An unusual case of intestinal obstruction due to internal herniation from adhesions between two appendices epiploicae.

Internal hernia of the small bowel is a rare finding especially in previously non-operated abdomen. Such a hernia occurring due to involvement of appendices epiploicae is an even rare instance with less than five reported cases in the literature. We encountered a 75-year-old male who had internal herniation of small bowel through an aperture created by adhesion between two appendices epiploicae in a previously virgin abdomen. Laparotomy and division of adhesion was performed to manage him successfully. Even in a virgin abdomen, a high index of suspicion along with early intervention is the key to reduction in mortality and morbidity in cases intestinal obstruction.

Spigelian hernia: a diagnostic dilemma and laparoscopic management.

Spigelian hernias, also called as lateral ventral hernias, are rare hernias to present themselves in clinical practice. The significance of these hernias lies in the fact that they are commonly intraparietal hernias and are, hence, difficult to diagnose clinically. Moreover, the neck of these hernias is usually small, posing a fair risk of strangulation. With the advancement in laparoscopic hernia repair, there is evidence that Spigelian hernias too can be repaired laparoscopically, thereby causing less morbidity and shorter hospital stay. Here, we present a rare case of large Spigelian hernia that posed to us as a diagnostic dilemma. The symptoms, clinical findings, and ultrasound of the patient were not specific, and a CT scan had to be used as the measure to confirm the diagnosis. The patient was then managed successfully with laparoscopic intraperitoneal onlay mesh repair. The details of the case and a brief discussion are included.

A complex fistula-in-ano presenting as a soft tissue tumor.

INTRODUCTION: Anorectal abscess and fistula are quite commonly encountered diseases. Both of these are the acute and chronic manifestations of the same entity. While abscess are thought to begin as an infection in the anal glands, their spreading into adjacent spaces results in a fistula formation. At many times this spread occurs in a complex pattern which is difficult to map and treat. PRESENTATION OF CASE: This paper describes a complex perianal fistula that presented as a painless benign lump in the upper outer quadrant of the right buttock. The lump initially thought to be a soft tissue swelling was later diagnosed to be a chronic abscess cavity extending medially toward the anal canal in the form of a complex fistulous tract. DISCUSSION: Complex perianal fistulas are difficult to treat and are prone to recurrences. Correct diagnosis and characterization of the fistula is essential to optimize the treatment. Clinical examination alone may not give a correct picture of the actual disease, thereby requiring radiological investigations like MRI. CONCLUSION: Although rare, sometimes common clinical conditions like fistula-in-ano may also present in complex manner. It is important to establish the diagnosis firmly and map the fistula properly before going in for surgery. Complexity of fistulas and improper mapping often leads to recurrences and other complications like incontinence.

Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature.

The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 38-year-old lady who presented with vague pain and chronic lump in the right iliac fossa region. She had a history of cesarean section 4 years ago. Radiological investigations were inconclusive in detecting the retained sponge. A working diagnosis of mesenteric cyst was made and an exploratory laparotomy was done where she was found to have a large gossypiboma densely adhered to the small bowel and surrounding structures. Though rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain or chronic lump even years after the operation.

Persistent Müllerian duct syndrome with transverse testicular ectopia presenting as an incarcerated inguinal hernia.

The presence of both of the testes in one scrotal sac is one of the very rare presentations of testicular ectopia, which is known as transverse testicular ectopia (TTE) and is also known as crossed testicular ectopia. The presence of the uterus and fallopian tubes in a normally virilized male is termed as persistent Müllerian duct syndrome (PMDS). We report a case of an adult male who had a unique combination of both TTE and PMDS presenting as an incarcerated inguinal hernia.

Five year clinico pathological study of breast cancer.

UNLABELLED: Breast cancer is a prototype for exploring variations in pathological diagnosis and etiology. BASIC PROCEDURE: We analysed the various risk factors, age, Tamoxifen treatment and pathological diagnosis for Breast cancer. MAIN FINDINGS: We present a review of 105 cases of breast cancers diagnosed and treated at Dr Ram Manohar Lohia Hospital in a five years prospective study between 1997 and 2002. Breast cancer was most commonly found in age group 30-40 years and infiltrating carcinoma of breast was the commonest occurring in 90% of the cases. IMPLICATIONS: We demonstrated the utility of such study of ensuring greater equity and understanding in etiology. The risk factors and pathological diagnosis in cancer of breast were studied and need for comprehensive screening programme were outlined.

Impact of mass bathing on the water quality of the Ganga River at Haudeshwarnath (Pratapgarh), India--a case study.

This paper reports on the impact of mass bathing on Ganga River water quality on the occasion of the Maha-Shivaratri festival at Haudeshwarnath Ghat situated on the left bank of the River Ganga in the district of Pratapgarh, India. Water samples collected from three sampling points before and after mass bathing were analysed for a total of 17 physico-chemical and seven biological parameters. It was concluded from the results that mass bathing causes a significant change in water quality of the river, which may represent a health hazard to users of the river water.