Shamita Chatterjee

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.

Gastric outlet obstruction with perforation. A rare presentation of left-sided adult Morgagni hernia

Adult presentation of congenital diaphragmatic hernia (CDH) is rare. Out of the three varieties of CDH, Morgagni hernia is the rarest of all. Though most of them are asymptomatic and may be incidentally detected, they may also present in the emergency setting with respiratory or gastrointestinal features like obstruction or strangulation. Gastric outlet obstruction is a rare manifestation of adult Morgagni hernia. We present a case of adult left-sided Morgagni hernia with features of gastric outlet obstruction complicated with perforation.

Acute intestinal obstruction: A rare presentation of left sided adult congenital diaphragmatic hernia

A diaphragmatic hernia is defined as a communication between the abdominal and thoracic cavities, with or without abdominal contents in the thorax. It is usually diagnosed among newborns, but late presentation of congenital diaphragmatic hernias has also been reported with an incidence of 5 to 25%. Intestinal obstruction due to obstructed diaphragmatic hernia is very rare and represents a considerable diagnostic challenge. Herein, we report the case of an obstructed diaphragmatic Bochdalek-type hernia complicated by acute intestinal obstruction.

Dyspareunia due to leiomyoma of the urinary bladder: An unusual presentation of a rare bladder neoplasm

Leiomyoma of the urinary bladder is a rare neoplasm of the bladder and accounts for 0.04–0.5% of bladder neoplasms. Though most patients present with obstructive or irritative urinary symptoms, dyspareunia may be an unusual presentation that should be kept in mind to avoid missing the diagnosis. Though MRI is considered to be the imaging modality of choice, cystourethroscopy with guided biopsy usually clinches the diagnosis. Surgical excision is the treatment of choice in this prognostically favourable tumour.

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.

Congenital middle mesocolic hernia – An unusual cause of small bowel obstruction

Internal herniation is a rare cause of small bowel obstruction, with an incidence of 0.2-0.9%. Obstruction due to congenital internal hernias is even rarer. The commonest type of congenital internal hernia is the paraduodenal or the mesocolic hernia. The left and right mesocolic hernias constitute 75% and 25% of the mesocolic hernias respectively. Middle mesocolic hernias are an extremely rare and unusual variant of mesocolic hernia, and literature search revealed only three reported cases. In view of its rarity, a high level of clinical suspicion, supported by radiological evidence is required to diagnose it preoperatively. Prompt surgical management is mandatory to reduce complications and their associated morbidity and mortality.

Anterior neck lipoma — A giant predicament

Though lipomas are one of the commonest mesenchymal tumours in adults, a lipoma of the head and neck region is relatively rare. Among those lipomas that develop in the neck, the posterior triangle is the most common location; occurrence in the anterior triangle is very rare. Though most lipomas are <5cm in size, giant lipomas >10cm have also been reported in different parts of the body. Giant lipomas of the neck, particularly those >20cm, are extremely rare. Most patients of giant lipoma of the neck either present with complaints of cosmetic disfigurement or features of compression on deeper structures. Most lipomas do not pose any diagnostic dilemma. However, when a patient presents with a large, rapidly progressing lipoma of the head and neck region, the possibility of malignancy should be kept in mind. Surgical excision remains the treatment of choice.

Gall bladder duplication - A rare anomaly detected on preoperative imaging

Congenital anomalies are frequently encountered in surgery. They pose a dilemma in surgical decision-making and if undetected, they may lead to surgical complications. Gallbladder duplication is a rare anomaly with an incidence of 1 in 3000-4000. Preoperative imaging is often the only modality of diagnosis, as there are no specific symptoms for the pathology. Preoperative diagnosis and appreciation and of this anomaly is especially important to prevent possible surgical complications.

A prospective study on delayed shoulder exercises in reducing seroma formation after modified radical mastectomy

BackgroundSeroma formation is a well-known complication after modified radical mastectomy (MRM) for breast cancer. Another well known complication is shoulder movement dysfunction following the same operation. Traditionally, patients were asked to perform exercises of the shoulders as early as possible after surgery in the belief that it reduces subsequent shoulder dysfunction. The aim of this study was to evaluate whether delayed shoulder exercises after MRM could reduce seroma formation without compromising the outcome of shoulder mobility.MethodsFifty patients who underwent MRM were randomly divided into two groups, the early group and the delayed group, each consisting of 25 patients. Shoulder exercises were started in the patients allotted to the ‘early group’ from postop day 1, while those in the ‘delayed group’ began shoulder exercises from postop day 7. Seroma formation and other complications were closely noted. Their follow-up at one month and six months was assessed for shoulder movement dysfunction using the Constant scoring system.ResultsThere was significant increase in seroma formation in the ‘early group’ (79 %) compared to the ‘delayed group’ (p-value 0.027469) with an odds ratio of 5.76 [1.36, 24.36]. However, there was no significant difference in the shoulder dysfunction between both groups when measured after one month (p-value 0.889576) and six months (p-value 0.396509).ConclusionThe incidence of seroma after MRM is reduced by delaying shoulder exercises by one week rather than one day. The early initiation of shoulder exercises to avoid impairment of shoulder movements is not necessary.

Multimodality approach: A revolutionary concept in the management of diabetic limb ulcers

AimThe aim of the study is to evaluate the results of the multimodality approach to diabetic limb ulcers.BackgroundManagement of diabetic limb ulcers requires a multisystem approach that addresses the component problems of the nervous, vascular, skeletal, immune and integumentary system.Materials and MethodThe study period was from January 2012 to September 2013, and involved 60 patients with both type 1 and type 2 diabetes that also had limb ulcers.ResultsMean duration of healing in controls was 23.1564 ± 6.7859 weeks and in cases 15.6723 ± 4.0084 weeks. Ulcers converted from grade 2 to grade 1 in 18 cases, from grade 3 to grade 1 in five cases, and from grade 3 to grade 2 in three cases. Five controls and two cases had to undergo amputation.DiscussionDiabetes is the prime cause of non-traumatic amputations in the United States accounting for 54,000 to 55,000 limbs lost every year [5]. Hunt T K et al found that PDGF gel healed a greater percentage of patients after 10 weeks of application [19]. Edmonds M E et al (1986) observed that the recurrence rate of ulceration was 26% among those with special footwear and 83% among those who returned to using their regular footwear [23].ConclusionAlthough limb problems in diabetics cannot be completely eradicated, it is evident that a number of hospitalizations and health costs directly attributable to such problems can be reduced by adopting a multimodality approach.