International Surgery Journal
Permanent URI for this collection
Editor-in-Chief: Dr. Bhaven Kataria
ISSN: 2349-3305 (Print); 2349-2902 (Online)
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://www.ijsurgery.com/
Browse
Recent Submissions
Item Robotic assisted extended view totally extraperitoneal repair for inguinal hernia(Medip Academy, 2024-08) Singh, I; Sharma, A; Kapoor, R; Doley, RP; Wig, JD.Robotic assisted transabdominal pre-peritoneal inguinal hernia repair is an effective and safe approach. This report describes a new technique of robotic extended view totally extraperitoneal repair. A supraumbilical retro rectus approach, creation of pre-peritoneal space, separation of hernia sac from cord structures, placement of mesh and fixing with vicryl suture was employed in a 58-year gentleman with right inguinal hernia. The surgery was performed with the use of a DaVinci robotic system. No intraoperative problems were encountered. The patient was discharged within 24 hours of surgical intervention. The work has been reported in line with the SCARE criteria. The patient had no groin pain, inguinal or scrotal swelling at 30 day follow up. He was pleased with the cosmetic result and has gone back to work. Robotic e-TEP is a viable option in inguinal hernia repair.Item Giant free lying appendicolith perforated through the mid segment of appendix(Medip Academy, 2024-08) Sultana, R; Sindhu, AN; Parmeshwar, TM; Kallem, SR; Balachandran, H; Sahoo, S.Appendicoliths, though typically small and asymptomatic, occasionally manifest as giant calculi exceeding 2 cm in diameter and can precipitate acute appendicitis.1 This case report delineates the presentation, diagnostic challenges, and management of a rare 2.2 cm appendicolith-induced acute appendicitis in an adult male patient. Despite financial constraints necessitating an open appendicectomy, the procedure resulted in a successful clinical outcome without postoperative complications.Item Strangulated lumbar hernia: an exceptional case of intestinal obstruction(Medip Academy, 2024-08) Patil, A; Irpe, A; Satpute, A.Lumbar hernia is a rare condition and about 325 cases reported so far, not more than 30 cases of strangulated lumbar hernia have been reported in the surgical literature since 1889. Therefore, diagnosis can be easily misdiagnosed. We present a case of a 75-year-old gentleman, who had come with acute intestinal obstruction with strangulated right inferior lumbar hernia. We did exploratory laparotomy with resection and anastomosis and repair of hernia defect. As per our observation this is 31st reported case of strangulated/obstructed lumbar hernia in literature.Item Mesodiverticular hernia: a rare cause of intestinal obstruction(Medip Academy, 2024-08) Shetty, SS; Masrani, NN; Muzumdar, AS; Mane, KA; Gandhi, SR; Shenoy, NS; Shah, HS.A mesodiverticular band is a rare embryological remnant of arterial supply to the Meckel's diverticulum in utero. A persistent mesodiverticular band can cause bowel compression leading to obstruction. Internal herniation through a mesodiverticular band is very rare. We report a case of an 8yr old boy who presented with intestinal obstruction secondary to a mesodiverticular band and internal herniation. Internal herniation with a mesodiverticular band is a rare complication of Meckel抯 diverticulum.Item Unusual neuroendocrine tumor in unusual site: a case report and review of literature(Medip Academy, 2024-08) Ayyamperumal, JA; Anbalagan, A; Murugasen, SD; Thangasamy, S; Satyanesan, J.Paragangliomas (PGL) are uncommon tumors that develop in the extra-adrenal chromaffin cells of the autonomic nervous system. They are usually found in the retroperitoneum along the abdominal para-aortic region. PGL arising near the pancreas are extremely rare. These tumors can be difficult to diagnose as they can resemble more common pancreatic tumors, making it challenging for clinicians, radiologists, and pathologists alike. In this report, we describe a case of PGL that originated in the pancreaticoduodenal groove, which was initially diagnosed as a neuroendocrine tumor arising from the second part of the duodenum. The patient underwent pancreas-preserving surgery to remove the tumour.Item Diagnostic dilemma: axillary cysticercosis masquerading as breast mass(Medip Academy, 2024-08) Kalwaniya, DS; Singh, Y; Gupta, S.Cysticercosis, caused by the tapeworm Taenia solium, is a significant public health concern, particularly prevalent in developing nations. We present a case of isolated cysticercosis in the axillary region, mimicking a breast mass, in a 47-year-old woman who presented with a gradually enlarging mass in her right axilla and was initially diagnosed with fibroadenoma. However, further investigations revealed cysticercosis in the larvae, including ultrasonography and fine-needle aspiration cytology (FNAC). The patient underwent surgical excision of the cysts following a two-week course of albendazole therapy. Histopathological examination confirmed cysticercosis with a foreign body giant cell reaction. Cysticercosis typically involves muscular and subcutaneous tissues, posing diagnostic challenges due to its resemblance to other conditions. Ultrasonography, FNAC, and MRI play crucial roles in accurate diagnosis. Treatment involves a combination of surgical removal and antiparasitic medications such as albendazole. This case highlights the importance of considering cysticercosis in differential diagnosis, especially in endemic regions, and underscores the effectiveness of a comprehensive treatment approach integrating medical therapy and surgical intervention. Effective management ensures the eradication of parasitic infection and the alleviation of associated symptoms, exemplifying patient-cantered care for optimal outcomes. Increased awareness, preventive measures, and early diagnosis are essential for mitigating the burden of cysticercosis, particularly in regions with poor sanitation and high prevalence rates.Item Rapunzel抯 giant hairball: a report of Rapunzel syndrome in a young man(Medip Academy, 2024-08) Gabsi, K; Cheng, E; Yu, Y.Rapunzel syndrome, a rare form of trichobezoar, is a condition in which an accumulation of hair forms in the stomach and extends to the small intestine. Here we describe a case of a 17-year-old male presenting with gastric outlet obstruction secondary to Rapunzel syndrome, requiring laparotomy and gastrotomy.Item Gallbladder agenesis associated with dextrocardia in an adult patient: case report(Medip Academy, 2024-08) Ramos, BG; Jim閚ez, AF; Trejo, MA; Becerra, JMR.The aim was to disseminate information about gallbladder agenesis and its association with some congenital malformations, in this case, with dextrocardia. The case report of a patient with dextrocardia and diagnosis of cholecystolithiasis (by ultrasound) who presented with agenesis of the gallbladder is presented. The patient was scheduled for laparoscopic cholecystectomy, however, during the surgical procedure, the absence of a gallbladder was evident. Gallbladder agenesis is a rare anatomical variant and its association with cardiac malformations in adult patients is uncommon.Item Case report of rare cause of small bowel obstruction: distal migration of metal biliary stent requiring enterotomy(Medip Academy, 2024-08) Rumble, WT; Lonie, JM; Donovan, M; Kia, C.Endoscopic biliary stent placement is a mainstay in the management of biliary strictures both malignant and benign. Distal stent migration is a known complication of metal biliary stents, however small bowel obstruction or perforation are rare. In this report from a tertiary referral centre, we detail a mid-small bowel obstruction caused by covered metal stent migration requiring a laparotomy and enterotomy for definitive management. A 69-year-old male was admitted to the Sunshine Coast University Hospital with obstructive jaundice on a background of previous metal biliary stent placement. On day 3 of his admission, he developed worsening abdominal pain. Cross-sectional imaging demonstrated distal migration of his stent to his mid-jejunum, causing a high-grade small bowel obstruction. He underwent laparotomy to retrieve the stent. He recovered well and underwent a percutaneous transhepatic cholangiogram with stent replacement. In this case, distal biliary stent migration causes a small bowel obstruction. Whilst uncommon, risk factors including previous intra-abdominal operation can be used to identify patients unlikely to achieve successful expectant management of distal migration.Item Extensive deep neck infection associated with acupuncture(Medip Academy, 2024-08) Hassanesfahani, M; Tian, J; Cervellione, KL; Louis, MA.Deep neck infections are rare but potentially lethal conditions that require prompt identification and management. They can occur in the peritonsillar, submandibular, parapharyngeal and retropharyngeal spaces. The most affected areas tend to differ by age, with tonsillitis being more common in children and odontogenic in older adults. Predisposing factors to infection can also influence location. Early treatment is paramount as airway compromise, septic shock and extension to adjacent structures can lead to morbidity and mortality. Here we report a case of extensive deep neck infection in an elderly diabetic patient with multiple abscesses involving the paraspinal space and extending anteriorly close to the carotid sheet, yet without airway compromise or hemodynamic instability. After further questioning, the likely mode of infection was identified as acupuncture in the affected region. We present a review of the presentations, differential diagnoses, treatments, and clinical course of adults with deep neck infections to highlight the importance of expeditious diagnosis and treatment.Item A new variant in the heterotaxy polysplenia syndrome(Medip Academy, 2024-08) Ramos, BG; Trejo, MA; Hern醤dez, MVA; Mil醤, RS.Heterotaxy is a low incidence genetic disorder of multifactorial inheritance characterized by various abnormalities in the position of organs and vessels relative to the midline of the body. It is most often associated with fatal congenital heart defects at birth. As a result, only a small percentage of patients survive into adulthood. The following clinical case presents a female adult patient with abdominal pain secondary to choledocholithiasis. During the diagnostic workup, she was diagnosed with intestinal malrotation complicated by portal vein thrombosis, which later developed into portal hypertension. In addition to several anomalies (agenesis of the inferior vena cava with direct communication of the suprahepatic veins to the right atrium, polysplenia and shortening of the pancreas), a possible variant of heterotaxy syndrome was diagnosed.Item Multilocular cystic renal neoplasm: a rare tumor in kidney(Medip Academy, 2024-08) Reddy, GPV; Malave, ND; Srinath, N; Ram, S.Multilocular cystic renal cell carcinoma is a rare cystic tumour of kidney with excellent outcome. It is usually included in the group of tumours of undetermined malignant potential with low nuclear grade. We are presenting a case of 61 year. old female came with history of giddiness for 1 week and weight loss of 20 kg in 2 years. Imaging was suggestive of cortical based tumour arising from upper pole of right kidney. Right side partial nephrectomy was done. On histopathologic examination it was found to be MCRCC, stage 1 with Fuhrman nuclear grade 1. Immunohistochemistry with epithelial membrane antigen and cytokeratin-7 confirmed the diagnosis.Item Ultrasound guided aspiration versus incision and drainage in the management of breast abscess(Medip Academy, 2024-06) Prashanth, C; Neetha, V; Kumar, LR; Manohar, TMBackground: The aim of this study is to compare the results of ultrasound guided aspiration and incision and drainage in the management of breast abscess. Methods: This is a comparative study of between ultrasound guided aspiration and incision and drainage, consist of 50 patients with breast abscess who underwent both the treatment alternatively in our institution Sri. Siddhartha Institute of Medical Sciences and Research Begur during 2021 to 2023. 7th and 14th day following aspiration, patients should be assessed both clinically and by USG breast. Results were tabulated and analyzed. Results: 4 patients developed complications following Incision and drainage. 3 milk fistula and wound gaping, 1 recurrence and 3 patients developed complications following USG guided aspiration All 3 cases were recurrence. Conclusions: USG guided aspiration is simple, painless, day care procedure and effective alternative method of treatment to incision and drainage in properly selected patient and with timely support by sonologist with early postoperative recovery and good patient satisfaction.Item Study of cases of obstructive jaundice due to biliary and pancreatic tumors(Medip Academy, 2024-08) Painter, ZZ; Kuswaha, MR; Dholaria, MV; Malek, TN.Obstructive jaundice has recently become more common, particularly among malignant cases. The aim was to study, evaluate and compare various operative managements for obstructive jaundice due to biliary and pancreatic tumors. This prospective study was conducted by random selection of 20 cases presenting with obstructive jaundice due to biliary and pancreatic tumors at a tertiary care hospital affiliated with Smt. N.H.L. Municipal Medical College. Majority of patients were in age group 51-60 years (35%) and 61-70 years (20%). Males (70%) were found to be in higher proportion compared to females (30%). Most comm on presenting symptom was jaundice (90%). Most common cause was periampullary carcinoma (60%). It was found that the most common complication following Whipple抯 procedure and Triple Bypass Surgery was pancreatic fistula.Item Superior vena cava syndrome: presentation of 7 cases and literature review(Medip Academy, 2024-08) Ixtl醜uac, JG; M閚dez, EAD; Nez, IJ; Achicanoy, DMP; Rodr韌uez, AS; Avilez, JHR.Superior vena cava syndrome (SVCS) is the result of obstruction of venous flow through the SVC. Mortality due to SVCS is rare (0.3%); however, the median survival in patients with SVCS secondary to malignancy is 6 months. Extrinsic occlusion due to malignancy is the most common cause; however, intraluminal thrombosis secondary to central venous catheters and pacemaker wires represents 30% of cases. The SVC is the main drainage pathway for the head, neck, and upper torso region, so SVCS is characterized by facial and neck edema, dyspnea, and distension of the neck and chest veins. Symptoms vary depending on the severity, location, and speed of onset of the obstruction and the establishment of collateral veins. Diagnosis is based on clinical presentation and imaging studies such as chest angiotomography and digital subtraction venography (gold standard). Regarding treatment, radiation therapy and chemotherapy were considered first-line; however, nowadays endovascular therapy (ET) (angioplasty, stent placement, and catheter-directed thrombus extraction) has demonstrated higher success rates and lower recurrence rates. Surgical diversion is reserved for cases of extensive venous thrombosis or occlusion not amenable to ET. We conducted a literature review and described 7 cases of SVCS treated with successful ET and their main complications at the national cancer institute of Mexico. SVCS is a condition with a diagnostic challenge. Currently, the use of endovascular treatment through angioplasty and stent placement leads to immediate improvement in patients, thus establishing it as first-line treatment.Item The laser pilonidoplaty(Medip Academy, 2024-08) Bhuva, B; Chovatiya, N; Baladaniya, S; Naik, R.Background: The aim of our study was to evaluate the safety, efficacy and clinical outcome of a laser procedure for the treatment of pilonidal sinus. Objectives were to investigate its effectiveness in terms of operation time, healing time, and the duration of hospitalization, resumption of normal activity, the degree of postoperative complications and rate of recurrence patient satisfaction. Methods: Patients suffering from pilonidal sinus were operated by laser pilonidoplasty at our institute. Laser pilonidoplasty done under spinal anesthesia or local + sedation after a small primary pit excision (0.5-1 cm incision), excision of secondary pits and careful cleaning of the sinus tracts with a curette. After curettage, the laser energy laser set at a wavelength of 1470 nm) was delivered in continuous mode 10 w/sec into the sinus tract f/b saline wash and dressing. Results: Mean duration of procedure was 35.5 min, mean duration of hospital stay was 1.3 days, mean resumption of normal activity within 8.4 days, mean duration for complete wound healing by secondary intention 29.33 days. Among complications, non-healing ulcer reported in 34% and pain noted in 26%. Recurrence rate was 14%. Success rate was 86% and overall patient抯 satisfaction was 94%. Conclusions: Laser pilonidopasty proved to be a safe and effective procedure for treating patients suffering from pilonidal sinus with average success rate, less morbidity, fewer complications with better patient satisfaction rate.Item Cystoductojejunostomy for pseudocyst associated with chronic pancreatitis(Medip Academy, 2024-08) Soori, A; Pottakkat, B; Murugesan, C; Raja, K; Pothugunta, SK.Pseudocyst is frequently associated with chronic pancreatitis (CP). We describe our experience of managing seven patients for pseudocyst associated with CP by bile duct preserving pancreatic head resection (BDPPHR) and cystoductojejunostomy. 88 patients were operated on for chronic pancreatitis between April 2021 till May 2023 out of which 7 patients underwent BDPPHR and cystoductojejunostomy for pseudocyst associated with CP. Key steps of surgery include meticulous dissection with exposure of the pancreatic head to tail, head excision up to the posterior capsule with laying open of the pancreatic duct till the tail and reconstruction incorporating pancreatic duct (PD) and pseudocyst to a single loop of jejunum. All seven patients were successfully treated with BDPPHR and cystoductojejunostomy. Mean operative time and mean blood loss was 478 minutes and 450 ml respectively. Mean hospital stay was 4.5 days. On follow-up at a one-year minimum, all patients had complete pain relief. In patients with pseudocyst associated with CP, surgery preferably needs to address both the pseudocyst and the underlying chronic pancreatitis to improve the quality of life. A combined anastomosis to the PD and cyst may be termed as cystoductojejunostomy.Item A retrospective study of predisposing factors and management of incisional hernia in a tertiary care hospital(Medip Academy, 2024-08) Yarra, P; Gogineni, RC; Kanuru, C; Kolli, H; Thota, MK; Polisetty, S.Background: An incisional hernia is characterized as any defect in the abdominal wall, with or without a noticeable bulge, in the region of a postoperative scar, identifiable through clinical examination or imaging. This condition can be detected through clinical examination or imaging and affects approximately 10-20% of patients who undergo abdominal operations. Aims and objectives of the study was to evaluate various precipitating factors, clinical presentations, management and post-operative complications in patients with incisional hernia. Methods: A retrospective study of 150 patients conducted at a tertiary care teaching hospital. Results: In this study, incisional hernia was more common in obese, elderly, and female patients. The incidence was higher with Pfannenstiel incision followed by lower midline incisions. Incisional hernia was common between 1-5 years of index surgery and it was observed that more the risk factors and complications associated with index surgery, earlier was the onset of incisional hernia. Patients had a defect of size <4x4 cm were 58.66%. Open onlay mesh repair was done in 36.66% patients, preperitoneal mesh repair in 13.33%, retro rectus mesh repair in 13.33%, laparoscopic mesh repair in 28.66% and anatomical repair alone in 7.99% patients. Duration of laparoscopic surgery was longer compared to open. Most common post- operative complication was seroma (4.66%) followed by wound infection (2.66%). Conclusions: Incisional hernias occur more in females as they commonly undergo lower abdominal surgeries. Subcutaneous suction drain decreased the incidence of post-operative wound complications.Item Retroperitoneal soft tissue sarcoma, a rare mimic and important differential of iliopsoas abscess(Medip Academy, 2024-08) Green, RJ; Vennam, S; Kirkham, C; Aylward, C; Caufield, W; Andraloj, L; Geldart, M; Sellars, JThis case report highlights the diagnostic challenges posed by retroperitoneal soft tissue sarcoma (STS) presenting as an iliopsoas abscess, mimicking common symptoms and radiological findings. This patients� symptoms recurred despite multiple percutaneous drains and revisions over a period of months. Further investigation revealed a partly solid, partly cystic mass consistent with sarcoma. Surgical excision confirmed the diagnosis, but recurrence necessitated palliation. This case emphasizes the importance of differential diagnoses of iliopsoas collection and the need for research into alternative imaging modalities to aid clinicians and radiologists in differentiating benign retroperitoneal collections from malignancy.Item Giant pancreatic cyst with extension to spleen managed by laparoscopy(Medip Academy, 2024-08) Casta馿da, JFM; Garc韆, RMC; Vega, AV; G髆ez, DO; Gonz醠ez, REH; Garc韆, BL; Salas, GD; Anzo, M罙; Ch醰ez, MJC; Salgueiro, JULTo review the etiology, clinical presentation, diagnostic evaluation, management, and prognosis of giant pancreatic cysts. Giant pancreatic cysts, defined as cysts exceeding 5 cm in diameter, include a diverse group of lesions such as pseudocysts, serous cystadenomas, mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). Their clinical significance stems from potential complications and the necessity to differentiate benign from malignant cysts. A comprehensive review of the literature was conducted, focusing on the pathophysiology, symptomatology, diagnostic modalities, treatment options, and outcomes associated with giant pancreatic cysts. The etiology of giant pancreatic cysts varies from benign conditions like pseudocysts and serous cystadenomas to potentially malignant or malignant neoplasms such as MCNs and IPMNs. Clinical presentation ranges from asymptomatic cases to severe abdominal symptoms and complications. Diagnostic evaluation includes imaging modalities like ultrasound, CT, MRI/MRCP, and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) for cytology and biochemical analysis. Management strategies depend on the type and characteristics of the cyst, with options including observation, endoscopic drainage, surgical resection, and percutaneous drainage. The prognosis varies, with benign cysts generally having a favorable outcome, while cysts with malignant potential require timely surgical intervention to improve survival rates. Giant pancreatic cysts pose a diagnostic and therapeutic challenge due to their varied etiologies and potential complications. Accurate diagnosis through advanced imaging and fluid analysis is crucial. Management should be tailored based on the cyst type, symptoms, and malignancy risk, involving a multidisciplinary approach to optimize patient outcomes. Further advancements in diagnostic and therapeutic techniques are anticipated to enhance the management of these complex lesions.