Understanding Superior Mesenteric Artery Syndrome: Etiology, Symptoms, Diagnosis, and Management.

Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, poses a diagnostic challenge due to its rarity and varied clinical manifestations. This review explores the syndrome's etiology, symptoms, diagnostic challenges, and management strategies. Symptoms range from early satiety to severe abdominal pain, often leading to malnutrition. Diagnosis involves a thorough gastrointestinal evaluation and various imaging modalities. Management includes medical interventions like nasogastric decompression and nutritional support, along with surgical interventions such as duodenojejunostomy. A thorough understanding of SMA syndrome's complexities is crucial for its timely diagnosis and effective management, especially considering its potential overlap with other gastrointestinal disorders or eating disorders. Further research is needed to enhance understanding and improve patient outcomes.

Rapunzel Syndrome: Diagnostic Challenges and Multidisciplinary Treatment Strategies.

Rapunzel syndrome, a rare yet complex condition, poses diagnostic and therapeutic challenges. Trichobezoars, stemming from trichotillomania and pica, manifest as hair conglomerates within the gastrointestinal tract, often necessitating surgical intervention. This review synthesizes literature on symptomatology, diagnostic methods, and treatment modalities, emphasizing the multidisciplinary approach essential for effective management. Psychological interventions, including cognitive-behavioral therapy, complement surgical measures in addressing underlying psychiatric factors. Diagnostic imaging, endoscopic examinations, and histopathological analysis aid in an accurate diagnosis. Enhanced awareness among healthcare providers regarding the association between psychological disorders and gastrointestinal complications is crucial for timely intervention and improved outcomes in individuals with Rapunzel syndrome.

Hidden in Muscles: A Case Study of Intramuscular Lipoma.

This case report presents a 64-year-old male with a giant intramuscular lipoma on the right lumbar region's latissimus dorsi muscle. The patient presented with painless swelling, which gradually increased over six years. Magnetic resonance imaging (MRI) confirmed the presence of the lipoma, prompting surgical intervention. The surgical procedure involved meticulous dissection and complete excision of the tumor. Histopathological examination validated the diagnosis. Comparative analyses with similar cases highlighted variations in surgical approaches and the challenges in managing intramuscular lipomas. This case emphasizes the importance of considering intramuscular lipomas in soft tissue mass differentials and the significance of comprehensive management strategies for optimal patient outcomes.

Complex Hernia Presentation: A Case Study of Concurrent Spigelian and Pantaloon Hernias in a 49-Year-Old Female.

A 49-year-old woman with a complicated hernia presentation, including direct and indirect inguinal hernias, Spigelian hernias, and Pantaloon hernias, is presented in the case report. The diagnosis was verified by a comprehensive physical examination and imaging, which resulted in a Lichtenstein operation for repair. The surgical procedure for hernia comprised of painstaking dissection, reduction of the hernia sac, and implantation of a prosthetic mesh. The instance emphasizes the value of individualized treatment programs and draws attention to the intricate anatomical details of hernia surgery. Analyzing situations that are similar to one another highlights the necessity of customized strategies to improve patient outcomes.

Pivotal Surgical Intervention for Pediatric Ileoileal Intussusception With Meckel's Diverticulum: A Case Report.

The most prevalent congenital gastrointestinal tract abnormality is Meckel's diverticulum. It is discovered in most instances incidentally. It can be observed as painless bleeding in the gastrointestinal tract. However, it can occasionally result in acute intestinal obstruction, which frequently masks the actual clinical presentation. This is a case of a four-and-a-half-year-old male child who presented with features of obstruction, which, on further evaluation, revealed ileoileal intussusception. An emergency surgical intervention was planned with an exploratory laparotomy and a reduction of intussusception. This case emphasizes the urgency of diagnosing and managing intussusception to prevent serious consequences such as bowel ischemia, bowel necrosis, bowel perforation, peritonitis, and sepsis. It stands as a stark reminder for medical professionals to stay vigilant for these critical gastrointestinal emergencies, and immediate treatment with a multidisciplinary approach is recommended to significantly enhance patient outcomes.

Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management.

Hemorrhoids are a prevalent condition that significantly impacts the quality of life of affected individuals. Traditional treatment modalities range from conservative management to invasive surgical procedures, each with varying degrees of effectiveness and patient burden. Recently, laser treatment has emerged as a promising alternative, offering a minimally invasive approach with the potential for reduced complications and faster recovery. This comprehensive review aims to evaluate the role of laser treatment in hemorrhoidal management, exploring its mechanisms, clinical outcomes, safety, and economic implications. Through an extensive literature review and analysis of clinical trials, this paper assesses the efficacy of laser therapy compared to conventional treatments, highlighting its advantages in pain reduction, healing times, and patient satisfaction. The review also discusses the different types of lasers, including diode and Nd:YAG, and their specific applications in hemorrhoidal treatment. The findings indicate that laser treatment can be an effective and safe option for patients, encouraging its consideration as part of standard hemorrhoidal care protocols. However, gaps in long-term outcome data and the need for further studies on cost-effectiveness are identified. The review concludes with recommendations for future research, the advancement of laser technology, and the potential integration of laser treatment into clinical practice, aiming to enhance patient outcomes in hemorrhoidal management.

Atypical Giant Lipoma in the Left Lower Abdomen: A Case Study.

In the present case report, we discuss a case of an uncommon giant lipoma in the left lower abdomen of a 55-year-old female. The case is presented to highlight the need to consider lipoma as one of the possibilities in cases with subcutaneous masses. Despite its abnormal location and considerable magnitude, surgical excision under short general anesthesia resulted in successful outcomes without immediate complications. Finally, by comparing with similar circumstances, it is possible to recognize that individualized management strategies based on patient characteristics can benefit surgical considerations. The significant message is that timely intervention, comprehensive assessment, and teamwork are essential in achieving satisfactory outcomes among patients with rare cases of lipomas, such as this one.

Incidental Discovery of a Phrygian Cap During Whipple's Procedure: A Case Report.

Obstructive jaundice, characterised by yellow discolouration of the skin and mucous membranes due to reduced bile flow, often necessitates surgical intervention for resolution. This article provides a comprehensive literature review to contextualise the management of obstructive jaundice, focusing on common treatment modalities such as common bile duct (CBD) stenting and Whipple's procedure for pancreatic head cancer. Additionally, the incidental finding of a Phrygian cap of the gallbladder during surgical intervention for pancreatic head cancer is described in detail. A case presentation of a 48-year-old female with obstructive jaundice and pancreatic head cancer is outlined, detailing the diagnostic process, treatment decisions, and surgical interventions. The patient underwent CBD stenting followed by Whipple's procedure to address the pancreatic head cancer, during which the incidental discovery of a Phrygian cap of the gallbladder was noted. The discussion of the incidental finding highlights the complexity it adds to surgical interventions and emphasises the importance of adaptability and precision in managing anatomical variations. A comparison with similar cases underscores varying approaches to managing incidental findings, ranging from conservative observation to surgical excision based on clinical indications. This case underscores the significance of thorough diagnostic evaluation and surgical intervention in managing incidental findings such as the Phrygian cap, ensuring appropriate patient management and favourable clinical outcomes in complex surgical scenarios.

Moyamoya Disease: Advances in Diagnosis, Treatment, and Surgical Interventions.

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive narrowing of the brain's arteries, leading to an increased risk of stroke. The primary susceptibility gene, RNF213, has been identified in individuals of East Asian descent, contributing to ongoing research into potential therapeutic targets. The distinction between idiopathic MMD and secondary forms, such as Moyamoya syndrome (MMS), is discussed, focusing on associated conditions and risk factors. Surgical revascularization emerges as the mainstay of treatment, with direct, indirect, and combination bypass procedures explored. The review delves into advancements in imaging technology for diagnosis and treatment planning, emphasizing non-invasive magnetic resonance examination's role in identifying asymptomatic patients. Additionally, insights into anesthetic care and therapeutic approaches underscore the evolving understanding of this complex disease. The presented information aims to contribute to the ongoing dialogue surrounding MMD, providing a valuable resource for clinicians and researchers.

Interplay Between Diabetes Mellitus and the Occurrence of Osteoarthritis and Associated Conditions in Women of Menopausal Age.

Osteoarthritis (OA) and diabetes mellitus (DM) have long-term deleterious chronic effects and are among the most prevalent chronic disorders. DM and its associated factors, such as hyperglycemia, have a significant contribution to the pathophysiology of OA, particularly in post-menopausal women. Women who have uncontrolled diabetes (DM) are more prone to develop osteoarthritis (OA), which may be exacerbated by poor glycemic control. Furthermore, this category of female patients with DM has an increased risk of developing fractures, even in those with initially normal bone density scores, further illustrating the correlation between DM and bone health. Additionally, multiple risk factors, including obesity, metabolic syndrome, hypertension, estrogen-based hormone therapy, and hyperuricemia, in menopausal women can lead to the development and exacerbation of OA. It is discovered that these variables have a direct or indirect impact, frequently causing inflammation and hormonal changes, which contribute to the intricate interaction between DM and OA. The management of OA and DM in women thus calls for a multi-faceted management plan including glycemic control, weight control, exercise, and specialized pain management methods catering to the specific requirements of the patients. Regularly screening for OA should be implemented for menopausal women with DM and utmost care should be provided by healthcare professionals. Regular monitoring of joint health and early management, encouraging interdisciplinary cooperation, putting preventative measures into place, and creating individualized treatment programs are essential. A thorough understanding of the link between DM and OA will ultimately lead to improved health outcomes and a better future for these individuals.

Preputial Calculus: Unveiling a Rare Encounter and Treatment Journey.

Preputial calculus is an infrequent manifestation of urolithiasis, primarily observed in ageing individuals with an uncircumcised penis and not maintaining proper hygiene, which can further be complicated by co-morbidities such as phimosis. On the contrary, phimosis and other neurological/urological malformations have also been reported in children to cause preputial calculus. Overall clinical presentations include a palpable mass within the prepuce, dysuria, hematuria, obstructive uropathy, diminished urine flow, and malodorous discharge. This is a case of a 65-year-old male presented with a complaint of obstructed urinary flow. The patient was diagnosed with obstructive uropathy due to the presence of preputial stone/s. This case illustrates both singular and multiple stones in the affected patient. The patient was managed by surgical intervention by circumcision followed by calculus removal. As per the available published literature, this case can be noted as the first report of the largest preputial stone in an elderly in any rural setup of central India.

Incidental Discovery of a Cervical Rib in a Case of Acute Cholecystitis: A Rare Anatomical Variant.

This case report discusses the incidental discovery of a cervical rib in a 53-year-old woman presenting with acute cholecystitis. While cervical ribs are rare, their identification holds clinical significance due to their potential implications for vascular compression or thoracic outlet syndrome. Despite the patient's primary complaint of cholecystitis, a chest X-ray incidentally revealed the cervical rib. This finding underscores the importance of a thorough radiographic examination. The report discusses similar cases, emphasizing varying clinical presentations and associated vascular complications. The case highlights the necessity for a comprehensive assessment of incidental findings to ensure holistic patient care and management, emphasizing the importance of considering anatomical variants in clinical practice.

Prevalence and Assessment of Factors Associated With Malnutrition in Children Residing in Slums of Mumbai: A Cross-Sectional Study.

Background Malnutrition in children continues to be a serious public health problem in India. Therefore, this study aims to evaluate the prevalence of malnutrition and assess factors contributing to it in children of the marginalized slum population of India, masked in the metropolitan cities.  Methods A retrospective data analysis with a cross-sectional model was conducted by medical volunteers affiliated with the Rotaract Club of Medicrew who had organized a free pediatric health check-up camp in the Dharavi village of Mumbai, India for children under five. Children under five years of age group of either sex residing in the slums of Dharavi and whose parents consented are included in the study. Neonates, children older than five years of age, and children whose parents did not consent for them to be included in the study were excluded. A pretested, pre-validated questionnaire was administered, and statistical analysis was done with p-values <0.05 considered to be statistically significant. Results  A total of 126 children were included. Out of these children, 109 of them (86.50%) had a mid-arm circumference of more than 12.5 cm (normal), 11 (8.73%) were between 11.5 cm and 12.5 cm (moderate acute malnutrition), and five (4.77%) were less than 11.5 cm (severe acute malnutrition). Among the 126 kids, 86 kids were above the age of two and their BMI was assessed, 36 (44.19%) were found to be underweight (<5th percentile) while 14 (16.3%) were obese (>95th percentile), and four (4.65%) were overweight (85th-95th percentile). For 106 (84.13%) of these children, the caregivers were mothers while others were fathers (n=4; 3.18%), grandmothers (n=5; 3.97%), sisters (n=5; 3.97%), and aunts (n=6; 4.76%). Out of those who had commenced receiving formal education, only 39 (55.71%) were in an appropriate grade for their age. The mean expenditure on food as a proportion of the total household income was 36.40% (standard deviation (SD) 15.0%). On the single-item sleep quality scale, the sleep of only 36 kids (28.58%) was reported by their caregivers as excellent. A high proportion of other medical problems were reported in the children. Conclusion Our study reports a substantial burden of malnutrition among children residing in the slums of Dharavi. Rigorous strengthening and conceptualization of on-ground nutritional programs targeted toward slum children should be done by Indian healthcare policymakers.

Correlation Between Hypothyroidism and Gallstone Disease in Central India.

Introduction The decreased thyroid-stimulating hormone (TSH) levels affect almost every nucleated cell in our body, which directly affects the basal metabolic rate (BMR). It tends to affect multiple organ systems in the human body. In recent times, there have been changes in lifestyle and the consumption of processed foods has increased. Thus, cholelithiasis and hypothyroidism are being encountered frequently, even in rural populations. In recent times, the overt clinical presentation of hypothyroidism is rare due to early diagnosis and treatment of the subclinical hypothyroidism state itself. Aim The aim is to determine the correlation between cholelithiasis and hypothyroidism. Methods This was a cross-sectional study done on the patients presenting to the surgical department at Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India between the duration from December 2020 to December 2022, having gallstone disease or with symptoms suggestive of gall bladder stones. The admitted patients were then evaluated for hypothyroidism by thyroid profile tests, and the results were documented. Using the collected data, factors such as clinical spectrum, correlation between cholelithiasis and hypothyroidism, relation with the demographic data, and body mass index (BMI) were studied. Results A total of 52 gallstone patients were included in the study. A greater number of patients were found to be above the age of 40 years (82.7%), with female preponderance (61.5%). More patients with cholelithiasis were from the group with having BMI more than normal (57.6%). More patients having both cholelithiasis and hypothyroidism were also from the group with having BMI more than normal. Most symptomatic patients complained of pain in the right hypochondriac region (88.5%). Of these 52 patients, nine (17.3%) were found to have hypothyroidism (seven were subclinical, two patients had overt clinical symptoms and signs) and the remaining 43 patients were euthyroid. Conclusions Our study supports that there is a correlation between cholelithiasis and hypothyroidism. Out of all the 52 patients, nine had hypothyroidism, seven were subclinical, and two had overt symptoms. Thus, we conclude that there is a correlation between cholelithiasis and hypothyroidism.

Unveiling a Coalescing Catastrophe: Pre-pyloric Perforation Co-existing With Sigmoid Volvulus in a Middle-Aged Patient.

Sigmoid volvulus is a common cause of colonic obstruction worldwide and constitutes the majority of all cases of colonic volvulus. It is more prevalent in those who are older than 70 years. The sigmoid colon, an S-shaped portion of the large intestine, is susceptible to this condition due to its redundancy and mobile nature. Treatment involves endoscopic detorsion with sigmoidectomy. Laparoscopic surgery has been found to be useful in terms of reduced morbidity, blood loss, analgesics, and hospital stay; contrarily, surgical management has been found to be associated with reduced recurrence. Early diagnosis is crucial to prevent complications and recurrence rates. Gastroduodenal perforation, whether spontaneous or traumatic, is predominantly associated with peptic ulcer disease. Specifically, the majority of perforated peptic ulcers are attributed to Helicobacter pylori infection. The presence of perforation as a comorbidity complicates surgical management, particularly when the patient has a history of H. pylori infections, as evidenced in our case. Addressing these infections is crucial for optimizing treatment outcomes and reducing potential complications. Laparoscopic surgery is popular due to its benefits and faster recovery periods, especially in the aged population. This is a case presentation of a 48-year-old male who presented at our tertiary care center with abdominal pain, multiple episodes of vomiting, obstipation, and abdominal distention. The patient was diagnosed with sigmoid volvulus with pre-pyloric perforation which was managed surgically by initial detorsion followed by sigmoidectomy with modified Graham's patch technique. He recovered well with no post-operative complications.

Comparative Analysis of Laparoscopic Versus Open Procedures in Specific General Surgical Interventions.

Laparoscopic and open surgeries are two distinct surgical approaches with significantly different procedures and outcomes. Minimally invasive surgery, also known as laparoscopic surgery, utilizes small incisions and specialized instruments like the laparoscope to perform procedures. This contrasts with open surgery, which requires larger incisions to directly access the surgical site. Open surgery was the preferred approach for any invasive procedure until the introduction of new technological advances in the form of laparoscopy. While laparoscopy is still evolving, preliminary results demonstrate promise for various operations. Open surgery provides the healthcare professional with more liberty in the form of increased visualization, but it also increases tissue damage and hospital stays. Laparoscopic and open procedures are both valuable surgical methods with advantages and disadvantages. While open surgery is favored for difficult patients, laparoscopic surgery offers a quicker recovery and fewer scars. The choice between the two approaches depends on the patient's condition, surgical demands, and the surgeon's skills. As these methods develop, they become increasingly important for offering safe and efficient surgical treatments across a range of medical specialties.

Unknown and Unacknowledged Dangers to Every Medical Student: A Rare Case of Nitric Acid Burns.

This case report delves into the often overlooked and unacknowledged hazards faced by medical students, exemplified by a rare incident of nitric acid burns. A 19-year-old male medical student with no notable medical, surgical, or familial history suffered a spillage of 69% nitric acid on the anterior aspect of the right thigh while engaged in laboratory work. Swift action, including immediate wound irrigation, application of silver sulfadiazine, and subsequent hospitalization, proved crucial in mitigating the burn's severity. Though vitally stable, the patient exhibited a distinctive color change in the wound during observation. Admitted to the general surgery ward, outpatient follow-ups revealed successful wound healing within four weeks, emphasizing the importance of prompt intervention and meticulous care in addressing chemical burn injuries among medical students. This report sheds light on the often-underestimated dangers inherent in pursuing medical education.

A Miraculous Save: Gangrenous Bowel and Meckle's Diverticulum With Acute Superior Mesenteric Artery Thrombosis.

The superior mesenteric artery (SMA) is vital for parts of the small intestine and ascending colon. Thrombosis of this major artery is a severe and potentially fatal condition involving the occlusion of the arterial vascular supply, causing ischemia predisposing to gangrene. Meckel's diverticulum is a congenital outpouching in the lower part of the small intestine. The condition of gangrenous meckels diverticulum is, therefore, even more limited. This study presents a unique case of a 45-year-old male with coexisting features of SMA thrombus with acute small bowel intestinal obstruction. During the study, the patient was found to have sickle cell anemia with an AS pattern, which may have predisposed the formation of a thrombus. The patient underwent sequential management of active thrombus by thrombolysis first, followed by resection anastomosis for gangrenous bowel. With precise monitoring and therapeutic care, the patient made a remarkable recovery. The condition possesses a high mortality rate. Prompt recognition and timely intervention in this case are of utmost significance.

Lung Hydatidosis Unveiled: A Multisystem Mirage of Pathological Rarity.

Lung hydatidosis is a zoonotic infection, primarily caused by Echinococcus sp., and has a significant role in the economy and public health. Canines are the predominant hosts of these parasitic tapeworms. Lungs are the most commonly infected organ after the liver. Hepatic pulmonary blood circulation is mainly reported to transport infection to the lungs. The prevalence of hydatid disease has increased over the past decade. In addition, patients with multi-organ involvement of hydatid cysts have been reported in different parts of the world. Hydatidosis can remain asymptomatic for years after infection in some conditions, especially in cases of splenic hydatidosis. Chest radiography and computed tomography findings can be used to confirm the diagnosis of hydatid disease. Hydatid disease is, in general, managed by pharmacological therapy, but if multi-organ involvement is observed, surgery along with medical management is required. Long-term follow-up is recommended in such cases to check the recurrence of the disease.

Idiopathic Thrombocytopenic Purpura: Current Limitations and Management.

Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenia, is a blood disorder characterized by a reduction in the number of platelets. A reduction in the number of platelets beyond the normal levels leads to several consequences. A severe reduction in blood platelet levels leads to a rash of purple spots on the skin, joints, etc. due to leakage in the small blood vessels, easy bruising, bleeding gums, intestinal bleeding, and hemorrhage. Suppose a case of ITP resolves in fewer than six months. In that case, it is an acute case of ITP. Still, if a case settles in more than six months, it is a case of ITP. The cause of a reduced platelet count can be increased peripheral destruction or impaired production; this is termed an autoimmune condition in which the body's immune system attacks platelets thinking it to be a foreign antigen. ITP in children occurs commonly following a previous viral attack. Even though evaluating patients' reports is useful for understanding and guiding the treatment, these estimates might not be regularly evaluated in clinical settings. First-line drugs in the treatment of ITP are corticosteroids, and long-term use of these drugs has several side effects, such as excessive increase in weight, mental health disturbances, and sleep disturbances; additional therapies to treat hemorrhage are usually momentary. As a result, it is essential to recognize the flaws in current procedures and adopt innovative measures for the management and minimization of difficulties.