Laparoscopic limited hemicolectomy for descending colo-colic intussusception in an adult.

Intussusception in adults represents 1% of bowel obstructions and up to 0.02% of all hospital admissions. Amongst these, colo-colic intussusception of the descending colon forms the rarest of causes due to the fixed nature of the descending colon. Most of adult intussusceptions follow a lead point and are commonly due to colonic malignancy which may get missed on pre-operative evaluation. Surgery is usually warranted as these patients are usually symptomatic and at risk of vascular compromise, leading to perforations and obscure malignancies. We present a case of laparoscopic limited hemicolectomy and primary anastomosis in a middle-aged male who presented with colo-colic intussusception, which appeared to be following a malignant mass on imaging and lipoma on colonoscopic biopsy done twice. Keeping in mind the possibility of a malignant lead point, no attempt was made to reduce the intussusception and a vessel first approach with 5 cm margin on either side was performed.

Superficial surgical site infection in delayed primary vs primary. Wound closure in complicated appendicitis.

<b><br>Introduction:</b> Wound infection is the most common post-operative complication encountered after open appendectomy. Various studies have compared the risk of superficial surgical site infection (SSI) in primary closure (PC) and delayed primary closure (DPC) of wounds. However, there is no uniform consensus regarding the method of wound closure.</br> <b><br>Aim:</b> The aim of this study is to compare the two wound closure techniques.</br> <b><br>Material and methods:</b> This is a prospective study which enrolled 50 patients who underwent open appendectomy. The patients' demographics, characteristics, and operative findings were recorded. Those who were older than 18 years and had an appendectomy with a right lower quadrant incision were included. Patients with any comorbidity, morbid obesity, or pregnancy were excluded. Patients were randomized to undergo two techniques of wound closure: PC and DPC. During follow- -up at 1 week and 1 month, SSI, post-op pain, and LOS were compared among the two groups. Clinical assessment included the Visual Analog Scale (1-10) for pain.</br> <b><br>Results:</b> In our study, the incidence of SSI in the DPC group was significantly lower than in the PC group (p = 0.0002), while post-op pain and LOS were not significantly different between the two groups.</br> <b><br>Conclusions:</b> We concluded that DPC was superior to PC in terms of reducing the incidence of superficial SSI, but with respect to post-op pain and LOS, the two techniques of wound closure were not different.</br>.

Comparative Study on Temporalis Fascia Graft Versus Tragal Cartilage in Type-1 Tympanoplasty in Paediatric Patients.

The aim of the study was to compare anatomical and functional outcomes of temporalis fascia graft versus tragal cartilage graft in type 1 tympanoplasty in paediatric patients. A prospective, comparative and randomised study. A detailed history was taken from all the patients visiting the ENT OP dept after fulfilling the inclusion and exclusion criterion patients were enrolled for the study. Written and informed consent was taken for all the patients from legally acceptable guardians. Preoperative assessment was done and the patients were subjected to type1 tympanoplasty with Temporalis fascia graft or tragal cartilage graft. All the patients were followed up on the third, sixth postoperative months to assess hearing improvement. All the patients were followed up on the first and third,sixth postoperative months for graft status with otoscopic examination. In the present study out of 80 patients, 40 patients underwent type 1 tympanoplasty with temporalis fascia and the remaining 40 patients with tragal cartilage. Both groups were assessed postoperatively for anatomical and functional success with maximum follow up of six months. There was no statistical significance between the outcome and the age or site and size of tympanic membrane perforation. Both groups had comparable graft success rate and hearing improvement. The cartilage group had a higher anatomical success rate. The functional outcome was similar. However, there was no statistically significant difference found in the outcome of two groups. Tympanoplasty can be performed in a paediatric age group with a good success rate in suitable patients. It can be done at an early age,safely with good anatomical and functional outcomes. The age group, site or size of perforation, the type of graft used for tympanoplasty does not alter the anatomical or functional outcome significantly. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03490-1.

The case of spontaneous stoma closure in patient with loop ileostomy.

INTRODUCTION: An ileostomy is a mean to empty the contents of the bowel via ileum rather than usual anal route to prevent distal anastomotic leak. It is considered a controlled entero-cutaneous (EC) fistula which prevents contamination of peritoneal cavity, protecting the peri-stomal skin from effluent and excoriation. Spontaneous closure of ileostomy is a very rare phenomenon. Thus, we hereby report a case of spontaneous closure of ileostomy. CASE PRESENTATION: An 18-years male presented with complaints of pain abdomen, vomiting for 6 days. Chest X-ray showed free air under the right dome of diaphragm suggestive of pneumo-peritoneum. So explorative laparotomy with primary repair of ileal perforation with diversion loop ileostomy (2 ft proximal to ileocecal junction) was performed. Over the months stoma retracted and eventually spontaneous closure of stoma took place after 4 months of surgery. DISCUSSION: Retraction of stoma depends on multiple factors. Firstly, on patient's general condition, if he/she is malnourished/obese/immunocompromised then retraction occurs due to poor healing of wound. Secondly, it results from inadequate mobilization of bowel. Separation of stoma with muco-cutaneous fascial planes leads to gradual retraction of stoma which is primary mechanism of spontaneous closure of stoma. CONCLUSION: To summarize, gradual retraction of stoma (complication of an ileostomy) and healing of EC fistula has to be correlated to know the complex mechanism of spontaneous closure of an ileostomy.

Pyelonephritis of an ectopic right kidney pretending as acute appendicitis: An unusual case.

INTRODUCTION: Acute appendicitis is a common condition presenting in emergency department. A patient presenting with pain associated with fever, and tenderness in the right iliac fossa will be suspected to have Acute Appendicitis. However a variety of other clinical conditions may have similar features and may be required to be excluded. Acute pyelonephritis in an ectopic right kidney is a rare clinical condition which may mimic Acute Appendicitis. CASE PRESENTATION: We present a middle-age male with complaints of pain in the right lower quadrant of the abdomen with high grade fever for one week. Clinical suspicion and initial ultrasonography (USG) of abdomen supported the diagnosis of acute appendicitis. The patient was initially managed conservatively and later non-contrast computed tomography (NCCT) scan was done that revealed right ectopic kidney with acute pyelonephritis. The appendix was within normal limits on NCCT scan. DISCUSSION: Ectopic kidneys result from anomalies of ascend which can result in several complications depending upon its position. Acute appendicitis can also cause pyuria and may mimic urosepsis amounting to its close anatomical proximity to urinary bladder. An un-ascended ectopic kidney with pyelonephritis mimicking acute appendicitis is a rare occurrence. USG and CT scan are important tools in the differential diagnosis but however, USG is greatly operator dependent; CT scan provides excellent diagnostic accuracy. CONCLUSION: This case report signifies importance of NCCT abdomen in accurate diagnosis of conditions featuring as right lower abdominal pain and fever. Also emphasizing significance of NCCT prior to any surgical intervention, if any conflict of diagnosis occurs.