Isolated duodenal adenoma presenting as gastrointestinal bleed - a case report.

Duodenal polyps are rare lesions in patients undergoing Esophago-gastro-duodenoscopy (EGD), and the prevalence varies widely with range of 0.3-4.6% of cases. Duodenal adenomas most commonly occur in association with familial adenomatous polyposis. Isolated occurrence of such adenomas is very rare and presentation as upper gastrointestinal (GI) haemorrhage is even rarer. We herein report a case of elderly male patient presenting to emergency department with features of upper GI bleeding. Patient was resuscitated followed by EGD was done. On EGD bleeding duodenal polyp was found and endoscopic polypectomy was done to control the bleeding. Subsequent colonoscopy was done and was normal. The histopathological examination of the polypectomy specimen revealed tubular adenomatous polyp which is a premalignant condition. We also highlight the clinical presentation, histological types and treatment modalities available in the literature. However, there is lack of consensus regarding the outcome of various procedure described in the literature.

Laparoscopic Colorectal Surgery: An Update (with Special Reference to Indian Scenario).

Laparoscopic cholecystectomy, being already declared as gold standard technique, laparoscopic surgery has advanced far and wide, touching almost every corner of the abdomen. This advancement has gradually expanded to colorectal surgery which is done for malignant diseases as well. However, laparoscopic colorectal surgery has not been accepted as quickly as was laparoscopic cholecystectomy. This is because of its steep learning curve, concerns with oncological outcomes, lack of randomized control trials (RCTs) and initial reports on high port site recurrences which occurred after curative resections. But all these initial concerns have been overcome by doing a series of RCTs globally, in the past decade, that revealed that laparoscopic colorectal surgery for malignant disease offered short term benefits without compromising on oncological principles of radicality of resection, tumour resection margins and completeness of lymph node harvesting as compared to those of open surgery. Favourable post-operative results with respect to less blood loss, less pain, lesser surgical site infections, lesser requirement of analgesics, early return of bowel function and shorter hospital stay in patients who underwent laparoscopic colorectal resections were obtained in studies done on individual series, including those done in India and more recently, in large trials. An update on recent studies done on laparoscopic colorectal surgery by reviewing many RCTs and individual series, including our experiences, was made, to support the advantages of this procedure which were obtained when it was carried out by skilled hands.

Simultaneous continuous ambulatory peritoneal dialysis catheter implantation and inguinal hernia repair.

Continuous ambulatory peritoneal dialysis is a new modality of treatment for end stage renal disease. Although this procedure is largely underutilised in India, in Manipur this procedure is routinely offered to patients of end stage renal disease. Continuous ambulatory peritoneal dialysis catheter implantation was started in Manipur in May, 2001. Till now continuous ambulatory peritoneal dialysis catheter has been implanted in 116 cases. Out of this 3 patients had associated inguinal hernia. Inguinal hernia is a relative contra-indication for continuous ambulatory peritoneal dialysis. Still the inguinal hernia was repaired in the same sitting with the catheter implantation. The procedure is described along with the outcome.

Laparoscopic common bile duct exploration for extraction of a round worm.

A 35 years old lady presented with fever, biliary colic, mild jaundice, indigestion and flatulence. The upper abdominal ultrasonography revealed cholecystitis with sludge and a round worm in the common bile duct. Laparoscopic cholecystectomy and exploration of the bile duct for the removal of round worm was performed. The post-operative period was uneventful and the patient was discharged fit on the 4th post-operative day.

Jejunal carcinoma.

We report here the case of a patient with jejunal adenocarcinoma who presented with features of upper gut obstruction and was diagnosed post-operatively on histology.

Colorectal cancer in younger patients.

Colorectal cancer is uncommon in India and particularly so in the younger age group below 40 years. The present study reports 18 patients with colorectal cancer between the age of 21 to 30 years. Rectum (n = 15, 83%) was the commonest site of the lesion and rectal bleed was the presenting feature in most (n = 16, 89%). Histopathologically, 9 (50%) had poorly differentiated adenocarcinoma. The tumor was unresectable in 5 patients (28%). Fourteen patients (78%) had advanced cancer indicated by TNM stage III or IV disease. Among the 13 patients subjected to surgical treatment followed by adjuvant chemotherapy, only 3 had long term disease free survival beyond 2 years. None of these patients had family history of colonic cancer or polyposis coli. In conclusion, colorectal cancer in younger age is not infrequent and had advanced stage at the time of clinical presentation with poor outcome.

Gastric outlet obstruction due to duodenal tuberculosis: a case report.

A 17-year-old boy was operated on for gastric outlet obstruction; laparotomy revealed a mass with nodules in the first part of the duodenum and multiple mesenteric lymph nodes. The histopathological examination of the duodenal mass and the lymph nodes showed caseating tuberculosis. Because of the rarity of duodenal tuberculosis, the case is reported herewith.

Puetz-Jeghers syndrome involving appendix.

Puetz-Jegher's syndrome is an autosomal dominant hereditary disease, which is characterized by hamartomatous polyposis and mucocutaneous pigmentation mainly over the circum-oral region. Patients with Peutz-Jeghers syndrome seek medical attention whenever there are complications such as intussusception, bleeding from the polyps, etc. Occasionally, gastrointestinal tract malignancies have been reported in Peutz-Jeghers syndrome. In this paper, we report a patient with Peutz-Jeghers syndrome who had multiple complications and polyposis involving the appendix, because involvement of the appendix is extremely rare in Peutz-Jeghers syndrome.

Phaeochromocytoma at the root of the mesentery.

A 65-year-old male reported with a freely mobile abdominal lump and hypertension. Though pre-operatively and intra-operatively, we have suspected the lump to be a mesenteric cyst, postoperative histopathological examination revealed it to be phaeochromocytoma which is rare. In view of its extra-adrenal site of presentation and rarity, this case is reported herein.