Shahana Gupta

Acute Intestinal Obstruction: A Rare Aetiology

Internal herniation of small intestine is a very rare entity, and it poses a real diagnostic challenge clinically. Recurrent entrapment of the bowel may lead to partial to complete intestinal obstruction and eventually strangulation of the small bowel. Of this rare clinical entity, left paraduodenal hernia is more common. High index of suspicion with prompt management may prevent bowel strangulation and gangrene. We present a case of acute intestinal obstruction due to left paraduodenal hernia with malrotation of midgut in a 55-year-old male patient.

Colorectal Carcinoma in the Young

Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract. In the United States, it is the third most commonly diagnosed cancer, next only to breast and lung. It is the second most common cause of cancer-related death both in the USA and in the UK. (www. cancer. org, O’Connell et. al. 2004a, Leff et. al. 2007). Its incidence has risen rapidly in Asia to pose a problem (Yuen et. al. 1997, Huang et. al. 1999, Mohandas et. al. 1999, Yiu et. al. 2004, Goh et. al. 2005,Gupta et. al. 2010). Sung et. al. (2005) in a review on CRC in Asia stated that many Asian countries, e. g., China, Japan, South Korea, Singapore have experienced an increase of two to four times in CRC incidence during the past few decades. In Hong-Kong CRC is the second most common cancer and the third most common cause of cancer death (Yuen et. al. 1997). Tamura et. al. (1996) in a Japanese study reported that age adjusted incidence for CRC per 100,000 population were 12. 6 and 8. 7 for males and females respectively in 1974, 20 and 13. 6 in 1980, 42. 5 and 25. 6 in 1991. Bae et. al. (2002) estimated on the basis of Korean data, that the expected number of cancer deaths in Korea showed an increasing trend for CRC, although the same did not hold for all cancers. In Iran, age adjusted CRC incidence per 100,000 population per year increased from 1. 61 in 1970-80 to 4. 2 in 19902000 in men and 2. 35 to 2. 72 for women (Hosseini et. al. 2004). The rising trend is more striking in affluent than in poorer societies and differs substantially amongst ethnic groups. Changes in dietary habits and lifestyle are recognized causes. Genetic characteristics of a population mediate the effect of life style change into disease propensity (Lin et. al. 2010). Although the common perception is that it is a disease of an older person, there have been many reports from different parts of the world on CRC in the young adults (Bulow 1980, Denmark; Ohman 1982, Sweden;Jarvinen and Turunen 1984, Finland; Ibrahim and Karim 1986, Lebanon; Adloff et. al. 1986, France; Isbister and Fraser 1990, New Zealand; Yuen et. al. 1997, Hong-Kong; Fante et. al. 1997, Italy; Ashenafi 2000, Ethiopia; deSilva et. al. 2000, Srilanka; Paraf and Jothy 2000, Canada; Turkiewicz et. al. , 2001, Australia; Singh et. al. 2002a, Nepal; Kam et. al. 2004, Malayasia; Frizis et. al. 2004, Greece; Guraya and Eltinay2006, Saudi Arabia; Fazeli et. al. 2007, Iran; Karsten et. al. 2008, USA; Gupta et. al. 2010, India). O’Connell et. al. (2004a) have reviewed the literature. The proportion of patients in the young group in a population of CRC patients was significantly larger in reports from Asia and Africa, as compared to the Western reports.

Plexiform angiomyxoid myofibroblastic tumour of the duodenum: a rare entity

Plexiform angiomyxoid myofibroblastic tumour (PAMT) has recently emerged as a new entity among gastrointestinal mesenchymal tumours. All of the 27 cases reported until now originated from the stomach. We report the first case of a duodenal PAMT arising from the first part of the duodenum in a 19-year-old woman presenting with upper abdominal pain and an abdominal lump.

Spontaneous retroperitoneal haemorrhage in a young adult.

We report a rare case of a primary adrenal cortical malignancy presenting with spontaneous retroperitoneal haemorrhage in a young adult. To the best of our knowledge, this is the thirteenth such case to be reported in the English literature.

Perforated isolated jejunal diverticulum: a rare aetiology of acute abdomen.

In the absence of trauma, perforated jejunal diverticulum (JD) is a rare entity. Perforated isolated JD is rarer. We report a case of perforated isolated JD in a 55-year-old woman who presented with features of peritonitis and had no history of trauma. Resection and anastomosis of the involved jejunal segment was performed.

Ascaris lumbricoides: an unusual aetiology of gastric perforation

Gastrointestinal (GI) infestation with Ascaris lumbricoides is common in the tropical countries, particularly in children. A wide range of clinical presentations are reported for GI ascariasis in both adults and children. We report a case of gastric perforation due to Ascaris, a rare presentation.

Sporadic Intra-Abdominal Desmoid: A Rare Presentation as a Hepatic Mass

We report an unusual presentation of a sporadic intra-abdominal desmoid tumour, possibly arising from the diaphragm, masquerading as a hepatic mass in a young female without any history of surgery or trauma. Histopathology ruled out a hepatic origin of the tumour as was inferred from pre- and intraoperative evaluation. Immunohistochemistry showed positivity of lesional fibroblastic cells for β-catenin and negativity for CD34, CD117, EMA, SMA, desmin, vimentin, cytokeratin, and ALK1 thereby confirming the diagnosis of a desmoid tumour. There exist only a few reports in the literature on desmoids related to the diaphragm, but only one on a diaphragmatic desmoid that is possibly primary.

Concurrent parathyroid carcinoma and adenoma: A rare presentation of a rarer disease entity.

Parathyroid carcinoma is a rare disease. But multiglandular parathyroid neoplasm is even rarer. A high level of suspicion, on the basis of clinical, hematological tests and intraoperative findings is necessary to treat this disease entity, particularly in the absence of palpable neck masses. Preoperative localization is important. Bilateral neck exploration should be done routinely and all 4 glands seen to avoid missing out other pathological glands.