Raman Gupta

Traumatic anterior abdominal wall hernia: A report of three rare cases

Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma. Associated intra-abdominal injuries are infrequent. In this study, we are reporting three cases, diagnosed as abdominal wall hernia associated with herniation of bowel loops due to blunt trauma. In one case, injury of the herniated bowel was seen. In western medical literature, only few cases have been reported especially with intra-abdominal injuries.

Superior mesenteric artery syndrome: A case report

Context: Superior mesenteric artery syndrome is a life- threatening upper gastrointestinal disorder due to compression of duodenum as it poses a difficult diagnostic dilemma. Third part of duodenum is in fixed compartment bounded anteriorly by the root of mesentery and superior mesentery artery and posteriorly by the aorta and lumbar spine. On barium contrast study and abdominal computerized tomography (CT) showed the dilatation of second part of duodenum and compression of the third part of duodenum between aorta and superior mesentery artery. Case Report: A 22 year young asthenic man admitted with the complaint of recurrent abdominal pain, epigastric fullness, and vomiting and weight loss. Abdominal examination revealed epigastric fullness and hyper peristaltic bowel sounds. Upper gastrointestinal barium study showed a dilated stomach with dilated second part of the duodenum and cut off at the third part of duodenum with no intrinsic mucosal abnormalities. There was no relief of obstruction in the left lateral decubitus or prone position. Conservative treatment was tried for one month but failed. Intra-operative findings confirmed the extrinsic obstruction of third part of duodenum with distension of 2nd part. A retrocolic duodenojejunostomy, side to side anastomosis done. In post-operative follow up, patient was symptom free. Conclusion: Superior mesentery artery syndrome is a life threatening disease. It should be treated as soon as possible. Conservative trial can be given but Surgery is the treatment of the choice.

Subcutaneous hydatid cyst of the thigh.

Letters to the Editor are welcomed. They may report new clinical or laboratory observations and new developments in medical care or may contain comments on recent contents of the Journal. They will be published, if found suitable, as space permits. Like other material submitted for publication, letters must be typewritten, double-spaced, and must not exceed two typewritten pages in length. No more than five references and one figure or table may be used. See “Information for Authors” for format of references, tables, and figures. Editing, possible abridgment, and acceptance remain the prerogative of the Editors.

Two port laparoscopic assisted appendicectomy versus three port laparoscopic appendicectomy: A prospective study of 50 cases

Background: To compare the operative time, intra-operative complications, hospital stay after surgery in patients undergoing appendicectomy with two port laparoscopic assisted appendicectomy versus three port appendicectomy considering all these factors. Patients and Methods: The is a prospective controlled randomized study performed on 50 patients admitted in Department of General Surgery, with diagnosis of acute appendicitis, recurrent appendicitis and those who were kept for interval. All patients with inflamed but non adhesive appendix were taken for study as cases irrespective of age and sex. They were randomly divided into two groups - group A and group B of 25 patients each. Patients with appendicular lump or those cases requiring conversion to open surgery were excluded from the study. Data were compared with cases of two port laparoscopic assisted appendicectomy versus three port appendicectomy. Results: In this study, 50 patients underwent appendicectomy, 16 patients were operated for acute appendicitis, 24 for recurrent appendicitis and on 10 patient′s interval appendicectomy were performed. In 2-port laparoscopic assisted appendicectomy group 9 (36%) patients were operated for acute appendicitis, 11 (44%) for recurrent appendicitis and 5 (20%) as interval appendicectomy. In 3-port laparoscopic appendicectomy group 7 (28%) patients were operated for acute appendicitis, 13 (52%) for recurrent appendicitis and 5 (20%) as interval appendicectomy. None of the patients undergoing 2 - port laparoscopic assisted appendicectomy needed conversion to open appendicectomy. The mean duration of surgery was shorter in 2 port laparoscopic assisted appendicectomy 22.4 ± 5.61 minutes as compared to 3-port laparoscopic appendicectomy 43 ± 16.89 minutes ( P value-0.05). Mean length of hospital stay after surgery was 1.28 ± 0.293 days after 2 port laparoscopic assisted appendicectomy and 2.48 ± 0.927 days after 3-port laparoscopic appendicectomy. Conclusion: It is better in terms of operative time, post-operative complications and hospital stay, although there is not much difference between either intra-operative or post-operative complications. Nowadays, laparoscopic surgery/minimally invasive surgery is the best choice and it causes less postoperative pain and early recovery because of minimal trauma to the patients during surgery. In view of cost, conversion to open surgery and cosmetic results, two port laparoscopic appendicectomy is better. Two port can be used as an alternative to the three-port laparoscopic procedure with acute appendicitis and a favourable outcomes.

Report of two cases of non-union of clavicle treated with nonsurgical management

Context: Fractures of the clavicle usually occur at the junction of the medial two third with the lateral one third and usually heal by nonsurgical measures. Radiographs and MRI of the shoulder provide helpful investigations for diagnosis and treatment. In the following cases, an anterior-posterior view revealed non-union of the clavicle on the right side, which is atypical in children. Case Report: Non-union of a clavicular fracture is an extremely rare condition, especially in children. We are reporting two cases in this paper; in the first case; an 8-year-old male child visited the hospital with a history of fracture of the right clavicle one year ago. In the second case, a 26-year-old male patient presented with a history of fracture of the right clavicle six years ago. Conclusion: Careful attention should be paid when obtaining a detailed history and physical examinations, as traumatic arthritis at either clavicular joint may mimic non-union. The explicable evidence of osseous non-union on radiographs may be minor and may not correlate with the clinical symptoms.

Sir Astley Paston Cooper: life and work on anatomy, science and surgery.

Sir Astley Paston Cooper (August 23, 1768-February 12, 1841), like so many of British great men, was the son of a country clergyman, his father being rector at Brooke, Norfolk, and later vicar at Great Yarmouth. He was born at Brooke Hall on 23rd August 1768, almost 250 years ago. He was the fourth son of 10 children. All his five sisters died of tuberculosis, only two of them reaching adult life. At the age of sixteen he was sent to London and placed under Henry Cline (1750-1827), Surgeon to St Thomas Hospital. In 1789 he was appointed demonstrator of anatomy at this Hospital, where in 1791 he became joint lecturer with Cline in anatomy and Surgery (Fig. 1). He was awarded the Copley Medal of the Royal Society in the year of 1801, the highest honour the Society could bestow, for two papers he read, suggesting that certain forms of deafness could be relieved by myringotomy. In the same year he actively participated in the formation of the Medical and Chirurgical Society of London, and in 1804 and 1807, he brought out the first and the second, part of his legend work on hernia respectively. In the same year he was appointed lecturer of comparative anatomy to the Royal College of Surgeons. He was very popular and became professor of comparative anatomy at the Royal College in 1813, succeeding Sir Everard Home (1765-1832), but left his chair already in 1815 because of the burdens of his enormous private practice, as a surgeon at Guy’s Hospital and his lecturing of anatomy and surgery at St. Thomas’s Hospital. In 1820, he was made a baronet for removing a sebaceous cyst from the scalp of King George IV. In 1827, he became Sergeant-Surgeon to the king, a dignity he retained with the successor, William IV (Fig. 2).