RESUMO
Background Cholecystectomy is one of the most commonly performed surgical procedures, and it is indicated for symptomatic gallstone disease. Symptoms of gallstone disease vary; many patients complain of the persistence of symptoms post-operatively. Hence, it is imperative to know the characteristics of symptoms that predict post-operative resolution. Methodology A prospective cross-sectional study was performed at a tertiary care centre. Patient demography and pre-operative symptoms were noted. Post-operative persistence or relief of symptoms was also documented. The occurrence of any new symptoms was noted. Data were collected at three and six months after surgery. Results Pain was the most common (85%) symptom. The mean frequency of pain was 2.45 per year (range 0-10). The mean duration of pain was 39.7 minutes (range 15-90 minutes). The right hypochondrium (39%) and the epigastric region (42%), along with 8% of patients who experienced pain in both places, were the most frequent locations of pain. The radiation of pain to the right-side scapula is present in 48% of patients. The pain persisted after one-week follow-up in 28 (34%) of patients, 26 (22%) at the end of one month, and 18 (21%) at the end of six months. Dyspepsia was unresolved in 25%, 20%, and 13% of individuals after one week, one month, and six months, respectively. Upper abdominal discomfort was still persistent in 29%, 26%, and 24% of study subjects at the time of follow-up periods, respectively. Similar persistence is found in symptoms of post-prandial fullness and nausea, where unresolved complaints of post-prandial fullness were present in 18%, 13%, and 10% of patients, respectively, and 26%, 14%, and 10% of patients complained of nausea. Conclusion The persistence of symptoms such as upper abdominal discomfort, dyspepsia, post-prandial fullness, and nausea is present, which gradually decreases in severity and presentation over the course of time after the surgical procedure. Some symptoms present after surgery, such as flatulence. Such persistent symptoms might lead to a decreased outcome in terms of patient satisfaction. Patients with atypical pain or dyspepsia need to be counselled pre-operatively regarding the poor resolution of such symptoms.
RESUMO
Phyllodes tumor (PT) is a rare benign tumor of the breast with a propensity to recur and metastasize. Ductal carcinoma in situ (DCIS) within PT is an extremely rare finding and is usually diagnosed postoperatively. We present a case of a 36-year-old female with a recurrent lump in her left breast diagnosed as a benign PT. Preoperatively, aspiration cytology revealed DCIS within the known case of recurrent PT. Emergency left modified radical mastectomy was performed due to an uncontrolled sudden hemorrhage from the tumor. Postoperatively, hormonal therapy was started based on immuno-histopathological findings. DCIS in PT is not encountered frequently and hence no standard management protocol exists for such cases, but when detected by histopathology, the clinical management and prognosis have to undergo a complete change. Preoperative diagnosis and proper individualized management by a multidisciplinary team that ensures clear surgical margins and planned adjuvant therapy play a crucial role in preventing the recurrence of DCIS within PT.
