Arvinder Singh

Retrograde Jejuno‑gastric Intussusception

Retrograde jejuno-gastric intussusception is a rare complication following gastric surgery. We present a case of retrograde jejuno-gastric intussusception in a 42-year-old female who presented with upper abdominal pain, vomiting and swelling in left hypochondruim. Intussusception was suspected on ultrasound of the abdomen and later confirmed with computed tomography scan. At laparotomy, efferent loop was intussuscepting into stomach. This was reduced and fixed to the abdominal wall and transverse mesocolon. It should be suspected in a patient with the previous history of gastric surgery as it is a rare complication. Early diagnosis and management can prevent further complications like bowel gangrene and its associated morbidity and mortality.

Massive Ovarian Dysgerminoma Presenting as an Unusual Large Intra-abdominal Mass

The management for ovarian dysgerminoma is different from those of other ovarian tumors, making accurate diagnosis crucial for patient care. We report a case of 9 year old girl who presented with abdominal distension. Examination revealed a huge palpable intra-abdominal mass. Plain X ray abdomen showed a large homogenous mass filling the mid part of the abdomen and causing displacement of bowel loops laterally. Abdominal sonography showed a large heterogenous lobulated abdominal mass reaching up to the pelvic brim. CECT abdomen showed a large well defined lobulated heterogeneously enhancing mass of 59-61 HU occupying most of the mid part of abdomen and reaching up to the pelvic brim. It showed multiple areas of necrosis with few small specks of calcification. The mass was removed after laparotomy under general anesthesia. Finally, after histopathological examination with raised β-human chorionic gonadotropin (β-hCG) levels, the diagnosis of ovarian germ cell tumor (Dysgerminoma) was made.

Abnormally Large Wooden Foreign Body Impacted in the Rectosigmoid Colon without Bowel Perforation

A 46 years old male presented with a history of assault and insertion of a long wooden object through his anus. Examination and radiological investigations of the patient revealed a 34x4.0 cm long wooden object in the rectosigmoid colon. The foreign body was delivered by colotomy under general anesthesia.

Ultrasonographic evaluation of gall bladder diseases in diabetes mellitus type 2

Diabetic autonomic neuropathy gives rise to varied manifestations in the gastrointestinal tract i.e. gastropathies, nocturnal diarrhoea, oesophageal dysmotility, constipation and gallbladder dysfunction, being consequence of vagal neuropathy leading to reduced G.I. Motility. Gallbladder involvement in diabetic autonomic neuropathy is in the form of high incidence of gall bladder stones and a significant increase in gall bladder volume with poor concentration and poor visualization, with lack of symptoms of gallbladder disease. The present study concluded that gall bladder disease is more prevalent among type 2 diabetics. Diabetics with autonomic neuropathy tend to have larger gall bladders with poor contraction in response to fatty meals (due to vagal neuropathy), thus predisposing these patients to various forms of gall bladder disease.

Role of ultrasound in detection of antenatal foetal malformations

Aims and Objectives:The aims and objectives of this study was to detect foetal malformations ultrasonographically ,to evaluate associated anomalies and to evaluate outcome of pregnancy. Material and Methods:The prospective and retrospective study was conducted on 10890 pregnant women. All pregnant women were subjected to US examination by Siemens, Sonoline SL-2 ultrasound machine. using real time system.3.5 MHz transducer. Results: Total 124 foetuses were found to have major congenital malformations.Pregnant women were referred in routine US for foetal well being or risk factor related to foetal malformations.The average incidence of malformations was 1.14% with maximum no. of malformations 96 (77.41%) during 3rd trimester of pregnancy.Majority of cases were in age group 21-25 years (51.6 %) with youngest women of 18 years and oldest 38 years. Most of the foetal malformations were seen in primigravida (45.96 %). During study 52.42% of pregnant women were at risk ofmalformed foetus in form of discrepancy of height of uterus and period of gestation, 47.58% were clinically routine cases.Majority of malformations were detected during 3rd trimester 98(79.04%) with the range of 13-41 weeks and mean gestational age of 31.16 weeks. Most common anomaly was ventriculomegaly 41 cases (27.33%) followed by anencephaly 39cases(26.00%).Neural tube defects accounted for more than 50%of the anomalies with common association withspinal deformities. Polyhydramnios 28 (71.79%) cases was common association with neural tube defects. Oligohydramnios was associated with 4 (66.66%) cases of renal anomalies.Foetal malformations had predilection female fetuses with male to female ratio of 1:1.3 . Spinal abnormalities were common in male fetuses.Overall mortality of malformed.fetuses was 90(72.58%) cases,however in anencephaly, diaphragmatic hernia and hydrops foetalis it was 100%.In skeletal dysplasias it was 80%. Most common site of encephalocele was occipital in 18(94.73%)cases.Most common renal malformation was found to be bilateral hydronephrosis in 4 patients. Skeletal dysplasia was seen in 5 cases with 3 cases had associated pulmonary hypoplasia. Achondroplasia was seen in 3 cases and achondrogenesis in 2 cases. Conclusion:We concluded in our study that ultrasound should be done between 16-20 weeks in routine and earlier in high risk pregnancy. This leaves adequate time for determining the outcome and fate of pregnancy.Hence it would be worth to aware the practitioner about advantage of early scanning in pregnancy.