An Assessment of the Etiologies Associated With Acute Abdomen Subjected to Exploratory Laparotomy: A Study From a Rural Area of Himachal Pradesh.

Background The aim of this retrospective study is to establish a correlation between clinical features, surgical diagnosis, and the final diagnosis of laparotomies, as well as to establish the relationship between preoperative delay on the outcomes of surgery in the form of mortality and morbidity. Emergency surgery is high-risk in patients with acute abdomen with uncertain diagnosis. The results of surgery are remarkable and provide quick relief to the suffering and agony of patients with the dreadful condition of acute generalized peritonitis. Methodology Patients presenting with complaints of acute abdomen who needed laparotomy based on clinical judgment and investigations were included in this study. The study data were reviewed from April 2007 to January 2011 and March 2014 to February 2016 in a government hospital. Results A total of 174 patients with acute abdomen in whom there was an indication of laparotomy based on clinical judgment and radiological investigations were selected. Most patients had gastrointestinal perforation (n = 115) and acute intestinal obstruction (n = 23). The most important clinical features analyzed were abdominal tenderness (n = 160), guarding (n = 153), distention (n = 75), and tachycardia (n = 63). Conclusions Among the total patients, 150 underwent surgery within 24 hours of the presentation in the emergency and the remaining after 24 hours. The most common cause of laparotomy was a duodenal perforation in 79 patients and gastric perforation in 24 patients. A total of 114 patients developed no complications postoperatively. Among patients who developed postoperative complications, wound sepsis and acute respiratory distress syndrome were the most common. Mortality was noted in three patients.

Hydrocele in the canal of nuck in a young female: a rare case report.

Hydrocele of the canal of Nuck is a rare condition seen in younger females which is an extension of the peritoneum into the inguinal canal. Incomplete proximal obliteration and collection of serous fluid in the sac leads to the formation of a hydrocele of the canal of Nuck. A 28-year-old woman presented with swelling in her right groin for 5 months of 6cm × 5 cm. Ultrasound revealed a well-defined tubular cystic structure, measuring 5 cm × 3.5 cm × 5 cm with a volume of 50-60 ml. The cyst was dissected and the neck of the sac was extended up to the deep ring. Clear fluid was found on opening the sac. Clinically, it appears either as a painless or a moderately painful fluctuant inguinal mass. Clinical findings alone do not help in diagnosing the disease. Treatment includes surgical excision of the mass but without puncturing it as aspiration is inadequate and results in recurrence.

Two cases of lead poisoning associated with occupational exposure presented as intestinal obstruction: a case report.

Lead exposure in India is common in industries that may present with nonspecific signs and symptoms or symptoms of toxicity, depending on the amount of lead absorbed. We are presenting two case reports of occupational lead exposure in a lead-based battery manufacturing unit, which were presented as intestinal obstruction. Both the patients aged 28 and 24-year old presented with complaints of pain in the abdomen with blood lead levels of 61.1 and 85 µg/dl, respectively. The diagnosis was made clinically before any other radiological investigation or intervention. Both the patients were treated conservatively with D-Penicillamine, following which, both the patients improved symptomatically and the blood lead level also decreased. The importance of a detailed history of occupation & clinically diagnosing such patient will avoid unnecessary investigation and intervention. This will help to reach the correct diagnosis in such cases.

Dermatofibrosarcoma- An uncommon entity, commonly mismanaged: a case report.

INTRODUCTION & IMPORTANCE: Dermatofibrosarcoma protuberans (DFS) is a slow-growing, recurrent, cutaneous soft tissue sarcoma with low metastatic potential. It is not uncommon for DFS to get misdiagnosed and treated like commoner parietal wall swellings, viz., epidermal cysts, lipomas and fibromas. Suboptimal management often leads to recurrence, which may be difficult to manage. CASE REPORT: A 33-year male was referred to us with a lump in his lower abdomen for 15 years, without any symptoms. The patient underwent medical management for 6 years, followed by excision. The swelling recurred four years later and progressed in size till the next 5 years. At our centre, the patient underwent imaging and aspiration cytology, which established diagnosis of DFS, followed by wide local excision. Biopsy was conclusive and margins negative. DISCUSSION: DFS presents commonly as an asymptomatic indurated plaque that slowly enlarges over months to years. Untreated, DFS can attain massive dimensions, producing the large "protuberant" nodules, and hence the name. In the current report, 15 years elapsed before the correct diagnosis was established. In this case, recurrence first appeared after four years of excision. The possibility of primary wound closure after wide excision decreases with every subsequent excision, and reconstructive options may not be readily available. CONCLUSION: The current report highlights a diagnostic delay of 15 years in a case of DFS. Asymptomatic, indolent nature combined with low awareness among community doctors contribute to delay in timely diagnosis. Community doctors should consider DFS as a differential in any long-standing, indolent, asymptomatic parietal wall swelling, especially with a history of recurrence.