Retrospective histopathologic findings of routine cholecystectomy specimens in a teaching hospital in North East India.

Background: Cholecystectomy is one of the most common general surgical operations performed worldwide. Limited data is available about the histopathological diagnoses of various gallbladder diseases in North Eastern part of India even though a higher incidence of gallbladder cancer has been reported from this part of the Country. Hence, a retrospective review of the histopathological findings of routine cholecystectomy specimens was done to assess the incidence of gallbladder cancer and other gallbladder pathologies. Aims and Objective: To study the incidence of gallbladder cancer and other pathologic findings in routine cholecystectomy specimens. Methodology: A retrospective study of the histopathological findings of cholecystectomy specimens with presumed benign gallbladder diseases who had undergone cholecystectomy from June 2013 till October 2021. Results: A total of 1683 patients had undergone cholecystectomy during the study period. In total, 1354 patients underwent laparoscopic cholecystectomy and 339 patients underwent open cholecystectomy. Gallstones were present in 1631 patients. Chronic cholecystitis and cholesterosis were the most common histopathologic findings, followed by pyloric metaplasia. Unsuspected gallbladder cancer was detected in eight patients (0.48%). Conclusion: Chronic cholecystitis was the most common histopathologic finding followed by pyloric metaplasia. Gallstones were found in most patients. Incidental gallbladder cancer was detected in 0.48% of patients.

Enhancement pattern of differentiated and undifferentiated gastric carcinoma on multiphasic contrast-enhanced computed tomography.

PURPOSE: To study the enhancement pattern of differentiated and undifferentiated gastric carcinoma on multiphasic contrast-enhanced computed tomography (CT). MATERIAL AND METHODS: Seventy patients with biopsy-proven gastric cancer underwent multiphasic contrast-enhanced CT. The CT protocol include plain, arterial, portal venous, and hepatic venous phase. Tumour size, location, peak-enhancement characteristics, and staging were evaluated. RESULTS: The peak-enhancement type was 'arterial' in 20 out of 28 within the differentiated-type GCAs and 'portalvenous' in 37 out of 42 within the undifferentiated-type GCAs (c2 statistic with Yates correction = 23.3981, p < 0.00001). The maximum attenuation value was statistically significant for the arterial phase between differentiated and undifferentiated GCAs (p < 0.05). CONCLUSIONS: Assessing peak-enhancement in a multiphasic CT can help identify the histological subcategory of gastric carcinomas that has prognostic significance. Arterial phase peak-enhancement is frequently seen in differentiated carcinomas whereas venous phase peak-enhancement is seen in undifferentiated carcinomas.

Primary inflammatory myofibroblastic tumor of stomach-report of a very rare case.

Primary inflammatory myofibroblastic tumor (IMT) is a very rare tumor arising from stomach and it closely mimics gastric GIST. It usually affects the lung and found in children and young patients. The diagnosis of gastric IMT is usually done post-operatively by immunohistochemistry examination where it is seen that IMT is positive to SMA and vimentin. Complete surgical excision is the treatment of choice and local recurrence is usually seen in incompletely resected cases.

Meckel's diverticulum causing acute intestinal obstruction: Report of two cases.

Reporting herewith 2 cases of Meckel's diverticulum presenting with acute intestinal obstruction. The patients were managed surgically. The cases were presented in emergency department and management were based on clinical and imaging after a initial resuscitation. The intra-operative findings are discussed in herewith.

A comparative study of postoperative port-site pain after gallbladder retrieval from umbilical versus epigastric ports in laparoscopic cholecystectomy.

INTRODUCTION: Gall bladder (GB) retrieval is an important cause for postoperative pain after laparoscopic cholecystectomy (LC). GB is usually extracted either from the epigastric or the umbilical port and there are limited data to decide the superiority of one over other in terms of postoperative pain. This study was designed to determine whether GB retrieval from the umbilical port was associated with less pain as compared to epigastric port in adult patients undergoing four ports elective LC. MATERIAL AND METHODS: A total of 100 patients took part in the study and were randomly allocated into 2 groups. Postoperatively, port-site pain score was assessed at 1, 6, 12, and 24 h by visual analog scale (VAS) score both for the epigastric and umbilical ports in all the patients and the collected data were analyzed by using SPSS version 22. RESULT: VAS score for postoperative pain at epigastric port at 1, 6, 12, and 24 h found to be higher as compared to umbilical port (6.640 ± 1.494 vs. 5.500 ± 1.176, 6.620 ± 1.549 vs. 5.320 ± 1.188, 6.100 ± 1.549 vs. 4.660 ± 1.232, 5.250 ± 1.459 vs. 3.970 ± 1.274, respectively) which was statistically significant (P value 0.001). But the time taken for retrieval of GB was significantly longer in the umbilical group (4.94 ± 1.56 vs. 3.24 ± 1.29). CONCLUSION: Umbilical port is better as compared to epigastric port for GB retrieval in patient undergoing elective four port LC in terms of postoperative port-site pain but it takes relatively longer time for the extraction.

Spontaneous Enterocutaneous Fistula Resulting from Richter's Hernia.

Richter's hernia is due to the entrapment of a part of circumference of the bowel wall. As the bowel continuity is maintained, the patients usually do not have intestinal obstruction. Some patients with Richter's hernia may present with enterocutaneous fistula either spontaneous or due to surgical intervention mistaking the obstructed hernia to be inguinal abscess. This is more so in developing countries due to lack of awareness among the masses or due to the delay in seeking medical attention. Presenting here is a case of a 53-year-old male patient with enterocutaneous fistula which occurred spontaneously and sought medical attention only after about three years of repeated discharge of yellowish fluid from the left inguinal region. Magnetic resonance fistulogram confirmed the diagnosis of enterocutaneous fistula. Laparotomy with resection and primary anastomosis of the fistulous bowel was done. Patient recovered uneventfully without any complications or recurrence.

Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences.

BACKGROUND: Although burns are a major problem in health care, a lot of the variation in risk factors exists from region to region which if uncovered correctly could help take effective prevention measures. AIMS AND OBJECTIVES: To assess the 3-year (January 2012 to January 2015) epidemiology of burn injuries admitted to our hospital (primary objective) and to find areas of improvement in burn care (secondary objective). MATERIALS AND METHODS: After obtaining ethical approval data were obtained from the medical record section regarding age, sex, residence, occupation, marital status, socioeconomic status, dates of admission and discharge, circumstances regarding the place, intent, cause, and source of heat. Clinical assessment was done using Wallace's "Rule of Nine" in adult and "Lund and Browder" chart in the pediatric age groups. The interrelationships between clinical and epidemiological variables with burn injury were studied. RESULTS: An increasing trend in the admission rates of burn victims noted in last 3 years males (55.47%) outnumbered females (44.52%). The most common age group affected is older children, adolescents, and young adults (between 11 and 30 years). Flame (38.3%) and scald (25.3%) burns contributed to most of the injuries. Females (52.30%) are the major victim of flame burns. Electrical and chemical burns affected only the males suggesting work-related injuries. Trunk (30.8%) is the most severely affected site in all cases. Depression (6.8%) and power line workers (4.7%) seem to be important risk factors in our study. Inability to complete treatment (26.7%) was a major concern in our study. CONCLUSIONS: This study highlights the need for proper burn care that could be provided at the primary health-care level. The majority of burns were accidental in nature in school going children, young adults, and females. Flame and scald burns were the most common cause. Preventive measures directed toward burn safety and first aid measures may improve the outcome in burn injuries.

Laparoscopic cholecystectomy under epidural anesthesia: a feasibility study.

BACKGROUND: Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia. AIMS: The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated. MATERIALS AND METHODS: In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study. RESULTS: The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia. CONCLUSIONS: The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.