RESUMEN
Benign esophageal strictures are characterized by the narrowing of the esophageal passage due to fibrotic changes. These strictures can arise from various causes, including gastroesophageal reflux disease, which leads to peptic strictures; surgical procedures causing esophageal injury, resulting in anastomotic strictures; radiation therapy, ingestion of corrosive substances, or endoscopic resection. Approximately 10% of benign esophageal strictures do not respond to conventional dilation therapy, prompting the consideration of temporary stent insertion as an alternative treatment approach. However, only about one-third of patients with refractory benign esophageal strictures experience sustained relief from dysphagia following self-expanding stent placement. Challenges such as stent migration and hyperplastic tissue response pose limitations to the effectiveness of this intervention. The utilization of self-expanding metal stents (SEMSs) in benign esophageal diseases is not standard practice due to the associated risks of adverse events such as tissue ingrowth at the uncovered portions, migration, and bleeding. One of the major challenges encountered is the growth of hyperplastic tissue around the stent during retrieval and subsequent serial esophageal bougie dilations. Long-term self-bougie dilations, coupled with the patient's gained self-confidence, played a crucial role in the management. While most migrated esophageal metallic stents are typically left in the stomach, in this particular case, the patient's progressive dysphagia necessitated retrieval. This article discusses a 65-year-old female with a benign esophageal stricture treated with a self-expandable metallic stent. Eight months post-insertion by another doctor, she presented to us with worsening dysphagia. Endoscopy revealed a stent migrated into the antrum of the stomach with a proximal esophageal stricture. Endoscopic dilation and stent retrieval were performed, followed by serial esophageal bougie dilations. Subsequently, her dysphagia settled with self-insertion of a 9 mm esophageal dilator.
RESUMEN
Introduction Emergency surgery has a high risk of complications due to the detrimental effect of perioperative sepsis and the relative lack of preoperative optimization of patients. Despite advances in critical care for the management of sepsis, its prevention is dependent on various patient and surgeon factors. Surgical site infection continues to be a major determinant of morbidity and mortality following emergency abdominal surgery, especially in contaminated or dirty wounds. This study aims to compare two techniques of abdominal wall closure, primary closure with subcutaneous suction drains and delayed primary closure following negative pressure wound therapy, in terms of incidence of surgical site infection and morbidity. Materials and methods The study was a prospective comparative study including 50 patients with an acute surgical abdomen requiring laparotomy. The patients were randomized into two groups, Group A (n=25) who underwent primary closure, and Group B (n=25) who underwent delayed primary closure. In Group B patients, a vacuum-assisted closure device was applied in the subcutaneous space for five days prior to the closure of the skin. Outcomes were compared in terms of the incidence of superficial and deep surgical site infection, its association with diabetes mellitus, and the total duration of hospital stay. A chi-square test and an unpaired t-test were used for the test of significance. Results A total of 50 patients, comparable in age, were included in the study. The overall incidence of surgical site infection was significantly higher in patients of Group A as compared to Group B (p=0.0046). There was a positive correlation between diabetes mellitus and the occurrence of wound infection in both groups with the odds ratio being 2.67 and 2.38 respectively. The incidence of superficial wound infection was significantly higher in Group A when compared to Group B (52% versus 24%; p=0.04). Deep surgical site infection was higher in patients of Group A (20% versus 8%) but was not statistically significant (p=0.22). The average duration of hospital stay was 41.56 ± 6.96 and 37.86 ± 6.68 days for patients who developed complications from Groups A and B respectively, while it was nearly two and a half times lower in uncomplicated cases of Groups A and B (11.71± 1.70 days and 16.58± 1.06 days respectively). The one-tailed unpaired t-test showed a significant difference in means of hospital stay between patients with and without complications (T: 17.06, critical value: 1.677). Conclusion Delayed primary closure is an effective method of managing contaminated and dirty wounds following emergency laparotomy. Negative pressure wound therapy is one technique for preventing wound bed infection and accelerating wound healing in such cases. By combining the above in emergency surgeries, the incidence of surgical site infection and duration of hospital stay can be significantly reduced.
RESUMEN
Phyllodes is a rare tumor found exclusively in females. It can be classified into benign, intermediate, or malignant variety based on the aggressive nature of the disease. With adequate preoperative clinical assessment combined with histopathology and radiological investigations the adequate treatment strategy can be formulated to avoid future recurrences. Complete androgen insensitivity syndrome (CAIS) is associated with a genotypic male, which can be confirmed by karyotyping, with phenotypic female characteristics. The present case is the first case of bilateral breast phyllodes tumor in a patient with CAIS. Preoperative assessment was suggestive of bilateral phyllodes tumor with bilateral gonads in the inguinal region which was confirmed to be testis postoperatively on histopathological analysis. A brief case report with review of literature is presented.
