Primary Jejunal adenocarcinoma - An unsuspected culprit.

Primary Small bowel adenocarcinoma, a rare entity and having varied clinical presentation, makes its clinical detection a diagnostic challenge. Moreover, its true prevalence in sub-continent population has not yet been established, which makes it more difficult for its detection. We present the case of a 60 year old male who came with abdominal pain and weight loss for two years as the only symptoms. A series of tests in the two year period remained inconclusive. Later Computed tomography showed a suspicious mass at the terminal ileum. On exploration, there was a grossly dilated jejunal loop due to stricture one foot from ligament of Trietz and mesenteric lymphadenopathy. En-bloc resection of jejunum with suspicious of malignancy was done and primary end to end anastomosis was made. Histopathology and follow up metastatic workup showed poorly differentiated adenocarcinoma of jejunum with T3N1M0. Small bowel malignancy should also be kept in mind, when managing patients with weight loss of unknown origin.

Tuberculosis of Open Cholecystectomy Wound.

Tuberculosis of the wound is a rare entity. A50-year lady presented with an "on and off discharging wound" from the postoperative wound site of open cholecystectomy, which was done 7 years ago. Patient did not respond to standard antibiotic treatment regimens; and also the culture remained equivocal during this period. We explored the wound and found a mass in subcutaneous tissue. Resection of mass was done and wound left open for closure by secondary intention. Histopathology of the resected mass revealed tuberculosis. Patient was started on anti-tuberculous therapy (ATT). Patient responded to the ATTtherapy, with satisfactory healed wound at one month follow-up visit. Thus, surgeons should keep in mind the increased possibility for the tuberculous etiology of wound infection in chronic, non-healing wounds.