Spontaneous Evisceration of Small Bowel in Incisional Hernia.

Spontaneous rupture of an incisional hernia leading to the evisceration of the intra-abdominal organs is one of the malefic complications seen in these patients. In addition to its rarity, it gets accompanied by possible lethality in the form of incarceration, sequential strangulation, necrosis, and eventual gangrene. If not treated aptly, the clinical scenario could lead to a life-threatening condition with a delay in timely intervention. With less than 20 documented cases, herein, we report a 48-year-old female with a previous history of a midline laparotomy who presented to us with an acute spontaneous evisceration of the small bowel. The patient was immediately decided on surgical management with exploratory laparotomy, adhesiolysis, and primary repair of the abdominal wall defect. Postoperatively, the patient improved without any complications.

Fulminant Necrotizing Pyomyositis Tropicans.

Pyomyositis tropicans is a purulent invasive infection of the striated muscle tissues, usually caused by Gram-positive bacteria Staphylococcus aureus and Streptococcus in immunocompromised patients. We hereby report a case of fulminant necrotizing pyomyositis that occurred in a 16-year-old immunocompetent patient, and it is the first one of its kind to the best of our knowledge. The patient underwent imaging which suggested extensive intramuscular abdominal wall abscess formation, for which the patient underwent multiple surgical debridements of the lateral thoracic wall. Subsequent cultures grew Escherichia coli as the causative organism. Postoperatively, the patient went into catastrophic, irreversible septic shock ending in an eventual fatality.

Incarcerated Epigastric Hernia.

An epigastric hernia is a form of ventral hernia. Most of these contain preperitoneal fat or the omentum. Herniation of intra-abdominal organs, a rare form of rectus sheath midline herniations, is seldom seen, and incarcerations in these cases are rare. A 56-year-old male presented with complaints of irreducible epigastric swelling. Thorough clinical examination and imaging studies revealed that the patient had an epigastric hernia. An intraoperative image showed that the small bowel had herniated through the epigastric defect and was obstructed; however, the small bowel was viable. The contents were reduced after enlarging the constricting ring, and anatomical repair with mesh reinforcement was done. Postoperatively, the patient had an uneventful recovery and was discharged.

Regurgitation and prolapse of oesophageal mucosa: a dramatic presentation of the oesophagitis dissecans superficialis.

Oesophagitis dissecans superficialis is a rare benign entity that is usually self-limited, characterised by sloughing of the oesophageal mucosa. We preset a 38-year-old woman, known case of epidermolysis bullosa acquisita who presented to us with regurgitation and prolapse of the oesophageal mucosa from the mouth. Upper gastrointestinal endoscopy showed sloughing of the mucosa. The patient was managed conservatively and discharged.

Hepatic Hydatid Cyst With Cystobiliary Communication and Cystoduodenal Fistula.

The liver is the most common site affected by hydatid disease. Hepatic hydatid cyst (HHC) with cystoduodenal fistula is an unusual and infrequent complication. We present a 48-year-male diagnosed with an HHC with cystobiliary communication (CBC) and cystoduodenal fistula. The patient underwent partial cystectomy. Intraoperative demonstration of CBC was done with injection propofol, followed by primary closure of the CBC. The duodenal fistula was closed primarily with an omental patch, also known as a Graham patch. The patient improved well without any complications, and there was no recurrence of the symptoms for the subsequent five-month follow-up.

Kimura Disease Presenting as Right Parotid Swelling and Neck Lymphadenopathy.

Kimura disease is a rare chronic inflammatory disorder commonly affecting young males. We present a 35-year-old male who had right parotid region and neck swellings for two years. The patient underwent imaging studies, blood investigations, and fine-needle aspiration cytology diagnostic of the Kimura disease. The patient was screened for the presence of renal disorder. However, there was no evidence of kidney involvement. The patient was started on oral steroid therapy and advised for further follow-up.

Lymphoedema praecox in a young woman: a rare disease.

Primary lymphoedema is a rare disorder. Often presents at a young age with asymptomatic limb oedema with gradual progression. We present a 16-year-old woman who presented with a history of swelling of the left lower limb for 6 years. There was the presence of isolated left lower limb oedema, which was a non-pitting type. The patient underwent imaging studies and was diagnosed to have primary lymphoedema. The patient was managed conservatively as the patient did not have any other problems other than the left lower limb oedema.

A Rare Case of Primary Small Cell Carcinoma of Esophagus.

Primary small cell carcinoma of the esophagus is a rare, highly aggressive disease with a poor prognosis. A definitive diagnosis is made by histopathological study. As the disease is usually metastatic, palliative chemoradiotherapy is the usual treatment. We present a case of a 57-year-old female presenting with dysphagia. The patient underwent imaging studies showing the growth at the gastro-esophageal junction, with extensive abdominal lymph node metastasis and liver and lung metastasis. Biopsy was suggestive of small cell carcinoma of the esophagus. The patient underwent a feeding jejunostomy and was planned for chemoradiotherapy. Primary small cell carcinoma of the esophagus is an infrequent entity. As the disease is usually diagnosed at a later stage, the prognosis is inferior and abysmal.

A Rare Case of Occult Extra-Baudet Period in a Patient With Spontaneous Splenic Rupture.

Spontaneous splenic rupture in the extra-Baudet period is a rare phenomenon demanding a high clinical suspicion for diagnosis with prompt treatment. We present a case of a 39-year-old male presenting with left upper abdominal pain following six months after abdominal trauma. The patient underwent imaging studies showing a large subcapsular splenic hematoma with near-total parenchymal displacement and moderate hemoperitoneum. Sequential scans revealed a non-progressive resolving hematoma with no active extravasation. The patient underwent aggressive initial resuscitation followed by successful conservative management and was discharged.

A Rare Occurrence of Cutaneous Recurrence in a Patient of Post Modified Radical Mastectomy.

Carcinoma breast is the second most common malignancy in females. Due to the recent awareness and medical advances, most of the cases are diagnosed and treated at an early stage. Cutaneous recurrence without other distant metastasis post-surgery in carcinoma breast is usually uncommon. We report a 52-year-old lady who presented to us with cutaneous recurrence of carcinoma right breast, post neoadjuvant chemotherapy and modified radical mastectomy. The diagnosis was confirmed on histopathology after the biopsy from the cutaneous nodule. The patient was discussed in the tumor board and planned for palliative chemotherapy considering extensive cutaneous metastasis.

Caecal Volvulus Presenting as the Obstructed Right Inguinal Hernia.

Caecal volvulus is an uncommon cause of intestinal obstruction with varied clinical presentation. Surgical intervention without delay is considered the gold standard in its management. Strangulated inguinal hernia with caecal volvulus is a rarity. We report a case of a 55-year-old male with a history of long-standing right inguinal hernia, presented with the irreducibility of the hernia along with pain for one day. Clinically patient was diagnosed to have an obstructed inguinal hernia. On exploration, we found that there was a caecal volvulus in the hernia sac along with gangrene of the distal ileum, redundant sigmoid, and ascending colon. Resection and anastomosis of the gangrenous segment of the bowel were done along with herniorrhaphy and sigmoidopexy. Postoperatively patient improved without any complication.

Catastrophic Sequalae Following Percutaneous Intervention in Case of Sigmoidectomy for Sigmoid Volvulus.

Injury to the inferior epigastric artery is infrequent and iatrogenic in most cases, which can be fatal and life-threatening in some cases due to unnoticed excessive hemorrhage. We present a 23-year-old male who underwent sigmoidectomy, end-to-end colorectal anastomosis with covering loop ileostomy for sigmoid volvulus. He developed intra-abdominal pus collection one week following surgery, for which ultrasound-guided aspiration was attempted. Post aspiration, the patient developed abdominal distension, pain with a significant drop in hemoglobin. Imaging showed active bleed from the branch of the inferior epigastric artery with massive intra-abdominal hematoma. The hematoma was evacuated, and the bleeding artery was identified and ligated. Postoperatively, there was no further drop in hemoglobin, and the patient was stable and hence discharged.

A Rare Case of Primary Anorectal Malignant Melanoma.

Malignant melanoma affecting the anorectum is very rare. We present a 63-year-old female who presented with features of bleeding per rectum and painful defecation. On examination, the patient had a palpable mass on the right side of the anorectum, with predominant exophytic growth and intraluminal extension. Biopsy and imaging studies were diagnostic of malignant melanoma. The patient was discussed on the tumor board and planned for abdominoperineal resection. Postoperatively, the patient was started on chemotherapy. The patient was followed up for two years, and there was no evidence of any recurrence.

Feeding gastrostomy stoma site cutaneous myiasis: a rare entity.

Infestation of any dead or necrotic tissues by the larvae of flies (maggots) is myiasis. This form of habitation is not restricted to any particular tissues in the body and can occur anywhere. However, myiasis at the surgical stoma site is very rare. We present a 55-year-old woman diagnosed with metastatic carcinoma of the oesophagus who underwent feeding gastrostomy (FG). The patient later presented with worms at the FG site. We removed the FG tube, cleared all the maggots, thoroughly cleaned the wound and placed a new FG tube. Although its occurrences have been reported enough in medical history, there are only two documented cases of percutaneous endoscopic gastrostomy stoma site myiasis. Hence, we present the first case in the literature of cutaneous myiasis around an FG stoma site.

Intestinal Obstruction Due to Giant Bilateral Krukenberg's Tumors Synchronous of Colorectal Origin.

Giant bilateral Krukenberg tumors are rarely seen, especially causing complications due to their size. We present a 35-year-old female, diagnosed with carcinoma rectum one year back, now presented to us with intestinal obstruction features. Imaging was suggestive of features of acute intestinal obstruction. Intraoperatively, we found that the patient had bilateral giant ovarian cysts, which compressed the proximal part of the descending colon, causing the obstruction. The patient underwent bilateral excision of the ovarian cyst with diversion sigmoid colostomy. Postoperatively the patient was started on palliative chemotherapy.

Antegrade Jejunojejunal Intussusception: An Unusual Complication Following Feeding Jejunostomy.

Feeding jejunostomy (FJ) is a simple surgical procedure for enteral nutrition. But it can develop complications that may require re-exploration and can be life-threatening. Common complications include mechanical ones such as tube migration or dislocation, infection, gastrointestinal symptoms and fluid and electrolyte imbalances. However, intussusception is a rare complication of FJ. A 54-year-old gentleman underwent a D2 subtotal gastrectomy with Roux-en-Y gastrojejunostomy with FJ. On the sixth postoperative day, he developed severe colicky pain associated with abdominal distension and bilious vomiting. Ultrasonography and computed tomography revealed a 10-cm long jejunojejunal intussusception with the FJ tube at the center of the intussusception with proximal jejunal loops' distension. The patient was taken up for a re-exploratory laparotomy with manual reduction of the intussusception and a new FJ insertion distal to the previous enterotomy site. The patient had an uneventful postoperative recovery.

Left Gastric Artery Pseudoaneurysm Due to Pancreatitis.

Acute or chronic pancreatitis can cause pseudoaneurysms of visceral arteries. The left gastric artery (LGA) is the least common visceral artery being affected. Here, we report a case of chronic pancreatitis with a pseudoaneurysm of the LGA. A 42-year-old male, a chronic alcoholic, and smoker, presented with abdominal pain, haematemesis, and melena. Diagnosis of pseudoaneurysm of LGA aneurysm was confirmed by computed tomography abdomen. The endovascular coil embolization was done successfully, following which the patient had an uneventful recovery.

Small Cell Carcinoma of Gallbladder With Nodal Metastasis Mimicking As Synchronous Malignancy in Gallbladder and Common Bile Duct.

Small cell carcinoma of the gallbladder is an extremely rare disease. Even with current aggressive and diverse treatments, small cell carcinoma of the gallbladder has an extremely poor prognosis. The presence of synchronous malignancies in the gallbladder and the biliary tract is even rare. Synchronous malignancy can be due to either local spread or metastasis. It can also occur due to field change in the extrahepatic malignancy or can arise de novo as multifocal malignancy. Small cell carcinoma of gallbladder with nodal metastasis mimicking as synchronous malignancy in the gallbladder and distal common bile duct is rare. We report a 74-year-old male who presented with abdominal pain and jaundice. Initial imaging studies were suggestive of the possibility of synchronous malignancy in the gallbladder and common bile duct. However, further imaging studies showed that carcinoma of the gallbladder had metastasis to the lymph nodes, causing external compression to the common bile duct rather than synchronous malignancy. Cytology was diagnostic of small cell carcinoma of the gallbladder. The patient had metastasis to other sites also. The patient underwent endoscopic retrograde cholangiopancreatography with stenting and started on palliative platinum-based chemotherapy with cisplatin and gemcitabine, and he is under regular follow-up.