Dinesh Singhal

Transabdominal gastroesophageal devascularization without transection for bleeding varices: Results and indicators of prognosis

Background:  Esophagogastric devascularization is an operation that can be performed for endoscopically uncontrolled variceal bleeding in hospitals having only basic surgical instruments and is therefore an appropriate procedure for small hospitals in developing countries. The aim of this study was to analyze one hospital’s experience of this operation in consecutive patients with variceal bleeding.

Elderly Woman With Acute Abdomen and Gastric Mass on Imaging.

An elderly woman presented to the emergency department with sudden-onset upper abdominal pain and vomiting for 7 days. She underwent gastric surgery more than 25 years ago, of which no details were available. On general physical examination, her vital signs were stable. The abdomen was soft and nondistended. There was epigastric tenderness. The results from initial blood tests, including hemogram, liver and kidney function tests, and serum amylase, were unremarkable. Contrast-enhanced abdominal computed tomography was performed (Figure 1). Figure 1. Abdominal computed tomography with intragastric target mass.

Young Adult With Abdominal Lump

A young adult presented with a progressively growing abdominal lump that left him feeling a dull ache and heavy. Ten weeks previously, he was hospitalized and conservatively managed for acute pancreatitis. He had a history of prolonged alcohol abuse. A physical examination revealed stable vital signs and a normothermic, nontender, nonpulsatile, fixed lump in his upper abdomen (Figure, A). A routine blood test revealed leukocytosis (white blood cell count of 12 000/μL [to convert to ×10 per liter, multiply by 0.001]), and his liver and kidney function test results were unremarkable. His serum amylase level was 487 U/L (normal range, 28-100 U/L [to convert to microkatals per liter, multiply by 0.0167]). A contrast-enhanced computed tomography (CT) scan of his abdomen was performed (Figure, B). Abdominal lump A Contrast-enhanced CT scan of abdomen B

Young Adult With Multivisceral Lesions and Hypoglycemia

Gastroe A 28-year-old male patient presented with complaints of episodic sweating, palpitation and restlessness for 1 year. He had documented recurrent hypoglycemia which was relieved by consumption of sugars. There was a past history of craniotomy for cerebellar hemangioblastoma in 2009 and 2011. There was no significant family history. A general physical examination did not reveal any abnormality except for well healed craniotomy scars. The evocative testing for hypoglycemia revealed fasting blood sugar 40mg%, serum insulin levels 37 (range 1.9–23) mU/mL, C-peptide -6.68 (range 1.1-4.4) ng/mL. The patient was further investigated with contrast enhanced abdominal magnetic resonance imaging (MRI scan) (Figures A and B). The MRI scan depicts multiple simple cysts and/or serous cystadenomas of varying size in the pancreas. The left kidney has Bosniak 3 cystic lesions. There is a 3.1 2.8 cm heterogeneous solid tumor in the distal body pancreatic tail region.

Management of Giant Gastric Ulcer Perforation: Report of a Case and Review of the Literature

Giant gastric ulcer (GGU) is defined as an ulcer more than 3 cm in diameter. Now infrequent in clinical practice, in the pre-H2 receptor antagonist (H2RA) era, the incidence of GGU varied between 12 and 24% of all gastric ulcers. Proton pump inhibitors reportedly achieve better healing rates and symptom relief in comparison to H2RA. The GGU is associated with high incidence of serious complications such as hemorrhage. A perforated GGU though rare (<2%) offers serious challenges in management. We report one such case wherein the role of multidetector CT scan (MDCT) for diagnosis and treatment planning, surgical options for GGU perforations, and factors affecting outcome are discussed.