Total Thyroidectomy for Benign Thyroid Diseases: What is the Price to be Paid?

INTRODUCTION: Total thyroidectomy has been used to treat patients with malignant thyroid disease. But for patients with benign thyroid disease, the safety and efficacy of total thyroidectomy is a matter of debate. Subtotal thyroidectomy that was previously the treatment of choice for benign thyroid disease has been associated with high recurrence rates. The risk of permanent complications is greatly increased in patients who undergo surgery for recurrence of benign thyroid disease. Total thyroidectomy is an operation that can be safely performed, with low incidence of permanent complications, which allows one to broaden its indications in various benign thyroid diseases, thus avoiding future recurrences and reoperations. AIM: To assess the benefits of total thyroidectomy for benign thyroid diseases. MATERIALS AND METHODS: This randomized prospective study was conducted between Feb 2013 and Nov 2014 in the Department of General Surgery at Bangalore Medical College and Research Institute. It included 116 patients undergoing total thyroidectomy procedure for benign thyroid disease. All cases were followed-up for a period of 6 months for incidence of RLN palsy, hypoparathyroidism, disease recurrence and number of incidental malignancies detected on postoperative histological analyses of the thyroid specimens. RESULTS: Most of the patients were in the third decade of their lives. The female to male ratio was 6.7:1. Total thyroidectomy was done for 116 benign thyroid diseases with multinodular goiter as the most common diagnosis. The incidence of postoperative hypocalcaemia was 16.37% (however, only 1 patient developed permanent hypocalcaemia) and that of wound infection was 2.58% and seroma formation was 2.58%. None of the patients included in this study had haematoma formation or RLN paralysis. An incidental malignancy was identified in 11.20% patients. CONCLUSION: Total thyroidectomy shows benefits in eradicating multinodular goiter, alleviating Grave's opthalmopathy, treating Hashimoto's thyroiditis and preventing recurrence. It decreases the likelihood of future operations for recurrent disease or completion thyroidectomy for incidental thyroid cancer thus decreasing the associated risks of increased morbidity associated with second operation. Therefore, for benign thyroid diseases requiring surgical management total thyroidectomy can be considered the treatment of choice.

Appendicular Tourniquet: A Cause of Intestinal Obstruction.

Intestinal obstruction is one of the common surgical emergencies seen in daily practice. Postoperative adhesions are notorious for being the most common cause for intestinal obstruction. Occasionally, laparotomy findings do come as a surprise to surgeons. Here one such case is discussed. A patient was operated on with suspicion of intestinal obstruction secondary to postoperative adhesions. However, laparotomy revealed the appendix to be inflamed, curled around the terminal ileum and acting as a tourniquet.

Ileostomy for Non-Traumatic Ileal Perforations: Is this the Beginning of the End?

INTRODUCTION: Ileal perforations are a common place of occurrence in emergency operation rooms around India. They are also significant contributors to mortality in our country. They are very distressing for patients because of the high morbidity of a laparotomy and in certain cases a stoma if its necessity is felt by the operating surgeon. The nature of the disease itself predisposes to a number of complications including wound infections, faecal fistulas and complications associated with a stoma. AIM: To evaluate the role of ileostomy in patients with non-traumatic ileal perforation. MATERIALS AND METHODS: A total of 192 cases of ileal perforation, diagnosed per-operatively, were prospectively studied between June 2012 and July 2014. Cases were treated according to standard resuscitation protocols and underwent repair of the ileal perforation either as primary closure or as a bowel resection and anastomosis with or without a proximal diversion ileostomy. Cases were followed up for a period of six months and immediate and late complications and outcomes were noted. RESULTS: A total of 192 patients were studied during the given study period out of which 170 (88.5%) were males. The disease was treated primarily without diversion stoma in 176 patients and in 16 patients a proximal diversion ileostomy was performed. The overall mortality was 15 (7.8%) that was noted to be not significantly different in patients with respect to the performance of a stoma. Enterocutaneous fistula was a complication seen exclusively in the non-ileostomy group whereas stomal complications were expectedly noted only in the stoma group. CONCLUSION: The authors found that though conventional ileostomy diversion may appear a safe option in patients with ileal perforations, it has its own additional morbidity, which at times can be very difficult to manage. An ileostomy is of use in a very small group of patients that is diminishing as better facilities and equipment are obtained to manage this dreaded disease.

Recurrent Primary Angiosarcoma of the Breast Presenting as Kasabach-Merritt Syndrome: A Case Report and Review of Literature.

Angiosarcoma of the breast is an unusual tumour. The diagnosis of this condition is difficult clinically, pathologically and radiologically. Treatment includes surgery followed by chemoradiation. The tumour is notorious for its recurrence and is generally associated with poor prognosis. Kasabach-Merritt syndrome also is a very rare entity seen primarily in infants with vascular malformations and carries a poor prognosis. In this report, the authors describe a patient with recurrent primary angiosarcoma of the breast, which presented as Kasabach-Merritt syndrome.

Chondromyxoid Fibroma: An Unusual Tumour at An Atypical Location.

Rib tumours are mostly secondaries arising from breast or prostrate malignancies. Among primary rib tumours, osteochondromas are reported as the commonest cause. Chondromyxoid fibromas are primary benign rib tumours that are seldom seen, occurring almost exclusively at the metaphyseal ends of large tubular bones. Here a case of chondromyxoid fibroma of rib, its clinical and radiological features, management and prognosis, is discussed which has only an occasional mention in literature.

Gastro pleural fistula: a rare entity presenting as a complication of empyema thoracis following stab injury to the chest.

Gastro pleural fistula is an infrequently seen lesion. Here, a case of stab injury to the chest that led to the formation of a gastro pleural fistula has been presented. An intercostal drainage (ICD) tube was inserted after haemothorax was identified on this chest X-ray. The patient noticed the presence of ingested food particles at the site of ICD tube twelve days following the stab injury. The diagnosis of gastro pleural fistula was subsequently confirmed after a contrast enhanced computed tomography (CECT) of the chest and abdomen. Intraoperatively, a defect in the left hemi diaphragm with a fistulous tract between stomach and the left pleural cavity was identified. Closure of the gastric fundal perforation, excision of the fistulous tract and repair of the diaphragmatic defect was done.