Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes.

Background Stapled hemorrhoidopexy is widely practiced worldwide since its introduction to the world of proctology and replaced conventional hemorrhoidectomy in treating hemorrhoids. The technique of executing the procedure dictates the outcomes and complications. Here, we attempted to establish the cause of postoperative complications and attributed them to the presence of muscle of fibers in the excised doughnut specimens. Materials and Methods A prospective observational analysis of histopathological specimens obtained from patients who underwent stapled hemorrhoidopexy using procedure for prolapse and hemorrhoids-03 circular staplers in the department of surgery of a tertiary care hospital in southern India was performed, and the correlation between the presence or absence of muscle fibers in the specimens and postoperative complications was evaluated. The patients were followed up for 12 months after the procedure. Results In this study, 155 patients, including 54, 91, and 10 patients with Grade 2, Grade 3, and Grade 4 hemorrhoids, respectively, were included. Group A consisted of 19 patients with muscle fibers on the specimens, whereas Group B consisted of 139 patients without muscle fibers on the specimens. Early complications within 7 days after the procedure were as follows: 21 and 0.7% of the patients in Groups A and B, respectively, presented with postoperative pain with a visual analog scale score of more than 4; 47 and 6% of the patients in Groups A and B, respectively, presented with urinary retention; 26 and 2% of the patients in Groups A and B, respectively, presented with bleeding; and 21 and 2.9% of the patients in Groups A and B, respectively, presented with fecal urgency. A significant association was found between the presence of muscle fibers and early complications ( p < 0.001). Late complications, such as proctalgia and bleeding, accounting for 36.8 and 6.6% in Groups A and B, respectively, were significantly associated with the presence of muscle fibers in histopathology ( p < 0.001). Meanwhile, other late complications, such as incontinence, stenosis, and recurrence, exhibited no association ( p > 0.05). Conclusion The technique in taking purse-string sutures and the depth of the suture bite above the dentate line carry the utmost importance in preventing postoperative complications. Therefore, surgeons should refine their technique of appropriate depth to avoid incorporation of muscle fibers while executing the procedure.

Long-term survival in a patient with carcinoid syndrome receiving treatment for Zollinger-Ellison syndrome.

A case of carcinoid syndrome in a patient receiving treatment for a malignant non-B-cell tumor of the pancreas is presented, and a survival of >14 years is noted. The probable cause is discussed. The literature is reviewed. It was found that such a presentation is rare, and long-term survival in these cases exceedingly rare.

Gastric Schwannoma: A Case Report and Review of Literature.

Schwannomas are usually benign, slow growing tumors, that originate from any nerve that has a Schwann cell sheath. Here, we report the case of a 40 year-old female patient with an incidentally noted submucosal gastric tumor while being evaluated for cervical lymphadenopathy as a part of workup for lymphoma. She underwent sleeve resection of the stomach under suspicion of a gastrointestinal stromal tumor, but postoperative histopathological and immunohistochemical findings confirmed the diagnosis of shwannoma. Although schwannomas are mostly benign, they are often indistinguishable preoperatively from malignant tumors such as gastrointestinal stromal tumors. Therefore, resection is the treatment of choice for all such tumors.

Ectopic thyroid tissue in the parotid salivary gland.

Benign ectopic thyroid tissue within the parotid salivary gland is very rare. A 32-year-old woman presented with a slowly-growing, painless mass in the parotid region. The mass, which was clinically diagnosed as a parotid tumour, was found at surgery to be cystic in nature. Histological examination showed thyroid tissue with secondary changes in the cyst wall and colloid in the lumen. On iodine isotope scan, the thyroid gland was found in its normal location. The possible origin of the ectopic thyroid tissue in the parotid salivary gland could be due to a common evolution of the thyroid and parotid glands, a heteroplasia or a metaplasia.

Spontaneous aseptic pneumoperitoneum.

Pneumoperitoneum indicates the need for urgent laparotomy. But under certain clinical situations like, patient on ventilatory support should arouse the suspicion of supradiaphragmatic source of pneumoperitoneum. Supradiaphragmatic causes account for 10%. This article describes two patients, both on ventilatory support in the intensive care unit. Failure to recognize spontaneous aseptic-pneumoperitoneum can result in unnecessary laparotomy with its risks. Hence under relevant circumstances, non-surgical causes of pneumopreitoneum should be excluded.

Double breasting technique for residual cavity in hepatic hydatid.

Nine patients with univescicular echinococcal cysts in the liver were subjected to operative removal followed by a novel technique of obliteration of the residual space in the liver. The simple double breasting procedure was not associated with any complications and there was a considerable reduction in the median operating time (2 h 15 min) as well in median hospital stay (5 days). There was no recurrence with a median follow-up of 2 years and 4 months. None of the patients received albendazole either prophylactically or post-operatively.

Meckel's diverticulitis caused by roundworm incarceration.

Meckel's diverticulitis (MD) may occur de novo or may result from a foreign body in the diverticulum. A case is reported where MD was caused by incarceration of a roundworm. There do not appear to be previous documented reports of this condition.