangrene; and 1, with ulcerated gastric mucosa in the MD. Among these, in 2 (13.3%) cases there was heterotopic epithelium (ulcerated gastric mucosa- 1, colonic mucosa- 1). CONCLUSION: We recommend that a search for MD in every case of appendicectomy/ laparotomy done for acute abdomen should be conducted, and if found, Meckel's diverticulectomy or resection should be performed to avoid secondary complications arising from it.

Primary Tuberculosis of the Appendix.

Primary (isolated) tuberculosis of the appendix is a clinical rarity, its reported incidence being 0.1 to 0.3%. Diagnosis is often made only after histopathological examination of resected specimen. This report describes two patients with clinical diagnosis of acute appendicitis and appendicular mass respectively, who were finally diagnosed to have tuberculosis of the appendix on histopathological examination. This article stresses the importance of histopathological examination of resected appendix.

Double Meckel's diverticulum.

Meckel's diverticulum is present in 2% of the population. Duplications of the alimentary tract are rare congenital malformations. The small bowel is the commonest site of alimentary tract duplication. They mimic other surgical diseases and may result in significant morbidity if left untreated. Pre-operative diagnosis of Meckel's diverticulum is difficult. A case of duplication of Meckel's diverticulum is reported here.