Madhumita Mukhopadhyay

Amoebic liver abscess: presentation and complications.

BackgroundAmoebic liver abscess (ALA) is the most common inflammatory space occupying lesion of the liver. It has a highly variable presentation causing diagnostic difficulties. Untreated, complicated ALA has high morbidity and mortality.ObjectiveTo study the various types of clinical presentation and complications of ALA in order to establish early diagnosis and prevent complications.Materials and methodsA prospective study was conducted in the Department of Surgery of Calcutta National Medical College and Hospital from July 2005 to June 2008. All patients with a confirmed diagnosis of ALA during this period were included in the study.ResultsSeventy-two patients with 76 ALAs were studied over a 3-year period. The age ranged from 21 to 72 years (mean age being 43.64 years). There were 66 males (91.67% of the patients) and 6 females (8.33% of the patients). The (31–40 years) age group showed the highest incidence consisting of 40.28% of the cases. Pain was located most commonly in the right hypochondrium in 60 patients (83.33%). Fever was observed in 58 patients (80.56%). Solitary abscess cavity was present in 68 patients (94.44%). The right lobe alone accounted for 65 (85.53%) of the abscesses. The most common echo pattern encountered in ultrasonography was the echorich pattern in 54 (71.05%) abscesses. Forty-four patients (61.11%) gave history of alcohol consumption. Diagnosis was missed in 21 patients (29.17%), particularly in those with atypical presentations. The most common complication was pleuropulmonary in 24 patients (33.33%), followed by intraperitoneal rupture in 19 patients (26.39%). Other complications were jaundice (n = 11), ascites (n = 9), subhepatic effusion (n = 7), subphrenic abscess (n = 3) and intrapleural rupture (n = 2). Ultrasonography was useful in diagnosing ALA. Despite successful therapy 23 patients (31.94%) had residual abscess cavities on ultrasonography even after 6 months.ConclusionIn an endemic area a patient presenting with lower chest or upper abdominal pain along with tender hepatomegaly should raise the suspicion of ALA. Sonography remains an important tool in the diagnosis of ALA.

Fibroadenoma of the ectopic breast of the axilla

Polymastia is a term that is used to describe the presence of more than two breasts in human beings. It is synonymous with supernumerary or accessory breast tissue. Ectopic breast tissue (EBT) may occur any where along the primitive embryonic milk lines, which extend from the axilla to the groin, and may occur unilaterally or bilaterally. In the EBT any disease can develop that affects the normal breast, including fibroadenoma. Since publications describing this anomaly are rare, we decided to report a case of fibroadenoma in axillary breast tissue.

Isolated Gastric Tuberculosis: A Case Report and Review of Literature

Isolated gastric tuberculosis is a rare condition, even in those parts of the world where intestinal tuberculosis is common. Herein we describe a case of a thirty year old female patient with isolated gastric tuberculosis who presented with features of gastric outlet obstruction.

Gastric gangrene due to necrotizing gastritis.

Gangrene of the stomach is a rare, often fatal disease which may be due to vascular, chemical, mechanical or infectious etiologies. We report a case of gastric gangrene due to necrotizing gastritis in a 50 year old female.

Enterolith Containing Uric Acid: An Unusual Cause Of Intestinal Obstruction

Enterolith is a rare clinical entity that may be found on imaging or at surgery. We report an unusual case of intestinal obstruction caused by a large uric acid containing enterolith which was formed in the absence of any bowel inflammation, stricture or diverticulum.

Sessile fibrolipomas: A case report

AimTo report a case of multiple sessile fibrolipomas of the lower dorsal trunk.Case ReportA 27-year-old female patient presented with multiple, broad-based fibrolipomas of the lower dorsal trunk.ResultThe lesions were excised with primary skin closure. The histopathological diagnosis was fibrolipoma.ConclusionFibrolipomas are rare tumours. Excision with skin cover, either primary or secondary, is the treatment of choice.

Breast tuberculosis: A series of 28 cases

BackgroundBreast tuberculosis is a rare form of tuberculosis. The significance of breast tuberculosis lies in its rare occurrence and mistaken identity with breast carcinoma and pyogenic abscess.ObjectiveTo study the various clinical presentations of breast tuberculosis, so as to distinguish it from malignancy and prevent mutilating surgery.SettingA tertiary referral Medical College Hospital in Kolkata.Patients and methodsA retrospective study was conducted over a period of three years and the data collected were analyzed and compared with other studies.ResultsTwenty-eight cases of breast tuberculosis were retrospectively studied over a period of three years, All patients were female. The age ranged from 19 years to 55 years, the mean age being 33.64 years. An isolated lump in the breast was the most common clinical presentation found in 13 patients (46.43%). Other presentations included a lump with associated sinus in eight patients (28.57%), a lump with associated ulcer in two patients (7.14%), tubercular breast abscess in four patients (14.29%) and tender nodularity in one patient (3.57%). Associated axillary lymphadenopathy was found in 11 patients (39.29%). Fine needle aspiration cytology was the most reliable diagnostic modality. Antitubercular chemotherapy formed the mainstay of treatment. Surgical intervention was reserved for selected refractory cases.ConclusionBreast tuberculosis should be considered in the differential diagnosis of any case of a painful breast mass, mastitis, or breast abscess that appears refractory to conventional therapy. Antitubercular chemotherapy represents the mainstay of treatment.

Spontaneous rupture of the bladder: Report of two cases

AimTo report two cases of spontaneous urinary bladder rupture following binge-drinking.Case ReportTwo male patients with history of alcohol abuse and no history of trauma, presented with progressive abdominal distension and features of peritonitis.ResultIn both cases. exploratory laparotomy revealed intraperitoneal rupture of the bladder. Primary repair was performed which was followed by an uneventful recovery.ConclusionSpontaneous rupture of the bladder is a rare occurrence and when encountered, it presents a diagnostic challenge. A diagnosis of spontaneous perforation of the bladder should be considered in alcoholic patients presenting with an acute abdomen in a relatively stable condition and blood biochemistry showing a disproportionately elevated urea and creatinine.

An unusual cause of haematuria.

We report an unusual cause of haematuria in a young male patient due to leech in urinary bladder. The patient presented with undiagnosed haematuria of 12 days duration. Sonography is a safe and noninvasive procedure for diagnosis. Most of the leeches are micturated out spontaneously.