Melanoma of anal canal

Melanomas are primarily tumours of the skin, but rarely occur at other sites like retina and anal canal. Anorectal melanoma is an uncommon condition associated with a very poor prognosis. The patient usually presents with per rectal bleed or mass. These are often misdiagnosed on presentation. Diagnosis is confirmed by biopsy. Treatment is abdominoperineal resection or wide local excision if tumour free margins can be obtained. We present a case of a 60 years old female who presented to the outpatient department with per rectal mass and bleed since 4 to 5 months and was diagnosed with melanoma anal canal on biopsy. CT scan abdomen and pelvis was done. Patient underwent abdominoperineal resection as wide local excision with sphincter saving was not possible due to the location and extent of tumour as seen on CT scan. Patient had an uneventful recovery after the procedure.

Hydatid cyst of broad ligament: a rare case report

Hydatid cyst is a parasitic disease caused by tapeworm Echinococcus. It affects the liver and lung most commonly, but may rarely affect fallopian tube, broad ligament and other structures. One such peculiar case is where a 17 years old female presented with a rapidly growing cystic mass in lower abdomen, clinically suspicious of ovarian mass or mesentric cyst. Investigations failed to identify the nature. On laparotomy, excision of the mass was done. Suprisingly histopathological examination identified the lesion as hydatid cyst arising from the broad ligament. Patient responded well to surgical excision followed by albendazole administration. Female genital tract hydatidosis is a rare entity and in most cases the involvement is secondary. Primary hydatid disease of female genital tract is even very rarer and generates considerable diagnostic difficulty.

Bedside Index of Severity in Acute Pancreatitis (BISAP) score for predicting prognosis in acute pancreatitis.

Introduction: Bedside Index of Severity in Acute Pancreatitis (BISAP) is a simple bedside tool which helps in early identification of risk of higher mortality in acute pancreatitis. Objectives: Our aim was to study clinical and laboratory profiles of patients with acute pancreatitis presenting to a tertiary care hospital in Mumbai, India and to stratify patients according to their risk of mortality by applying the BISAP score and its correlation with Computed Tomography Severity Index (CTSI). Material and methods: Patients who came to Lokmanya Tilak Municipal Medical College (LTMMC) and General Hospital, Mumbai with definitive features of acute pancreatitis from January, 2013 to April, 2013 were prospectively observed for 24 hours and their clinical information was collected. CT abdomen was used as the gold standard for the diagnosis of acute pancreatitis. Descriptive analysis for various patient variables was performed using SPSS. Results: Alcoholism was the most common etiology; 97% patients presented with abdominal pain. Higher serum amylase, lipase and blood urea nitrogen levels, hypocalcemia, presence of systemic inflammatory response syndrome and bilateral pleural effusion were found to significantly associate with mortality. There was a statistically significant trend for increasing mortality with increasing BISAP score (p<0.001). However, no significant correlation between BISAP score and CTSI was found [(p = 0.101), Pearson’s correlation coefficient = 0.168]. Conclusion: Traditional severity indices have not been clinically useful since they require collection of huge amount of clinical and laboratory data over time. In such circumstances, BISAP score can predict patients who are at higher risk of mortality.