Lalendra Upreti

Tuberculous Gastric Perforation: Report of a Case

A 21-year-old woman presented with a 2-day history of acute abdominal pain. Contrast-enhanced computed tomography (CT) showed a perforation in the lesser curve of the stomach. The patient suffered a bout of hematemesis, following which an endoscopy showed a bleeding blood vessel at the edge of the perforation. We performed an emergency distal gastrectomy, including the ulcer site. Histopathological examination revealed tuberculous granulation tissue and acid-fast bacilli in the ulcer. The patient was given antituberculosis therapy (ATT) postoperatively, and was well when last seen 1 year 5 months after surgery. We analyzed the clinical data of five cases of tuberculous gastric perforation (TGP), reported between 1948 and 2003, including our patient. The patients ranged in age from 21 to 45 years, with a mean age of 36.8 years (SD ± 10.21), and a male to female ratio of 3 : 2. The diagnosis was confirmed by surgery or autopsy. Abdominal lymphadenopathy was present in all patients. Gastrectomy was performed in four patients, and two were given ATT. All four patients in the previous reports died of their disease.

Fetus-in-fetu

Abstract Fetus-in-fetu (FIF) is a rare congenital condition first described in early nineteenth century. In this anomaly, a malformed parasitic twin is found within the body of its partner. Less than 100 cases have been described in the English-language literature.

Case report: Filariasis presenting as an intra-abdominal cyst

Filariasis is an endemic infection seen in the tropical and subtropical regions of the world, presenting with lymphatic dysfunction in the form of lymphocele, hydrocele, chyluria, or groin lymphadenovarix. We report a rare presentation of filariasis as an intra-abdominal cystic mass.

Choledochal cyst of the cystic duct: Report of imaging findings in three cases and review of literature.

The choledochal cysts, which refer to the cystic dilatation of the biliary duct, are rare lesions generally seen in children. Choledochal cyst of the cystic duct is an uncommon entity. Often, it is associated with the choledochal cyst of the rest of the biliary tree. Isolated cystic duct choledochal cyst is quite rare. Most of these lesions have been recognized only on surgery. Modern cross-sectional imaging methods have facilitated preoperative recognition and characterization of cystic duct cyst enabling formulation of appropriate management strategy. We report the imaging findings in three cases of choledochal cyst involving the cystic duct. All these cases were correctly diagnosed preoperatively. A review of cases reported in the literature and the role of imaging in guiding the management are also presented.

Optimal utilization of pediatric computed tomography to minimize radiation exposure: What the clinician must know

The number of computed tomography (CT) scans being done for children all over the world is on the rise ever since the advent of Multi-Detector CT (MDCT). However, CT is a potential source of harmful ionizing radiation, and children are more susceptible to its adverse effects. It is essential for the pediatrician as well as the radiologist to be aware of some important principles and guidelines, by following which, radiation exposure to the child can be minimized to the bare essential. It is important to have knowledge of the valid and justifiable indications of CT for the child, the correct technique of performing the scan, and the new technological innovations now available on modern scanners that help to minimize radiation dose.

Gallstone abscess: some drops may end up costlier!

This 47-year-old female patient presented to the Gastrointestinal Surgery OPD at our hospital with long standing abdominal pain and 2 weeks history of fever. She had undergone laparoscopic cholecystectomy 18 months back. CT scan of the abdomen revealed a 4 cm×4 cm well defined extraperitoneal collection located between the left lobe of liver and the anterior abdominal wall compressing the left lobe (Fig. 1). MRI abdomen showed multiple signal void foci in all sequences within the collection (Fig. 2) suggesting the diagnosis of abscess complicating dropped gallstones. Surgical drainage of the abscess with stone retrieval was performed. Intraoperative perforation of the gallbladder and spillage of gallstones is a well-known complication of laparoscopic cholecystectomy, but subsequent abscess formation is unusual [1]. The incidence of gallbladder perforation has been estimated to occur during 15 % to 30 % of laparoscopic cholecystectomy. The incidence of intraabdominal abscesses is reported to be 0.6 % in patients who had bile spillage and 2.9 % in those who had both bile and gallstone spillage [2]. Dropped stones are a potential source of recurrent intraabdominal and intrathoracic abscesses. Hence in addition to drainage of abscess, attempts should be made to remove the calculi either percutaneously or by surgery.

Webgroups: A way of facilitating web-based professional interaction - Initial experience at the IRIA, Delhi state branch

Dear Sir, With the advent of the Internet, communication and teaching are gradually shifting from the print to the electronic media. The website of the Indian Journal of Radiology and Imaging (IJRI) receives 4000 hits daily.[1] In a study conducted among radiologists in the US, 97% of respondents indicated that they used the Web for education.[2] The setting up and maintenance of websites involves both initial and recurring monetary liabilities. Webgroups are an innovative tool for maintaining an online presence; they have the same basic functionality that full-fledged websites have but do not entail any significant financial burden. We have started a webgroup of the Indian Radiology and Imaging Association (IRIA) - Delhi state branch at the uniform resource locator (URL) http://groups.google.com/group/iriadelhi?lnk=gschg [Figure 1]. Two of the authors (AD and LU) have been chosen as moderators for administering the webgroup. The moderators job is to approve members who sign up directly at the groups webpage, thus eliminating spam and misuse. All posted messages are screened before being displayed online. The moderators also post details of the monthly or annual meetings of the Delhi chapter of the IRIA and other CME programmes. These posts are emailed automatically to all members apart from being universally accessible at the group webpage. Figure 1 Screen capture of the webpage of the Delhi chapter of the IRIA Google groups is a free webgroup hosting service provided by Google Inc. Disseminating information through a webgroup is fast, entails lower costs than traditional postage, saves stationary, and is eco-friendly. The finances thus saved can be channelized into more productive avenues. Some disadvantages of using a group instead of a regular website include the inability to offer advanced functions such as payment gateways or an online voting system for state body elections. Future directions include posting of interesting cases, online registration for conferences and CMEs, and uploading scientific sessions of CME programs.

Umbilicobiliary fistula in a neonate.

We describe a unique case of congenital umbilicobiliary fistula. A full-term neonate presented with passage of bile through the umbilicus. A contrast study demonstrated communication with the intrahepatic biliary system.