Journey of a stone-thirty years on.

Laparoscopic cholecystectomy is the gold standard surgical treatment of gallstone disease and a commonly performed procedure in general surgery. Retained gallstones from intraoperative spillage remain largely asymptomatic and complications are rare. Peak incidence of presentation occurs within a year; however, it is important to recognize retained gallstones as a differential for acute presentations even many years postoperatively. We present the case of a 74-year-old female who presented with a retained-gallstone-associated abdominal wall abscess 30 years after spillage during the original surgery, which was successfully treated with a stepwise extraperitoneal approach with local drainage.

Bronchial varices in a child with tricuspid atresia six years post Fontan correction.

Tracheal and bronchial varices are rarely found in children. However, they have been described in adults with failing Fontan circuits or secondary to vascular pathology, such as portal and pulmonary hypertension. We report the presentation of haemoptysis and bronchial varices in a child, six years after a Fontan procedure for tricuspid atresia. She had tortuous mediastinal and transpleural arterial collaterals on computed tomography (CT) angiography and cardiac catheterization and subsequently underwent embolization of these collaterals. While the haemoptysis settled post embolization, the bronchial varices persisted on repeat bronchoscopy. She has since been clinically well with no further haemoptysis.

Polyarteritis nodosa presenting atypically as appendicitis and pyelonephritis in a single patient.

A 17-year-old man presented to the emergency department 10 days postlaparoscopic appendicectomy with ongoing lower abdominal pain. The pain was associated with fevers, chills, sweating and constipation. There were no other associated symptoms. On examination, there was suprapubic and right lower quadrant tenderness and an elevated blood pressure (140/90 mm Hg). The patient later developed severe bilateral flank pain. Investigations revealed elevated C reactive protein, leukocyturia and microscopic haematuria. Blood and urine cultures were negative. CT angiogram demonstrated bilateral wedge-shaped peripheral renal hypodensities suggestive of several peripheral infarcts with intrarenal microaneurysms. Treatment with steroids and cyclophosphamide was initiated, leading to significant clinical improvement. Review of the histological appendix specimen revealed features consistent with small-medium vessel vasculitis.

Regression of a solitary osteochondroma of the distal humerus in a toddler following trauma.

Osteochondromas are bone exostoses, with the vast majority extending from the metaphyseal region of long bones and are capped by cartilage. A review of the current literature reveals spontaneous regression of osteochondromas is a rarely documented event, with all but two of these recorded events resolving before skeletal maturity and within 6 years of identification. We present a case of trauma-induced resolution of a solitary osteochondroma after less than 3 months in a 15-month-old male, with a review of current literature.

Giant intradural extramedullary spinal hydatid cyst--a rare presentation.

The hydatidosis, or echinococcosis, has a characteristic geographic distribution, occurring most frequently in sheep-raising regions in Mediterranean, Central Asian, and South American countries and in Australia. Spinal hydatidosis is very rare, and intradural location is a rarer category of spinal hydatidosis. We report a case of intradural extramedullary spinal hydatid cyst in a 9-year-old boy. On magnetic resonance imaging, an intradural extramedullary giant cystic lesion was seen mimicking an arachnoid cyst. However, endemic origin of the patient and positive serology helped to make the diagnosis of hydatid cyst, which was confirmed on postoperative histopathology.

Balo's concentric sclerosis involving bilateral thalami.

Balo's concentric sclerosis (BCS) is a rare inflammatory demyelinating disease of central nervous system, pathologically characterized by alternate bands of demyelination and preserved myelin tissue. Before the era of magnetic resonance imaging (MRI), most cases of BCS were diagnosed on postmortem examination. MRI allows for noninvasive diagnosis by demonstrating characteristic changes which closely parallels the histopathological features of BCS. We report a case of 26-year-old female with BCS involving bilateral thalami, with typical MRI appearance.

Gallstone abscess: a delayed complication of spilled gallstone after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has become the preferred method of treatment of cholelithiasis since its inception in 1987. Although overall complication rate is less than that of traditional approach, two operative complications of laparoscopic cholecystectomy have been frequently described in the literature. One is the bile duct injury or leak and the other one spillage of stones resulting in delayed abscess formation (Horton and Florence, Am J Surg 175:375-379, 1998; Frola et al., BJR 72:201-203, 1999). The incidence of abscess is very rare (approximately 0.3%). The location of the subsequent abscess and the inflammatory masses containing stones or stone fragments is generally in the abdominal wall, subhepatic space, or the retroperitoneum below the subhepatic space but can occur anywhere in the abdomen, right thorax, at trocar site, and at incisional hernia (Zehetner et al., Am J Surg 193:73-78, 2007; Offiah et al., BJR 75:393-394, 2002; Morrin et al., AJR 174:1441-1445, 2000). We report here a case of abscess formation due to spilled stone occurring 6 months post-laparoscopic-cholecystectomy. The diagnosis was suggested by ultrasound examination and was further confirmed by computed tomography scan of the abdomen.

Giant thoracolumbar extradural arachnoid cyst: a case report.

This report is presented to demonstrate the image findings of a patient with a recent onset of progressive spinal cord compression caused by a giant arachnoid cyst of the thoracolumbar spine. The patient presented with gradual onset paraparesis and the diagnosis of arachnoid cyst was made on MRI. Surgery was successful with respect to in-toto removal of the cyst, following which there was reversal of cord compression and symptoms. Histological diagnosis was of an arachnoid cyst.

Sacral rib: a rare congenital anomaly.

A 45-year-old patient reported for a follow-up visit after a motor vehicle accident with a history of vague right flank pain. He underwent a pelvic radiograph which revealed a long bony protuberance arising from the right sacral region; the appearance was consistent with a sacral rib. However due to the limited nature of his complaints the patient denied any surgical treatment.

Concomitant bilateral testicular epidermoid cysts.

Epidermoid cyst of the testis is a rare benign germ cell tumor, comprising 1-2% of all resected benign testicular masses. Approximately 300 cases have been reported to date. Unilateral involvement has often been reported in the English literature. However, bilateral occurrence is very rare and to the best of our knowledge, there are only 3 previous reports of bilateral testicular epidermoid cysts. The fact that they are completely benign makes them amenable to treatment by local excision, thereby saving patient from orchidectomy. Recognition of their characteristic ultrasonographic features is very important to avoid unnecessary intervention. We present here, a case of bilateral epidermoid cyst in which characteristic ultrasound (US) findings allowed testis-sparing enucleation instead of radical orchiectomy.

An experience with a rare diagnosis of isolated tuberculosis of sternum at JNMC Hospital, Aligarh, India.

OBJECTIVE: To diagnose isolated tuberculosis of the sternum in patients presenting with signs and symptoms suggestive of tuberculosis. METHODS: A prospective study conducted at Jawaharlal Nehru Medical College JNMC Hospital, Aligarh, India from July 2000 to July 2006 of 2512 patients presenting with a suspected case of tuberculosis. Cases were confirmed using different investigations along with treatment of the patients with antitubercular treatment ATT, with further follow up for next 2 years. RESULTS: Nineteen patients were suffering from isolated tuberculosis of sternum. The main presenting feature was retrosternal discomfort 100% while 14 73.6% patients presented with a cold abscess of sternum. All the patients were treated successfully with 12 months of ATT and followed up for 2 years for any relapse. CONCLUSION: Although tuberculosis of sternum is rare, it should be considered as an important differential diagnosis in patients presenting with chronic lesions of the sternum, particularly in endemic/developing countries. Twelve months of treatment with ATT is optimal for achieving cure without any risk of relapse.

Giant cell tumour of the anterior arc of a rib presenting as a breast lump: a case report.

Giant cell tumour (GCT) of the anterior arc of a rib is a very rare occurrence and quite often the diagnosis is delayed. We report a case of GCT of a rib arising from the anterior arc which presented as a breast lump. The diagnosis of GCT was considered in the differentials only when percutaneous biopsy revealed multinucleated osteocleastic giant cells. Further diagnosis was confirmed by spotted oblique radiographs and computed tomography (CT). Surgical excision with repair of the chest wall by a mesh was done. The postoperative histopathological examination of the resected specimen confirmed the preoperative diagnosis of giant cell tumour. The present article aims to aware the reader about such rare presentations of GCT, which should be included in the differential diagnosis of a tumour originating from the anterior arc of the rib.

Intrarenal post-traumatic pseudoaneurysm-USG colour Doppler diagnosis: a case report with review of literature.

Renal artery pseudoaneurysm, although a well-known complication in patients after penetrating trauma or iatrogenic injury, has rarely been described after blunt torso trauma. A 22-year-old man suffered an accident while on a motorcycle. Upon arrival in the Emergency Room, the patient was unconscious, hypotensive and had hematuria. Initial investigations revealed a fractured shaft of the right femur, multiple rib fractures with hemothorax, extradural haematoma on the right side and a laceration in the right kidney. After the evacuation of intracranial bleed, the patient was managed conservatively. The patient recovered well and was discharged on the 15th post-trauma day. The patient was again present in the emergency room after 6 weeks with 1-week history of gross hematuria. Ultrasonography revealed an anechoic lesion in the right kidney with pulsatile flow on colour Doppler. Further investigation with computed tomography renal angiography was done, which confirmed the pseudoaneurysm of a branch of renal artery. The patient was referred to a higher centre where he was successfully managed with selective arterial coil embolisation.