A case report of coexistence of ectopic lingual thyroid with hypoplastic normal thyroid gland.

Ectopic lingual thyroid along with a normally located thyroid gland is an uncommon condition caused by an aberrant descent of thyroid during embryogenesis. It is more common among females and expresses during puberty, pregnancy and menopause. It is mostly associated with hypothyroidism. Patient usually presents with complaints of dysphagia, dysphonia and suffocation. Treatment of choice depends upon the primary complaint of the patient. We present the case of a young female who underwent tracheostomy to relieve respiratory tract obstruction during puberty and was later diagnosed as a case of ectopic lingual thyroid by radioactive iodine uptake and CT scan imaging. She had an associated hypothyroidism; patient was then put on thyroxine and after making her euthyroid she was operated by transoral route and her ectopic lingual thyroid was removed. She was discharged on a maintenance dose of thyroxin.

Dermatofibrosarcoma Protuberans Of Trunk In A Male Patient.

Dermatofibrosarcoma protuberans is a rare cutaneous malignancy. Usual sites of origin are trunk and extremities. Aetiology of the condition is not well understood but a genetic basis is explained as a reciprocal translocation t (17l;22) (q22; q13). Distant metastasis is quite rare as it is mostly a locally advancing tumour. Histopathology is the most accurate investigation to make a diagnosis. Imaging is still required to rule out distant metastasis. Surgical excision is the treatment option for stage I tumours. Imatinib, a tyrosine kinase inhibitor, has shown promising results in management of locally advanced and metastatic disease.

Double Peptic Ulcer Perforation due to Cumulative Effects of Post-surgery Stress and NSAIDs: A Rare Event in Surgical Practice.

Peptic ulcer disease affects a large number of people around the world. Complications occur in 10-20% of patients and perforation develops in 2-14% of the cases. It can either be in the pyloric part of the stomach or in the first part of duodenum. Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) abuse and smoking are noted to be the most common risk factors in developing countries. Other risk factors are steroid abuse, post-surgery stress, burns and Zollinger-Ellison syndrome. Although small perforations can be treated conservatively but Graham patch repair is the treatment of choice. Double peptic ulcer perforation is a rare event with only a few cases reported worldwide. This patient presented with double peptic ulcer perforation in emergency due to post-surgery stress. She had cesarean section 10 days earlier with delayed recovery. Key Words: Peptic ulcer disease, Perforation, Graham patch repair, Cesarean section.

Delayed Splenic Rupture due to an Occult Primary Injury.

Spleen, due to its unique position and relative mobility, is the most vulnerable organ in blunt abdominal injuries. After splenic trauma, hemodynamically unstable patients are treated with splenectomy. Delayed splenic rupture presents 48 to 72 hours after blunt abdominal trauma and is a rare entity. It is usually associated with low-velocity blunt injuries. The sequela is usually a minor trauma that is concealed initially and presents later as subcapsular hematoma, hemodynamic instability, abdominal pain, and positive Kehr's sign in most cases. Computed tomography is the investigation of choice in such cases. We discuss here a case of delayed splenic rupture that presented after eight weeks of a minor abdominal injury due to a fall. The patient presented with a tender left hypochondrium, positive Kehr's sign, and tachycardia. Computed tomography of the abdomen revealed delayed splenic rupture and hemoperitoneum. As the initial imaging is usually normal in these cases, a routine follow-up and close monitoring of trauma patients can help in the early detection of complications. Key Words: Splenectomy, Splenic rupture, Kehr's sign, Hemoperitoneum.

Chylous Ascites: A Rare Initial Presentation of Pancreatic Carcinoma.

Chylous ascites as first manifestation of pancreatic carcinoma is very rare. Usual presentations of pancreatic malignancy are abdominal discomfort, back pain, obstructive jaundice and duodenal obstruction. Development of chylous ascites during the course of the disease signifies poor prognosis. Malignancy and tuberculosis are the most common causes of this condition in developed and developing countries, respectively. Diagnosis is made on elevated triglyceride levels in ascitic fluid examination. Management is directed towards the treatment of primary cause and the chylous ascites. High protein and medium chain triglyceride diet is usually advised along with Orlistat for managing this condition. Peritoneovenus shunting can also be done but at the risk of complications. Our patient developed chylous ascites early in the course of the pancreatic carcinoma. CT scan abdomen was non-conclusive and cervical lymph node biopsy later on revealed that the primary disease was occult pancreatic carcinoma. Key Word: Chylous ascites, Triglyceride level, Pancreatic carcinoma.

Spleenic Abscess As A Complication Of Extrapulmonay Tuberculosis.

Tuberculosis continues to be a fatal infectious disease in developing countries. Despite the advances in medical sciences and introduction of potent therapeutic regimes tuberculosis has still managed to survive and prevail worldwide. It can affect many organs of body. Isolated splenic tuberculosis is uncommon in immunocompetent host and only some cases are reported internationally. Extrapulmonary tuberculosis with splenic involvement is also rare and only comes after lungs and liver. We present a case of patient presented with complaints of prolonged fever, cough and insidious onset of abdominal pain and sepsis. Exploratory laparotomy revealed spleenic abscess as incidental finding associated with tuberculous perforation of colon. She underwent double barrel colostomy and spleenectomy followed by intensive care unit admission. Measures such as awareness about the disease, early medical assistance and good compliance regarding treatment can produce positive results in combating tuberculosis and its complications.

Impaction of Phytobezoar at Meckel's Diveticulum.

Small bowel obstruction secondary to phytobezoars is a rare presentation in surgery. These are masses of undigested food and vegetables, which obstruct the narrowest part of gut. We discuss a case of a young patient presenting in emergency department with history of acute abdominal pain, distension and constipation. Diagnosis of acute intestinal obstruction was made on the basis of history, examination, and initial investigations. Exploratory laparotomy revealed a phytobezoar at the origin of Meckel's diverticulum, which was an incidental finding. He underwent wedge resection with primary closure and removal of phytobezoar. The change in dietary habits, decreased fiber intake, and psychiatric evaluation can prevent recurrence.