Mohit Kumar Joshi

Traumatic abdominal wall hernia in two adults: a case series

IntroductionTraumatic hernia of the abdominal wall is a rare entity. A large proportion of reported cases are in children with a particular type of injury, i.e. from a handlebar injury. In adults, the presentation can vary substantially and the diagnosis is difficult. We present two cases in adults, with widely varying presentations and management.Case presentationsA 40-year-old woman from rural north India presented with a low-velocity blunt injury to the lower abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin, and was hemodynamically stable. An emergency mesh repair of the defect was performed, and she recovered well.A 38-year-old man from rural north India presented with blunt trauma to the abdomen following a motor vehicle accident. He was stable, with a central abdominal parietal wall swelling and bruising. A computed tomography scan revealed herniation of bowel loops in the area with minor intra-abdominal injuries. A laparotomy, resection-anastomosis of the ischemic bowel, and primary repair of the defect was performed and he recovered well.ConclusionFollowing blunt abdominal trauma, particularly high-velocity injuries, a high index of suspicion must be reserved for parietal wall swellings, as missed hernias in this setting have a high risk of strangulation. Computed tomography is the best aid to diagnosis. Management of each case needs to be individualized.

Tuberculotic osteomyelitis of rib – a surgical entity

Primary tuberculotic osteomyelitis (TBOM) of the rib is rare. We report our experience of seven patients presenting with primary TBOM of rib. Over a period of eight years, otherwise healthy patients presenting with discharging sinus on the chest wall were managed. Patients included four males and three females, aged between 4 and 18 years. Following history and examination, radiological and histological investigations were performed. After confirming osteomyelitis of rib, excision of the sinus tract along with subperiosteal resection of the affected part of the rib was done. Tuberculosis was confirmed on histological examination of the resected specimens. Oral anti-tubercular therapy (ATT) was given for a period of one year. Patients were followed for 5-8 years. The lesion was demonstrable in all the patients on plain X-ray. Histological confirmation of tuberculosis (TB) before surgery could be done in one patient. The anterio-lateral part of the rib was most commonly affected. Mean operative time was 35 min. Mean postoperative hospital stay was four days. There were no wound complications. No recurrence or relapse was seen. Resection of affected part of the rib with the sinus tract followed by oral ATT for one year is an effective modality of treatment for TBOM of rib.

Extra-nodal Small Cell Lymphocytic Lymphoma of Prostate: An Unusual Cause of Lower Urinary Tract Symptoms

Malignant lymphoma of the prostate is a rare occurrence. We describe a case of 60-year-old man presenting with acute urinary retention due to small cell lymphocytic secondary lymphoma of the prostate. We present the clinical manifestation of the disease emphasizing that all lower urinary tract symptom (LUTS) cases should be evaluated for the potential that metastatic cancers or lymphomas may present with such a diagnosis. We also present and tabulate a detailed review of at least 5 such similar reports (in which LUTS was the presenting symptom) published in the English literature to date.

Comparison of diagnostic peritoneal lavage and focused assessment by sonography in trauma as an adjunct to primary survey in torso trauma: a prospective randomized clinical trial.

BACKGROUND Lately, Focused Assessment with Sonography in Trauma (FAST) is preferred over diagnostic peritoneal lavage (DPL) as adjunct to primary survey. However, this is not evidence-based as there has been no randomized trial. METHODS In this study, 200 consecutive torso trauma patients meeting inclusion criteria were randomized to undergo either DPL or FAST. The results were then compared with either contrast enhanced computerized tomography (CECT) (in patients managed non-operatively) or laparotomy findings (in patients undergoing operative treatment). Outcome parameters were: result of the test, therapeutic usefulness, role in diagnosing bowel injury and time taken to perform the procedure. RESULTS Two hundred patients with a mean age of 28.3 years were studied, 98 in FAST and 102 in DPL group. 104 sustained blunt trauma and 76 sustained penetrating trauma due to stabbing. In addition, 38 (38.7%) were FAST positive and 48 (47%) were DPL positive (p=0.237, not significant). As a guide to therapeutically beneficial laparotomy, negative DPL was better than negative FAST. For non-operative decisions, positive FAST was significantly better than positive DPL. DPL was significantly better than FAST in detecting as well as not missing the bowel injuries. DPL took significantly more time than FAST to perform. CONCLUSION This study shows that DPL is better than FAST.

Emergency total thyroidectomy for bleeding anaplastic thyroid carcinoma: A viable option for palliation

Anaplastic thyroid carcinoma (ATC) is a rare and highly aggressive thyroid neoplasm. Bleeding from tumor is an uncommon, but potentially life-threatening complication requiring sophisticated intervention facilities which are not usually available at odd hours in emergency. We report the case of a 45-year-old woman who presented with exsanguinating hemorrhage from ATC and was treated by emergency total thyroidectomy. The patient is well three months postoperatively. Emergency total thyroidectomy is a viable option for palliation in ATC presenting with bleeding.

Cytopathologic Diagnosis of Spontaneous Infarction of Fibroadenoma of the Breast / Spontan Enfark Gösteren Meme Fibroadenomunun Sitopatolojik Tanısı

Abstract Infarction is an uncommon event in a fibroadenoma, which is the commonest benign tumor of the breast. Most often it occurs in pregnancy, lactation or is secondary to fine needle aspiration. Spontaneous infarction of a fibroadenoma in the absence of a predisposing condition is very rare. The cytopathologic features of infarction are necrosis and worrisome nuclear features, which are often misinterpreted as either inflammation or malignancy. We detail a report of accurate cytopathologic diagnosis of spontaneous infarction of fibroadenoma in a 17-year-old adolescent non pregnant girl. Careful attention to the cytopathologic clues like uniform thickness of the necrotic epithelial fragments, branching pattern reminiscent of the staghorn pattern despite atypical nuclear features and clinical details like young age of the patient and recent onset pain in a pre-existing lump helped arrive at the correct diagnosis and spared the patient of a radical excision. To the best of our knowledge, there are no earlier reports of correct cytopathologic diagnosis. Öz Memenin en sık benign tümörü olan fibroadenomda infarkt nadiren görülür. En sık olarak gebelik ve laktasyon dönemlerinde ya da ince iğne aspirasyonuna bağlı olarak gelişir. Bu predispozan durumların yokluğunda, fibroadenomun spontan infarktı son derece nadirdir. Enfarktın sitopatolojik özellikleri, nekroz ve kuşkulu nükleer özelliklerdir. Bunlar inflamasyon ya da malignite olarak yanlış yorumlanabilir. Bu olgu sunumunda, 17 yaşındaki bir hastada gelişen spontan fibroadenom infarktının sitopatolojik özellikleri sunulmaktadır. Nekrotik epitelyal fragmanların uniform kalınlığı, geyik boynuzu şeklinde dallanma patterni, atipik nükleer özellikler ve hastanın yaşı, uzun süredir var olan kitlede son dönemde başlayan ağrı gibi klinik ayrıntılar doğru tanıya ulaşmada ve hastayı radikal eksizyondan alıkoymada yardımcı oldu. Literatürde doğru sitopatolojik tanıya ulaşılan olgu bildirimine rastlanmadı.

Plasticobezoar-another new entity for Rapunzel syndrome

Rapunzel syndrome- a form of trichobezoar occurs when a gastric trichobezoar extends beyond the pylorus into the bowel. We report two cases of Rapunzel syndrome, one of them caused by ingestion of plastic material, so as to name it as a ‘Plasticobezoar’. To the best of our knowledge no Rapunzel syndrome due to this material has been reported so far.

Gall bladder carcinoma presenting with spinal metastasis: A rare phenomenon

Skeletal metastasis as a primary presentation of gall bladder carcinoma is rare. A 50-year-old lady presented with neck pain and weakness in her right upper limb of 3 months duration. Clinical and imaging work-up suggested locally advanced gall bladder carcinoma with metastasis to cervical vertebra and sternum. Only one case till date has been reported where the patient presented with neurological symptoms due to pathological fracture secondary to metastasis from an occult gall bladder carcinoma. Although rare, an occult gall bladder cancer may present with neurological symptoms due to pathological fracture of spine secondary to metastasis. We present a brief review of literature of patients who presented with skeletal metastases in clinically silent gall bladder malignancy. Palliative care issues in advanced gall bladder carcinoma have also been discussed.

Virtual cystoscopy (pneumo-cystoscopy)-Its utility in the prospective evaluation of bladder tumor

Aim: To evaluate the role of virtual cystoscopy (VC) comparing it with cystopanendoscopy (CPE) for detecting bladder tumor(s). Material and Methods: Ethical clearance was obtained from the Institutional ethics committee. After an informed consent 30 patients fulfilling the inclusion criteria were enrolled in the prospective non-randomized clinical study and were evaluated as per protocol with VC performed by a qualified radiologist who was blinded to the findings of CPE performed by a qualified urologist. The results so obtained were analyzed using appropriate statistical tools. Results: The mean age of the patients was 56 years. Sensitivity of VC in detecting bladder lesions was 92%. However, when axial images were also interpreted along with VC, the sensitivity increased to 96% for detecting bladder lesions. The specificity of VC with axial CT was 40% in respect of detecting bladder lesions. VC with axial CT was 85.7% sensitive in identifying multiple bladder tumors. There were no complications on account of performing VC. Minor problems were encountered with VC and CPE in 16.7% and 13.3% patients respectively. Conclusions: VC with axial CT is 96% sensitive in detecting bladder lesions and 85.7% sensitive in detecting the multiplicity of the tumors. VC may be a useful complementary diagnostic tool for the workup of select patients with suspected bladder lesions. However, larger randomized controlled studies are needed to better define the precise clinical and diagnostic role of VC in routine practice. Settings and Design: Prospective Clinical Comparative Non Randomized Clinical Study.

Capsular renal leiomyosarcoma with encasement of the inferior vena cava - Diagnosed by immunostaining and review of literature

We report and describe the presentation, pathological diagnosis with immunostaining and management of a rare case of capsular renal leiomyosarcoma encasing the inferior vena cava (IVC). We have reviewed and tabulated other such similar cases. The present case was successfully managed by radical nephrectomy and adjuvant radio-chemotherapy. Immunostaining should be freely used to define the histological type of renal sarcoma in order to accurately counsel and deliver a prognosis for patients with renal leiomyosarcomas with a poor prognosis.