MRI evaluation of knee injury with arthroscopic correlation.

BACKGROUND: Magnetic Resonance Imaging has emerged as the primary investigation for evaluation of the knee injury because of its high resolution and accuracy and it has often been regarded as the noninvasive alternative to diagnostic arthroscopy. The objective of this study was to find out the various types of traumatic lesions of the knee on MRI, to correlate the results with arthroscopy, and to establish the accuracy of MRI in detecting ligament and meniscal injury. METHODS: This cross sectional study was conducted on 40 patients with knee injury over a period of one year. MRI of the knee followed by arthroscopy was performed in each case. Arthroscopy was done within 30 days of MRI examination and was considered as gold standard. RESULTS: Various types of lesion seen on MRI were as follows: joint effusion 27 (67.5%), anterior cruciate ligament tear 23 (57.5%), medial meniscus tear 20 (50%), bone contusion 18 (45%), lateral meniscus tear 16 (40%), medial collateral ligament injury 16 (40%), lateral collateral ligament injury 14 (35%) and posterior cruciate ligament tear 14 (35%). Sensitivity, specificity and accuracy of MRI in detecting meniscal and cruciate ligament injury were as follows: medial meniscus: 85.7%, 89.4%, 87.5%; for lateral meniscus: 83.3%, 95.4%, 90%; for anterior cruciate ligament: 91.3%, 88.2%, 90%; and for posterior cruciate ligament: 92.8%, 96.1%, 95% respectively. CONCLUSIONS: MRI is a noninvasive, useful and reliable diagnostic tool for evaluating knee injury and it can be used as a first line investigation in patients with knee injury.

Bile duct injuries during open and laparoscopic cholecystectomy: management and outcome.

BACKGROUND: The widespread application of laparoscopic cholecystectomy has led to a rise in the numbers of major bile duct injuries (BDI). Perioperative management of these injuries is complex and challenging. There are few published reports locally regarding the perioperative management of BDI. Purpose of this review was to analyze our experience in diagnosis, management and prevention of BDI. METHODS: This study was conducted in department of surgery at B. P. Koirala Institute of Health Sciences. From January 2001 to September 2010, a observational study of all patients with a BDI following cholecystectomy was maintained. Patients' charts were retrospectively reviewed to analyze incidence, type of injury, presentation, and perioperative management of BDI. RESULTS: A total of 92 patients had BDI which occurred during cholecystectomy, were analysed retrospectively. There were 60/92 (65.5%) patients with BDI resulting from the wrong identification of the anatomy of the Calot's triangle during cholecystectomy. Abdominal ultrasonography was diagnostic for BDI in 71/90 (78.8%). Magnetic resonance cholangiography could reveal the site of injury, the length of injured bile duct and variation of bile duct tree with a diagnostic rate 22/23 (95.6%). The most common injury was Strasberg's E2 in 65/92 (70.7%). A transection or stricture of the bile duct was repaired by hepaticojejunostomy (83 cases in this series). Seventy-five (81.5%) patients were followed up. The mean follow-up time was 2.6 years (range 0.16-6). Good results were achieved in 62/75 (82.6%) of the patients. CONCLUSIONS: The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.

Colonic inflammatory myofibroblastic tumours: an institutional review.

AIM: The aim of the study was to present the largest series of colonic inflammatory myofibroblastic tumour (C-IMFT) in the literature so far and to provide a review of this condition. METHOD: A retrospective review was carried out of a consecutive series of patients diagnosed with a C-IMFT at a community-based hospital with a specialized gastrointestinal unit between 2002 and 2011. The main outcome measures were success rate and postoperative complications. Using a set of terms we searched the PubMed database for papers published on C-IMFT. We reviewed the data from these studies and case reports. RESULTS: There were seven patients with a histopathologically proven C-IMFT. The patients' mean age was 39 ± 11.3 years. Four presented with clinical features of intestinal obstruction of varying severity and three with symptoms of anaemia. Complete surgical resection with end-to-end anastomosis was performed. The gross morphology included polypoidal myxoid tumours that served as a lead point for intussusception in two cases, a whorled mass in two and a circumferential infiltrative tumour in three. Microscopically, all tumours had typical features of IMFT with a variable expression of anaplastic lymphoma kinase (ALK-1) and tumour-free resection margins. All patients were well without local recurrence or metastasis at a mean follow-up of 46.8 ± 11.9 months. CONCLUSION: Surgical resection is effective for this rare tumour which mostly behaves in a benign manner. Our review supports the need for patients to be followed up for long periods because of the possibility of metastasis or late recurrence.

Rectosigmoid endometriosis causing an acute large bowel obstruction: a report of a case and a review of the literature.

Endometriosis is often seen in gynecology practice and is treated medically. However, intestinal involvement of endometriosis causing acute large bowel obstruction is uncommon and is difficult to differentiate from malignancy before surgery, owing to its similar colonoscopic and radiologic findings. We report a successfully-treated case of a 30-year-old woman in which endometrial infiltration of the large bowel caused acute obstruction, requiring emergency surgery to relieve the symptom and confirm the diagnosis. We present this unusual disease in general surgical practice and also review the literature.

Laryngocele masquerading as a soft tissue neck mass.

Laryngocele is a rare entity which can clinically present as a neck mass and requires Computed Tomography (CT) and laryngoscopy for diagnosis. We present an interesting case of bilateral laryngocele in a 45-year-old male presented clinically as hoarseness and left sided neck mass without any history of predisposing factors. Ultrasonography (USG) and CT features of laryngocele is also presented here.