Gastrocutaneous fistula after laparoscopic cholecystectomy: An unforeseen mishap.

A middle-aged woman presented to us with complaints of purulent discharge which was coming from the epigastric port site for two years following laparoscopic cholecystectomy, which was performed at an outside hospital for asymptomatic gall stone disease. Computed tomography and magnetic resonance imaging (MRI) confirmed the fistulous sinus track communicating with the anterior body wall of the stomach. At re-laparotomy, the sistulous sinus track was found and excised with primary repair of the defect in the stomach wall. The patient had an uneventful post-operative recovery and was doing well on follow-up. This was the second such case reported in literature where a common surgical procedure like laparoscopic cholecystectomy has led to the formation of gastrocutaneous fistula, which is a rare complication and was successfully managed.

Strength, Weakness, Opportunities, and Threats (SWOT) Analysis of Virtual Outpatient Department Under Telemedicine Department During the COVID-19 Pandemic.

Background COVID-19 pandemic has challenged all current management tools used for patient care. This study aims to determine strength, weakness, opportunities and threats (SWOT) to virtual OPD and consultants' perceptions of teleconsultation virtual OPD during the COVID-19 pandemic, adapting to newer technologies for successfully handling this situation. Material and methods A facility-based cross-sectional study was conducted at the Virtual OPD of All India Institute of Medical Sciences Rishikesh among patients availing Telemedicine consultation during the COVID-19 pandemic. All patients availing services from April 2020 to October 2020 were included in this study. Method for SWOT analysis: A checklist was prepared, and investigators assessed SWOT. An external evaluator was invited to evaluate the SWOT analysis conducted by the investigators. For numeric variables, the mean ± SD was used, and for categorical variables, percentages and proportions were used. Results  Around 22% of the patients who approached virtual OPDs were ≥ 60 years of age. More than half (55.3%) of the patients or their attendants who consulted Telemedicine OPD were from Uttarakhand, followed by Uttar Pradesh (42.6%). The proportions of male patients were 54.4%. Around 17.6% of teleconsultations were performed for radiotherapy. General medicine and cardiology consultations were (15.2%) and (12.8%), respectively. Conclusion Telemedicine can be effective if certain requirements had been provided. Maintaining privacy of the patient's data was a challenge.

A Giant Sacrococcygeal Teratoma in an Adult Male: A Case Report.

Sacrococcygeal teratoma (SCT) in adults is very rare with only a few cases reported in the literature. Its presentation in the adult is asymptomatic to a slow-growing cystic tumor with a 1-2% chance for malignant transformation and may attain a huge size causing pressure effect on pelvic and intra-abdominal organs. It can present unusually as a perianal abscess which needs to be evaluated radiologically. We present a giant, long-standing SCT in an adult male patient which presented as a tender fluctuating swelling with spontaneous rupture and whitish discharge in the perianal region masquerading as a perianal abscess. Diagnosis of our case was suspected by clinical examination, ultrasound, and magnetic resonance imaging of the pelvis and histopathology confirmed the diagnosis. It was excised en bloc with coccygectomy and primary wound closure and had a good postoperative recovery. Long-standing perianal swelling in an adult should raise the suspicion of SCT and should be kept in the differentials. The author prefers the posterior perineal approach for excision in Altman type 2, as it has convenient control over the mass during surgery with good cosmetic results as in our case, but the role of coccygectomy to prevent recurrence needs long-term data.

Acute Recurrent Pancreatitis and COVID-19 Infection: A Case Report with Literature Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection typically presents with respiratory symptoms, although presentation with gastrointestinal symptoms is not uncommon. Coronavirus disease 2019 (COVID-19) presenting as acute pancreatitis is rare. There are several etiological factors for acute recurrent pancreatitis, but its association with COVID-19 disease is not yet known. We present an unusual case of recurrent attacks of acute pancreatitis in a young woman with SARS-CoV-2 infection, which was diagnosed early but had a rapid downhill course in the second attack with a fatal outcome.

Surgical Diseases Management during COVID-19 Crisis at a Tertiary Care Hospital of India: Our Institutional Strategy.

Introduction In response to the national coronavirus disease 2019 (COVID-19) pandemic, all hospitals and medical institutes gave priority to COVID-19 screening and to the management of patients who required hospitalization for COVID-19 infection. Surgical departments postponed all elective operative procedures and provided only essential surgical care to patients who presented with acute surgical conditions or suspected malignancy. Ample literature has emerged during this pandemic regarding the guidelines for safe surgical care. We report our experience during the lockdown period including the surgical procedures performed, the perioperative care provided, and the specific precautions implemented in response to the COVID-19 crisis. Materials and Methods We extracted patient clinical data from the medical records of all surgical patients admitted to our tertiary care hospital between the March 24th, 2020 and May 31st, 2020. Data collected included: patient demographics, surgical diagnoses, surgical procedures, nonoperative management, and patient outcomes. Results Seventy-seven patients were included in this report: 23 patients were managed medically, 28 patients underwent a radiologic intervention, and 23 patients required an operative procedure. In total eight of the 77 patients died due to ongoing sepsis, multiorgan failure, or advanced malignancy. Conclusion During the COVID-19 lockdown period, our surgical team performed many lifesaving surgical procedures and appropriately selected cancer operations. We implemented and standardized essential perioperative measures to reduce the spread of COVID-19 infection. When the lockdown measures were phased out a large number of patients remained in need of delayed elective and semi-elective operative treatment. Hospitals, medical institutes, and surgical leadership must adjust their priorities, foster stewardship of limited surgical care resources, and rapidly implement effective strategies to assure perioperative safety for both patients and operating room staff during periods of crisis.

Post-traumatic necrotising fasciitis of the breast: a case study with literature review.

Necrotising fasciitis is a rare infection of the skin and underlying soft tissue. It primarily involves the extremities and rarely the breast. Primary necrotising fasciitis of the breast in a non-lactating, healthy female is rarer still. The authors present the case report of a patient presenting with primary necrotising fasciitis of the breast after sustaining a penetrating injury. The patient was managed successfully with serial debridement and negative pressure wound therapy (NPWT). To our knowledge only 19 such cases have been reported in the indexed literature so far. This is also the eighth case globally of primary necrotising fasciitis of the breast in a non-lactating female without any associated immunosuppression, which is the basis of reporting this case.