Ameet Kumar

Caecal perforation with faecal peritonitis – unusual presentation of Bochdalek hernia in an adult: a case report and review of literature

The improper fusion of the postero-lateral foramen of the diaphragm was first described by Bochdalek in 1848. The incidence of congenital diaphragmatic hernia varies from1:2000 to 1:5000 live births and Bochdalek hernias (BH) account for 75 to 85% of these. Although it is a well-known entity in neonates, it is occasionally discovered incidentally in adult patients. Until now, a total of around 100 cases of occult asymptomatic Bochdalek hernia have been reported. The symptomatic cases are encountered more rarely. Colon necrosis among the symptomatic cases was reported in some reports. We discuss the present case since we believe it to be, to the best of our knowledge, the first case of a Bochdalek hernia in an adult presenting with caecal perforation and faecal peritonitis and review the published literature about this rare condition.

Idiopathic sclerosing encapsulating peritonitis — Is a preoperative diagnosis possible? Report of three cases

Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is usually diagnosed during a laparotomy; however, a preoperative diagnosis is possible. Sclerosing encapsulating peritonitis can be classified as primary or idiopathic and secondary types and only about 70 cases of idiopathic type have been reported since it was first described. It is characterized by a total or partial encasement of the small bowel by a thick fibrotic membrane. This report presents a series of three cases in which a diagnosis of idiopathic SEP was made preoperatively based on the clinical features and radiological findings, which were confirmed by a laparotomy and histopathology. All of the cases were successfully managed by the excision of the membrane. This report demonstrates that based on the clinical features and radiological investigations, in the absence of other plausible etiologies for intestinal obstruction, it is possible to suspect a preoperative diagnosis of SEP, thereby preventing a “surprise“ finding during a laparotomy and allowing for better management.

Whipple's pancreaticoduodenectomy: Outcomes at a tertiary care hospital.

BACKGROUND Pancreaticoduodenectomy is a formidable surgery and was associated with high morbidity and mortality. Though the mortality rates have steadily improved, morbidity continues to be high. There is lack of published data on outcomes following pancreaticoduodenectomy in Armed Forces hospitals. The aim of this study was to analyze the short term outcomes at our center and to compare it with the published literature. METHODS A retrospective review of prospectively maintained data base was done. Preoperative, intraoperative and postoperative data was analyzed with emphasis on the morbidity and mortality rates. Follow up data was analyzed to look at disease recurrence. RESULTS Between Jan 2008 and March 2014, 69 patients underwent Whipples pancreaticoduodenectomy with a median age of 64 years. All had a malignant etiology with periampullary carcinoma being the commonest (42%). Overall, intra-abdominal complications occurred in 46% of patients which included postoperative pancreatic fistula (20%) and delayed gastric emptying (24%). The mortality rate for the whole was 11% which reduced to 8% in the second half of the study. CONCLUSION The short term outcomes at our center were comparable to those in published literature. The mortality rates showed a decreasing trend with time.

Branchial fistula: an imaging perspective

The branchial cyst, fistula, and sinuses are the anomalies of the branchial apparatus which consists of five mesodermal arches separated by invaginations of the ectoderm called as clefts. The branchial fistula is not a true fistula as it rarely has two openings. More often even if both ends are patent there is a thin membrane covering the internal opening.1 Demonstration of a complete branchial fistula on imaging studies is uncommon.2 We present a case of a complete branchial fistula in a young lady with a special emphasis on imaging.

Large Bowel Obstruction by Anomalous Congenital Band

The incidence of obstruction of large bowel is 3-4 times less frequent than the small bowel. The main causes of large bowel obstruction are malignancy, volvulus, diverticulae, inflammatory bowel disease and pseudo-obstruction [1]. Anomalous congenital bands (ACB) causing large bowel obstruction is a rare occurrence and to best of our knowledge, only three such cases has been reported in literature [2, 3, 4]. There is no report of congenital band causing both large bowel obstruction and jejunal ischemia. We report an unusual case of intestinal obstruction in a 76 year old lady who had an ACB obstructing the transverse colon causing a closed loop obstruction, caecal perforation and ischemia of proximal jejunum along with formation of pneumatosis cystoides intestinalis (PCI).

Interstitial Incisional Hernia following Appendectomy

Appendectomy is a common surgery and incisional hernia following appendectomy is uncommon, occurring in less than 0.12% of patients [1]. Post appendectomy interstitial incisional hernia is extremely rare [2]. In 1911, Hoguet first called attention to the occurrence of right inguinal hernia following appendectomy with drained wounds. Many of these had not only a right inguinal hernia but also an associated postoperative hernia at the site of the appendectomy scar. Hoguet and Watson attributed the occurrence of the inguinal hernia to a weakening of the abdominal wall following injury to the ilio-inguinal and ilio-hypogastric nerves [3]. A case of post appendectomy interstitial hernia is reported for the rarity of the condition and review of literature.

Differential Diagnosis for Acute Appendicitis: Epiploic Appendagitis

Epiploic appendagitis is a rare condition that may present with acute abdominal pain and it mimics appendicitis when it occurs on the right side [1]. In a series of 1320 cases of acute abdominal pain by Golash only eight cases were due to acute epiploic appendagitis [2]. Though there are case reports of epiploic appendagitis presenting as acute abdomen, it is seldom considered as a differential diagnosis for appendicitis. We report one such case which presented with right lower abdominal quadrant pain and was diagnosed as acute appendicitis but had torsion of an appendix epiploica of the proximal ascending colon on surgery.

Primary Tubercular Abscess of the Axilla—a Rare Case

Tuberculosis can be broadly classified as pulmonary and extrapulmonary. Though pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis is also an important entity. A tubercular cold abscess secondary to involvement of an adjacent bone or suppuration of lymph nodes is a well-known entity; however, a primary cold abscess is rare. We report a case of a young girl who presented with an axillary swelling which turned out to be a primary tubercular abscess of the axilla. To the best of our knowledge, this is the first reported case of a primary tubercular abscess presenting in the axilla. A primary tubercular abscess, though rare, should be considered as a possible diagnosis in appropriate clinical settings backed by evidence of Mycobacterium tuberculosis in form of AFB microscopy, L-J culture, BACTEC culture, or PCR test.

Mesenteric cyst in sigmoid mesocolon – A rare location and its laparoscopic excision

Wg Cdr Ameet Kumar , Brig C.K. Jakhmola , Maj Gen N.C. Arora, VSM**, Col S.S. Chauhan d a Assistant Professor (Surgery), Army College of Medical Sciences and Classified Specialist (Surgery) and GI Surgeon, Base Hospital, New Delhi 10, India b Professor and Head (Surgery), Army College of Medical Sciences and Consultant (Surgery) and GI Surgery, Base Hospital, New Delhi 10, India c Consultant (Surgery and Orthopaedic Surgery) and Commandant, Base Hospital, New Delhi 10, India d Professor (Surgery), Army College of Medical Sciences and Classified Specialist (Surgery) and GI Surgeon, Base Hospital, New Delhi 10, India