The Role of Palliative Surgery in the Management of Acute Intestinal Obstruction Secondary to Peritoneal Carcinomatosis.

Introduction: Acute intestinal obstruction secondary to extensive peritoneal carcinomatosis is an end stage event. The role of palliative surgery in these patients is debatable in view of the anticipated severe complications and its doubtful role in achieving adequate palliation. The primary objective of our study was to evaluate the feasibility and ability of patients to resume oral nutrition after palliative surgery for acute intestinal obstruction due to peritoneal carcinomatosis. Patients and Methods: It is an observational study in which we retrospectively reviewed the data from a prospectively maintained clinical database of 40 patients. The predefined pre- and intraoperative variables were obtained. The immediate outcome variables like postoperative complications, length of hospital stay, and mortality were analyzed. The short-term outcomes at 3 months in the form of survival, ability to resume enteral nutrition were analyzed. Results: Among the 40 patients 18 were males and 22 females. Ovarian cancer was the most common primary (27.5%) in the study. Twelve patients had acute intestinal obstruction as their first presentation without any past events and 25 (62.5%) patients had been operated on previously or received adjuvant systemic treatment. The palliative surgical option was technically feasible in 37 (93.5%) patients. The median length of hospitalization for the patients who were discharged was 10 days with a range of 6-18 days. Six (15%) patients died in the postoperative period. Severe post-operative complications were seen in 9 (26.4%) patients. Among the patients (n=34) discharged 26 (76.4%) were alive at 3 months. In those who were alive, 21 (80.7%) of them were on some form of oral nutrition at 3 months. Conclusion: Palliative surgery in patients with acute intestinal obstruction secondary to peritoneal carcinomatosis is feasible with acceptable morbidity and mortality. The enteral nutrition can be restored in the majority of these patients.

Calcified pseudocyst: an uncommon presentation of chronic pancreatitis.

Pseudocysts are localised fluid collections, usually developing as a complication of acute or chronic pancreatitis. Pancreatic ductal or parenchymal calcifications are commonly seen in routine radiological imaging, but calcification of pseudocyst is extremely rare. Calcified pseudocysts have been reported in literature as case reports, but a calcified pseudocyst in the lesser sac, without underlying pancreatic calcification, has not been reported. We report a case of a pancreatic pseudocyst with a calcified wall, requiring surgical excision and histological examination confirming the diagnosis.

Isolated dilatation of the cystic duct-Type VI choledochal cyst: a rare case presentation and review of the literature.

An isolated cystic dilatation of the cystic duct is extremely rare and very few cases have been reported in the world literature. The existing Todani's classification does not include this as a separate entity and thereby, it has been vaguely termed as a Type VI choledochal cyst by some authors in the past. We describe a case of a young male with a Type VI choledochal cyst suspected preoperatively on imaging studies and confirmed intraoperatively by laparoscopy. The cyst was localized to the cystic duct with no involvement of the common bile duct. It was excised en masse with the gall bladder by laparoscopic cholecystectomy. Considering the rarity of these lesions, an insight into the cases reported in the world is required and knowledge about the approach to managing such cases is important in surgical practice.

Adrenal incidentaloma does it require surgical treatment? Case report and review of literature.

INTRODUCTION: Adrenal incidentalomas have a prevalence of at least 5% in the general population. Among these adrenal myelolipoma are rare nonfunctioning tumors of adrenal with an incidence of 0.1-0.2% as documented in CT and autopsy series. We report such a rare case of adrenal myelolipoma incidentally detected while evaluating a case of chronic nonspecific flank pain. PRESENTATION OF CASE: 38-year-old obese female patient, known hypertensive on treatment presented with nonspecific right flank pain since 1 year. Ultrasonography and Computed tomography of the abdomen showed right adrenal gland mass with fat density measuring 6.3cm×6.2cm×5cm. Patient underwent right side adrenalectomy, post operatively patient had an uneventful recovery. Histopathological examination of the specimen revealed features of adrenal myelolipoma. DISCUSSION: Myelolipoma is an uncommon, benign; tumor like lesion composed of mature adipose tissue admixed with hematopoietic cells. Most myelolipomas appear as unilateral adrenal masses. Adrenal myelolipomas are usually small and asymptomatic. CT or MRI detects the areas of gross fat with in the lesion. These tumors can present as acute abdomen following tumor hemorrhage which is more likely in myelolipomas greater than 4cm in size, hence warrants adrenalectomy. CONCLUSION: adrenal myelolipoma are rare benign tumors, incidentally detected on CT. CT or MRI is diagnostic. Large myelolipoma warrants surgery due to the risk of hemorrhage.