Ankit Shukla

Percutaneous Closure of Internal Ring: A Leap Ahead

Surgery for inguinal hernia is commonly performed in children. Traditional approach is open herniotomy. However, numerous minimal invasive methods are evolving with the same or low complication and recurrence rates. Percutaneous internal ring suturing (PIRS) under vision is a minimal invasive technique which is simple, effective, remarkably cosmetic, economical, easy to learn and reproduce with short operative time, and helpful in identifying occult contralateral hernia. This procedure was performed first time in our secondary care set-up with gratifying results for the patient, parents, and the operating team.

Love sign's love for glomus tumor

Glomus tumors are rare benign painful tumors, which arise from the glomus body. The diagnosis is established with a detailed history and a bunch of efficient clinical tests, which are more beneficial than the radiological investigations. The surgical removal of the tumor is the mainstay of treatment. We present here a case of glomus tumor of right thumb suffering from agonizing paroxysms of pain since the last ten years, which was diagnosed clinically, whose tumor was surgically removed after localizing it with the love’s pin test.

Handlebar Hernia with Triple Herniation and Perforation: A Case Report and Literature Review

Blunt trauma abdomen is a very common entity but traumatic abdominal wall hernia is not that common. Herniation through abdominal wall usually occurs following trauma with seat belt, motor cycle, bicycle handle bar etc. Handlebar hernia is a less known variety of traumatic abdominal wall hernia as a consequence of injury with handlebar of a bicycle. It is difficult to diagnose and one should have high index of suspicion. Management in traumatic abdominal wall hernia is individualized based on various factors. We herein present an interesting case of a14-year-old boy, who sustained blunt trauma abdomen from bicycle handlebar leading to triple herniation and perforation of the small bowel and hematoma of the mesentery. Patient was resuscitated and operated with a favorable outcome. Blunt trauma abdomen is a very common and the possibility of traumatic abdominal wall hernia should always be borne in mind.

Primary Retroperitoneal Hydatidosis with Cholelithiasis; Management Dilemma: A Case Report.

Hydatidosis is an endemic disease in sheep rearing countries around the world. Mostly hydatid cysts are seen in liver and lungs. Primary retroperitoneal hydatid cyst is a very rare disease and it’s occurrence with cholelithiasis poses a management dilemma. The approach in cholelithiasis is laparoscopic cholecystectomy while retroperitoneal hydatid cyst is removed laparoscopally or through open surgical approach. Both should be operated separately with emphasis on special care to prevent of implantationof hydatid cysts in the abdominal cavity. Albendazole is the drug of choice which has been used preoperatively to sterilise the cysts as well as post operatively to prevent recurrences after surgery.

Nonsyndromic Phocomelia: A Case Series

Phocomelia is a rare congenital disorder seen in new borns. It means ‘seal limbs’ derived from greek language. The incidence of this disorder is very low, and true phocomelia cases are further low, hence there are not many studies on this disorder. Thalidomide was responsible for bringing this drug into limelight. In this report we have described two cases of isolated nonsyndromic phocomelia where there was no history to drug or radiation exposure during intra-uterine period thus showing that there are factors other than thalidomide, which needs to be studied.

Migratory Stent Leading to Ileal Perforation Less Known Complication of Therapeutic ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) has a vital role in the diagnosis and management of various biliary and pancreatic diseases but is also associated with adverse events. Commonly seen complications are pancreatitis, bleeding, cholangitis, cholecystitis, postspinchterotomy strictures and perforation. Migration of stents, which is more with plastic stents, is a well-known complication of endoscopic retrograde cholangiopancreatography however less than one percent of migrated stents end up in intestinal perforation. Moreover perforation of the ileum years after migration of ERCP stent is hardly heard off. The literature also reports very few cases of small bowel perforation by migration of biliary stents.

Abdominal Wall Abscess Harbouring Gall Stones and Adenocarcinoma after Laparoscopic Cholecystectomy: A Rare Case Report

Cholecystectomy is the most commonly performed operation worldwide. Laparoscopic cholecystectomy is the gold standard treatment of gall stones today. Over the decades the complications of laparoscopic cholecystectomy has decreased but gall bladder perforation and bile spillage is still a significant problem. The lost gall stones can lead to abscess formation both intra-abdominal and intraparietal. Rarely the port sites may harbor malignancy, which is the most feared of all complications. So gall bladder perforation and bile or gall stone spillage should be properly documented.

Cystic Duct Opening into Right Hepatic Duct; a Disaster Waiting to Happen During Cholecystectomy: A Case Report

Cholecystectomy is the most commonly performed elective surgery worldwide. Variations in the normal anatomy of the biliary tree are common. Cystic duct variations are surgically most significant. Incidence of cystic duct opening into right hepatic duct is very low. In the case presented in this report cystic duct opened into the right hepatic duct. An abnormally wide cystic duct made us suspicious and after careful dissection we could trace the cystic duct entering into right hepatic duct. Various radiologic investigations like ERCP (endoscopic retrograde cholangiopancreatography), MRCP (magnetic resonance cholangiopancreatography), Helical CT (computerized tomography) can give us excellent picture of biliary tree but they are seldom used preoperatively. Hence the proper knowledge of normal anatomy and anomalies of the biliary tree can help to avoid disasters during cholecystectomy, especially for surgeons beginning their careers.

Pin Worm Causing Acute Appendicitis: Case Report

Vermiform appendix should not be considered a vestigial organ in human beings. It is a lymphoid organ which when inflamed causes serious trouble. The most common cause of acute appendicitis is obstruction of it’s lumen. Among all the causes of appendicitis Enterobius vermicularis is a rare cause. It is commonly seen in children. It mimics the features of acute appendicitis but may not always be responsible for acute appendicitis. Mostly pinworms are seen in the appendices after appendicectomy but there may not be any evidence of acute appendicitis. Antihelminthic treatment should be given to the patient after appendicectomy before the patient is discharged from the wards and all other family members should be given the same treatment.

15 cm Long Appendix, A Management Dilemma: A Case Report

Apendix is a worm shaped tubular structure found attached to the ceacum just below the ileocecal junction in humans, some apes and wombats. It’s inflammation is the most common disease of the appendix which leads to appendectomy; the most common emergency operation throughout the world. It’s different positions are responsible for different clinical presentation apart from common symptoms and on top of that a long subhepatic appendix can further confuse the picture and produce a diagnostic dilemma. Hence a good clinical acumen and a high index of suspicion are required to lower the morbidity and mortality associated with a delayed diagnosis of acute appendicitis.