Expecting the Unexpected: Adenocarcinoma of Duodenojejunal Flexure in a 15-Year-Old.

A 15-year-old female patient presented to emergency with bilious vomiting after taking meals for the last 3 months along with intermittent colicky pain in the epigastrium for the last 1 month. Initially, the frequency of vomiting was 2-3 times/week which gradually increased to 4-5 times/day in the last 2 weeks. She had no history of any abdominal pathology or past history of tuberculosis or abdominal surgery. A review of systems showed she had a weight loss of about 10 kgs in the last 3 months along with loss of appetite. Physical examination revealed soft distention of the upper abdomen with mild tenderness in the epigastrium. CT scan of the abdomen showed concentric heterogenous luminal narrowing near duodenojejunal flexure with gross dilatation of the duodenum and stomach. The patient underwent resection of D4 and proximal jejunum with side-to-side D2-jejunum anastomosis. Histopathological examination revealed the luminal lesion to be an adenocarcinoma.

Platysma Sign: A Feature of Extra-capsular Spread.

A 60-year-old gentleman presented with a large swelling on the left side of his neck which was diagnosed as a metastatic cervical lymph node. It infiltrated the platysma muscle and caused partial contracture. This is known as Platysma sign. Presence of this sign indicates extracapsular spread and shows poor prognosis. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-023-01815-8.

The 'nick' or 'clip'? A giant hepatic artery pseudoaneurysm complicating laparoscopic cholecystectomy.

Right hepatic artery pseudoneurysm (HAPA) is a rare but potentially lethal complication following laparoscopic cholecystectomy. Its incidence is as low as 0.6%-0.8% and usually presents within the first month following the surgery due to iatrogenic injury to the concerned artery. A high index of suspicion is essential since it may often be missed leading to a catastrophic outcome. Often a contrast-enhanced computer-aided tomography of the abdomen done as evaluation of postcholecystectomy state suggests a pseudoanerysm. We report a single case of a 27-year-old female who presented to us and deteriorated rapidly due to a ruptured right HAPA, with an acute abdomen and melena, who was surgically managed by exploration and excision of the pseudoaneurysmal sac due to unavailability of transarterial embolization. During surgery, the cystic artery metal clip was seen eroding in hepatic artery producing pseudoanerysm.

Achieving Perfect Hand Washing: an Audit Cycle with Surgical Internees.

The aim of this study is to achieve 100% compliance in surgical hand antisepsis along with identification of areas of worst compliance and efficacies of various interventions best suited to deal with them. This audit was performed over 6 days in a tertiary care hospital in Calcutta, India, with 42 surgical internees. Compliance to ideal hand washing technique was recorded after each attempt with the first attempt as baseline. Video demonstration, personal demonstration by a consultant, and individual instruction were used as subsequent interventions to achieve 100% compliance. The baseline level of compliance was found to be 33.59%. A total of 6 attempts was required to achieve 100% compliance, with the increase in compliance being statistically significant (p = 0.0294). Personal instruction was found to be the most effective intervention. Hand washing technique was the criterion that needed the most number of attempts (n = 6) to rectify. This study found video-based instruction and individual guidance effective teaching tools for surgical hand disinfection and gave novel data regarding the reasons responsible for poor compliance to proper hand washing in a general surgical setting. This study demonstrated the efficiency of audit cycles in the improvement of surgical hand washing and can be the preferred mode of intervention in future studies aimed at achieving ideal hand antisepsis.

Surgical emergencies in pregnancy in the era of modern diagnostics and treatment.

Pregnancy can be complicated with different surgical emergencies which may potentially endanger the mother as well as foetus. In the modern era of advanced diagnostics and treatments, neither of them in response to a surgical emergency in a pregnant woman should be delayed. Appropriate early intervention is essential to decrease the morbidity and mortality. Following article encompasses common surgical emergencies that can arise in a pregnant woman and tries to suggest the approach that may be taken to reduce the burden of morbidity and mortality.

Scabbard Trachea in a Case of Retrosternal Goitre.

Scabbard is the sheath used for covering swords, knives or other large blades. A scabbard trachea is called so because of its resemblance of shape (Fig. 1) caused by lateral compression usually by thyroid enlargement. Here we present such a case depicting the radiological findings of a scabbard trachea.

A Field Fire Ulcer.

Basal cell carcinoma (BCC) is the most common skin cancer, mostly affecting areas of the skin exposed to UV radiation. Though metastasis is rare, the tumour may be locally invasive with a high recurrence rate. Pathophysiology involves neoplastic transformation of the pluripotent cells of the epidermis and follicular epithelium. 'Field fire BCC' is an uncommon type of BCC, showing concomitant crusting, ulceration and scarring which spreads peripherally with a central area of regression.

Strangulated double omental hernia presenting as an epigastric lump.

Internal herniations constitute one of the relatively uncommon surgical emergencies. Among them double omental hernia with bowel strangulation is very rare and is a major diagnostic challenge. A case of a strangulated double omental hernia in a 42-year-old female patient is reported. The patient presented with a painful tender epigastric lump.There was a diagnostic dilemma. CT scan was followed by laparotomy which revealed a strangulated double omental hernia.

Profile of colorectal cancer in Eastern India.

Although colorectal cancer is a major cause of concern in the western population, recent studies are showing the incidence and mortality of colorectal cancer to be rapidly rising in Asia. The present study is an insight into the epidemiological profile of colorectal cancer of a representative Eastern Indian population. Over a period of three years, all histologically proved patients with colorectal cancer were assessed for age, sex, body mass index, dietary habits, socioeconomic status and stage of disease. Of a total of 168 patients male to female ratio was 1.7:1.The mean age of presentation was 47.01 years. Although colorectal cancer has been known as a disease of sedentary obese men, 41.66% of the patients were from a low socioeconomic rural set-up and 40.47% were involved in heavy physical labour with only 15% of being obese; 62% patients were harbouring a locally advanced disease at the time of presentation. The epidemiological pattern of colorectal cancer in India is different from that of the west as regards to earlier age of presentation, prevalence in low socio economic class with low fat diet and scanty meat intake.

An epidemiological analysis of patients with abdominal trauma in an eastern Indian metropolitan city.

The profile and pattern of abdominal trauma is changing with progressing civilisation. We are lacking epidemiological data from most parts of the world. This study was conducted to prepare a database in our set up and look into the pattern of abdominal trauma, make an aetiological correlation of abdominal trauma with the types of injuries, identify the preventable factors causing delay in intervention and, compare the data with the other available national and international data. This prospective, observational study was done in a teaching hospital in a metropolitan city of eastern India. Records of patients with abdominal trauma were collected in predesigned forms, from admission to discharge. Data were analysed applying standard statistical techniques. Males (87.3%) predominated with the age range between 21 and 30 years, and the majority (73.5%) had blunt abdominal trauma. Compression injury (57.3%) commonly caused blunt trauma and stab injuries caused majority of penetrating trauma. The commonest organ injured both in blunt and penetrating trauma was small bowel (30.7% and 33.3% respectively). It was found that prehospital trauma care is virtually non-existent in this region. We are lacking a uniform protocol for the management of abdominal trauma across the hospitals. With the availability of better investigational modalities we are moving more towards a conservative approach to the abdominal trauma patients, especially the blunt abdominal trauma patients with solid organ injuries.

Herniation of a broad ligament dermoid cyst through sciatic foramen--a rare cause of gluteal swelling.

A 35-year-old lady presented with a slowly growing lump in her left buttock. Examination revealed a soft, partly reducible swelling having expansile impulse on coughing. CT scan and real time ultrasound showed it to be an extension of intrapelvic cystic space occupying lesion. At laparotomy, the cyst was found to be arising in between two layers of broad ligament and leaving the pelvis through greater sciatic foramen. Contents of the cyst were cheesy material and hair. Histopathological examination of the cyst wall confirmed the diagnosis. As such, sciatic hernia is a very rare surgical entity. Over and above, herniation of a dermoid cyst arising in the broad ligament is also an equally rare event.

Franz kaspar hasselbach (1759-1816).

Franz Kaspar Hasselbach (1759-1816) was an eminent anatomist and surgeon, remembered for his invaluable contributions in fields of anatomy and surgery. He gave accurate discription of triangle of Hasselbach made almost 200 years back, and it forms the basis of classification of inguinal hernia and is the cornerstone for laparoscopic repair of hernia, unheard of in his era. He has a number of eponyms named after him.