The clinical challenges in the management of deep lymphangioma of the foot.

A 12-year-old girl presented with swelling on the lateral aspect of the left foot since early childhood, progressively increasing in size and now causing pain on walking. Pain was relieved with medication only. There was also history of a single episode of blood-tinged discharge from the swelling 3 years prior. There was no history of trauma, diabetes, or hypertension.

Primary tuberculosis of the breast manifested as abscess: a rare case report.

Primary breast tuberculosis is a rare entity. We are reporting a case of primary breast tuberculosis, which presented as breast abscess. On histopathology, it was diagnosed as breast tuberculosis. Aspiration cytology was not done due breast abscess. Patient was put on anti-tubercular drugs. In follow up, after 3 months patient condition was improved.

Giant primary psoas abscess: masquerading peritonitis-for diagnosis and treatment.

Primary psoas abscess is a distinct clinical entity with vague clinical presentation and obscure pathogenesis, although the literature regarding it is sparse. Psoas muscle abscess is an uncommon clinical phenomenon, extremely difficult to diagnose and needs to be investigated with considerable thoroughness. We emphasize the importance of ultrasonography and computed tomography along with role of the treatment. A 15-year old female presented with pain and distention of the abdomen. We report an extremely rare case of bilateral giant psoas abscess diagnosed as peritonitis. Ultrasonography showed abscess of the left psoas muscle which ruptured anteriorly into the peritoneal cavity and caused intraperitoneal abscess but computed tomography revealed different picture. In our case, computed tomography has the main role in the diagnosis/management of the psoas abscess. Conservative treatment was given using antibiotics and drainage. The patient was discharged in good condition. In follow-up period of 9 months, she remained well and asymptomatic.

A rare anomaly of the foot presented as polydactyly.

Presence of one or more digit is called as polydactyly and may manifest singly or with other genetic disorders. The frequency of polydactyly varies widely among populations. It can occur as an isolated condition or as a feature of a congenital condition. Polydactyly is a rare condition, but still rare is in form of triple great toes. We describe a case in a 4-year-old child diagnosed as triphalangism foot with no other obvious visible anomaly. Osteoplasty-combined surgery, which was ideal for anatomical reconstruction. In a 16-month follow-up period child recovered very well.

A unique case of cervical osteochondroma causing dysphagia.

Osteochondroma of the spine is a rare condition. It may present in solitary form or with multiple exostoses or hereditary multiple exostoses. In this article, we report a 22-year-old male case who was diagnosed with cervical osteochondroma, originating from the third and fourth cervical vertebra.

An unusual presentation of giant extrathoracic tumor in a child--managed successfully.

Lipoma is one of the most common mesenchymal tumors, usually seen over the trunk and proximal portions of the extremities. However, giant lipomas are very rarely seen over the chest wall and axilla in children. In rural areas, patients usually do not bother to be treated, which leads to complications, as seen in our case. Here, we report a rare case of a three-year-old child who presented with a large swelling on the right side of the anterior chest wall and in the axillary region. On histopathology, the diagnosis was lipoma. At the six-month follow-up, the child was normal without any complications. The clinical features, radiological and pathological findings and management of the lesion are discussed. If such a large tumor is not treated in a timely manner, it can cause respiratory discomfort or lead to malignancy.

Successful enucleation of retroperitoneal cyst.

Retroperitoneal mesenteric cyst is a rare entity among the other mesenteric cysts and intra-abdominal tumours. A 42-year-old woman reported with pain abdomen off and on since one month. There were no other complaints. On ultrasonography a mesenteric cyst was diagnosed. Surgery was planned which revealed a retroperitoneal mesenteric cyst. Enucleation of the cyst was done. In follow-up of 6 months patient is asymptomatic. We are reporting a rarely reported retroperitoneal mesenteric cyst in the mesentery of the descending colon or sigmoid.

Appendico-cutaneous fistula presenting as a large wound: a rare phenomenon-brief review.

Appendicular inflammation can present as a discharging fistula on the abdominal wall. We are reporting a rare case of appendico - cutaneous fistula presenting as a large wound over the right iliac region. A 60 year old female reported to the emergency with a large wound and slough on right side of the abdomen. The thin shinning serous discharge from the wound revealed actinomycosis on microbiology. Patient was successfully treated conservatively with the help of percutaneous drainage and antibiotics. On follow-up of 3 months, patient is doing well and is asymptomatic. Acute appendicitis is considered one of the elementals of general surgical disease processes, yet its presentation often confounds its diagnosis by most surgeons. Its presentation as abscess in the abdominal wall and groin is a rare clinical entity. Because of insidious onset and subtle clinical signs of resulting abscess, the diagnosis of such cases is often delayed. USG and Contrast enhanced computed tomography are important part of investigations to make diagnose and helps in the treatment.

An unforgettable concurrence: Successfully managed gallstone ileus accompanied by diabetic nephropathy.

BACKGROUND: Gallstone ileus is an uncommon complication of gall stones associated with potentially serious morbidity and mortality. CASE REPORT: We reported a 60-year-old male case who presented with renal failure and pain in right hypochondriac region. He also had a history of brain infarcts along with diabetes which is an additional factor for mortality. On Computed Tomography of the abdomen, he was diagnosed to have cholecystocholedochal fistula including air in the gall bladder and obstruction in the distal part of the ileum. Computed tomography plays an important role to make the proper diagnosis and in treatment. CONCLUSIONS: As in our case, diagnosis was challengeable because of renal failure,diabetes, septicaemia and intestinal obstruction (peritonitis). We did surgery on the basis of peritonitis which remains the only choice in such cases. In follow- up of 1 month patient was doing well and asymptomatic.

Xanthogranulomatous cholecystitis: case series in a rural area, clinicopathological study and review of literature.

Xanthogranulomatous cholecystitis is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. We are reporting two of such rare cases in female patients attending our institute. In both patients xanthogranulomatous cholecystitis was diagnosed on histopathology.

A giant splenic hydatid cyst.

A 16-year-old girl presented with pain in the left hypochondrium, which had been progressing for 5 months. Examination revealed large splenomegaly, and ultrasonography showed a huge hydatid cyst in the spleen. Preoperative planning and postoperative care lead to successful management of this entity. Radiological investigations also play a major role in diagnosis and decrease morbidity.

Primary germ cell tumor of the mediastinum - presenting as a huge mass.

Germ cell tumors compromise 15-20% of all anterior mediastinal masses; 50-60% of these are benign mediastinal teratoma. There may be mature, immature, and rarely with malignant component within the tumor mass. There are more chances of malignancy with immature type. We are reporting a case in 20-year young male diagnosed as giant benign cystic teratoma which was adherent to superior vena cava. The patient underwent surgical excision. In follow up of 2 years, the patient is not having any complaints.

A huge immature cervical teratoma; antenatal diagnosis, and its management - an unusual entity.

Cervical teratomas are not reported quite frequently in medical literature, especially from Indian subcontinent. Prenatal diagnosis of this condition is even rarer, making the management protocols difficult. In absence of prompt intervention in the form of airway decompression, morbidity and mortality is very high. Presented here is the case of antenatal diagnosed cervical mass, which was managed successfully in immediate post-natal period with uneventful survival and normalized tumor marker levels.

Primary abdominal tuberculosis presenting as peritonitis in a young child-managed surgically.

Abdominal tuberculosis (TB) is the sixth commonest extra-pulmonary TB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. We are presenting a rare case in a young female of age 7 year diagnosed as peritonitis and intestinal obstruction. Operative findings revealed dense fibrosis in interloops and perforation of the small bowel. She was put on antitubercular treatment for one year. Patient was discharged in satisfactory condition and is in follow up for 2 months.

A rare case of chronic intussusception due to non Hodgkin lymphoma.

Chronic intussusception is defined as intussusception with a history of more than 14 days and is generally associated with a predisposing factor. We are reporting a rare case of chronic intussusception due to Non Hodgkin lymphoma of ileum, appendix, caecum and ascending colon presented as acute intestinal obstruction in emergency. Chronic Intussusception is rare in childhood due to Non Hodgkin lymphoma. A five year male child presented with fever, pain abdomen, vomiting, diarrhoea and mass in right flank. Ultrasonography of the abdomen revealed a mass in ileao-caecal region with chronic intussusception which was confirmed on surgery. X ray of the abdomen showed dilated bowel loops. It is very difficult to make diagnosis of intestinal lymphoma on pre-operative investigations. Patient presented with obstruction should be explored as surgery is the treatment of the choice. Diagnosis can be confirmed by histopathologically. In conclusion, a high index of suspicion and appropriate investigations (USS, Barium enema and CT scan) can result in prompt diagnosis. In majority of children the diagnosis is made at laparotomy and surgery plays a pivotal role in the management.

An incarcerated appendix: report of three cases and a review of the literature.

We came across three rare cases of incarcerated hernia, with different presentations. The first case was an elderly female, who presented with an incarcerated incisional hernia on the right lower iliac region diagnosed on contrast enhanced computed tomography (CT); the contents were the small bowel and the perforated tip of the appendix. In the second case of inguinal incarcerated hernia, ultrasonography showed the inflammed appendix in the subcutaneous plane of the hernial sac, which is very rarely diagnosed pre-operatively and was confirmed during surgery. Inflammed appendix with gangrenous tip was found in the inguinal hernial sac. In yet another case of incarcerated inguinal hernia, the contents were a gangrenous part of the ascending colon and transverse colon, with the tip of the inflamed appendix--also only rarely observed. The colon extended to the scrotum in this case. We could find no description within the existing medical literature on either transverse or ascending colon as contents in inguinal hernia although transverse colon alone has been reported in four cases. The surgical options for dealing with the appendix in an Amyand's hernia depend on the mode of presentation. The presence of a normal appendix does not require an appendicectomy to be performed, but its removal is necessary if inflamed.

A rare clinical case of an unfortunately current pathology - foreign bodies.

Medication errors can cause various complications and some of these are fatal also. A very unusual complication, an esophageal foreign body, is described herein. It was a single tablet with intact wrapper, cut out from a blister pack which was unknowingly ingested by a child in toto. She was not instructed properly regarding administration of the drug. The peculiarity of this case concerns the type, location of the foreign body and need of clear instructions to be given to the patient for taking a medication.

Complete bronchial transaction due to severe blunt trauma and chest; treatment and outcomes : A distinct entity.

An 18-year-young male patient came to the emergency department with history of severe blunt trauma. He was having respiratory distress and diagnosed as bronchial injury on the right side. A chest tube was put immediately and there was continuous air leak in the form of air bubbles in the intercostal chest tube bag with each inspiratory effort. Chest injury can be a life-threatening condition, if not managed timely and properly. Bronchoscopy showed injury over the right main bronchus. The features of this uncommon entity are discussed, with special emphasis on early diagnosis and surgical management.

Delayed presentation of the traumatic abdominal wall hernia; dilemma in the management - review of literature.

Traumatic abdominal wall hernia is a rare entity, and an uncommon type of abdominal wall hernia as far as the etiology is concerned. It is caused by blunt trauma and disrupts the fascial layers, but does not disrupt the elastic skin. In this study, we report the case of a 60-year-old female, diagnosed with traumatic abdominal wall hernia with delayed presentation. In this case, herniation of the bowels was present through the defect in the left iliac region. She was surgically well-managed. During the follow-up of 1 year, there was no recurrence. In the Western medical literature, only a few cases have been reported, especially with intra-abdominal injuries. Confusion still exists in the management of such a disease as to whether to treat the condition at an early or later stage.

"Amyand's Hernia" - Pathophysiology, Role of Investigations and Treatment.

BACKGROUND: In the present era, appendicitis and hernia are common problems but their presentations in different positions are rare to be seen. It is difficult to make diagnose pre-operatively of contents as appendicitis in obstructed hernia. The term "Amyand's hernia" was lost in the literature and we are describing its pathophysiology and management. The aggravating factors are: complex injuries related to hernia (size, degree of sliding, multiplicity, etc.), patient characteristics (age, activity, respiratory disease, dysuria, obesity, constipation). If not treated in the earliest stages then it can lead to significant morbidity and mortality. Existing literature describes almost exclusively its pathophysiology, investigations and treatment. MATERIAL AND METHODS: We have focused on clinical presentation, radiological investigations and management of "Amyand's hernia". In literature, there is still confusion regarding investigations and treatment. We are presenting such rare entity managed in time without encountering any post-operative complications. RESULTS: Ultrasonography and Computed Tomography are useful tests but clinical correlation is necessary in incarcerated appendix. Regarding treatment, it is clear that if appendix is inflamed then it should be removed, but we concluded that if appendix is found to be normal in obstructed hernia then it should also be removed due to possible later inflammation. CONCLUSION: If the appendix found in the hernial sac is inflamed then chances of mortality increase. Although emergency surgery is indicated in all obstructed hernias, morbidity and mortality can be decreased if operated on time. Early recognition and its awareness, along with good surgical technique in such cases are keys to success when dealing with this problem.