Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis.

BACKGROUND: To determine the indications, nature, and rate of early complications of temporary loop ileostomy created in emergency for benign diseases, their management, and to find out the associated risk factors. METHODS: A total of 630 patients undergoing temporary loop ileostomy for benign diseases were studied prospectively over a period of 6 years. Stoma-related early complications occurring within 6-8 weeks were analyzed. Only emergency cases were included in this study. Descriptive statistics were used to summarize the data and statistical significance was evaluated by applying the Pearson's chi-square test. RESULTS: Typhoid perforation (n=402) was the most commonpathology, followed by tuberculosis (n=106); trauma (n=81); and intestinal obstruction with gangrenous bowel (n=41). 299 patients had no stoma-related complications. Skin excoriation was the most commonstoma-related complication. Age more than 50 years; shock at presentation; delay in presentation; delay in surgery; presence of comorbidities; and surgery done out of working hours, were associated with increased complications. CONCLUSION: Temporary loop ileostomy for perforation peritonitis due to benign systemic diseases like typhoid fever and tuberculosis confers a very high morbidity.

Pancreatic Tuberculosis.

Tuberculosis of the pancreas is extremely rare and in most of the cases mimics pancreatic carcinoma. There are a number of case reports on pancreatic tuberculosis with various different presentations, but only a few case series have been published, and most of our knowledge about this disease comes from individual case reports. Patients of pancreatic tuberculosis may remain asymptomatic initially and manifest as an abscess or a mass involving local lymph nodes and usually present with non-specific features. Pancreatic tuberculosis may present with a wide range of imaging findings. It is difficult to diagnose tuberculosis of pancreas on imaging studies as they may present with masses, cystic lesions or abscesses and mass lesions in most of the cases mimic pancreatic carcinoma. As it is a rare entity, it cannot be recommended but suggested that pancreatic tuberculosis should be considered in cases with a large space occupying lesions associated with necrotic peripancreatic lymph nodes and constitutional symptoms. Ultrasonography/computed tomography/endosonography-guided biopsy is the recommended diagnostic technique. Most patients achieve complete cure with standard antituberculous therapy. The aims of this study are to review clinical presentation, diagnostic studies, and management of pancreatic tuberculosis and to present our experience of 5 cases of pancreatic tuberculosis.

Periappendicitis: our 13 year experience.

INTRODUCTION: Periappendicitis is defined as appendiceal serosal inflammation without mucosal involvement. It is a rare benign pathology, diagnosis is difficult and carries high morbidity. A detailed literature and large series are still lacking on periappendicitis. Aim of this study is to present our clinical experience with periappendicitis. METHODS: 36 of retrospectively reviewed 1232 acute appendicitis patients were found to have periappendicitis on histopathological examination. Histopathological finding of appendicitis with periappendicitis in emergency appendectomy, and cases of interval appendectomy were excluded. Descriptive statistics were used to summarize the data. RESULTS: The most common diagnosis was salpingitis (12), followed by pelvic inflammatory disease (9), typhoid enteritis (5), peritoneal tuberculosis (3), inflammatory bowel disease (3), and amoebiasis (1), while 3 cases remained undiagnosed. DISCUSSION: Periappendicitis is due to extra-appendicular pathologies resulting in serosal inflammation of the appendix without mucosal involvement. In the absence of any significant history, it is difficult to distinguish periappendicitis from the common entity of acute appendicitis only on the basis of clinical examination and laboratory parameters. CONCLUSION: Pre-operatively, it is difficult to diagnose periappendicitis, but it should be considered if the clinical signs and imaging findings are suggestive of any associated pathology in addition to the presence of typical picture of acute appendicitis and post-operatively if the patient develops any new clinical signs, as this can cause morbidity to a significant level.

Pancake kidney: A rare developmental anomaly.

There are many developmental anomalies of the kidney. Pancake kidney is one of the rarest types of renal ectopia. We report a case of pancake kidney which was detected incidentally while treating a female patient for a urinary tract infection. Although urinary system anomalies often coexist with malformations of other organs and systems, no associated anomalies could be detected in this case. Pancake kidney is usually managed by surgery, but this case was managed conservatively without any complication.

Acinar cell carcinoma: a rare pancreatic malignancy.

Acinar cell carcinoma of the pancreas is a rare pancreatic malignancy, constituting only 1-2% of all the pancreatic tumors. A young adult male presented with chronic diarrhea and upper abdominal pain, on investigations was found to have a large pancreatic tumor of size 12×7.5 cm involving the body of the pancreas. Pancreatic body and tail resection with splenectomy was done and final histopathological examination showed acinar cell carcinoma of the pancreas. Prognosis of acinar cell carcinoma is better than adenocarcinoma of the pancreas.

Extraosseous Ewing's tumor of lateral abdominal wall.

Extraosseous Ewings tumor (EES) is a rare entity. Few cases have been reported in literature. There are no specific guidelines for management of this disease. We are reporting a case of EES arising from left lateral abdominal wall. We did wide excision of tumor followed by chemoradiation. Patient is asymptomatic after 8 months of follow up.