A rare case of post-splenectomy gastric volvulus managed by laparoscopic anterior gastropexy.

We report an extremely rare case of recurrent gastric volvulus after open splenectomy for hereditary spherocytosis. The initial episode was managed by endoscopic derotation. Later, for recurrent symptoms, she was successfully managed by laparoscopic anterior gastropexy.

Pancreatic glucagonoma with pancreatic calcification.

BACKGROUND: Glucagonoma is an uncommon type of pancreatic neuroendocrine tumor [NET] which is characterized by diabetes mellitus, necrolytic migratory erythema, depression and deep vein thrombosis. The typical rash is often misdiagnosed and the diagnosis is delayed by 7-8 years. Pancreatic NETs and other pancreatic tumors are known to show calcifications within the tumor but calcification of the remaining normal pancreas is very uncommon. It occurs when there is ductal obstruction leading to acute or chronic pancreatitis. CASE REPORT: We present a case of glucagonoma with coexistent pancreatic calcification. CONCLUSION: Glucagonoma should be suspected in a diabetic patient with migratory rash. Pancreatic tumor should be suspected in patient with idiopathic focal pancreatitis.

Adult onset nesidioblastosis treated by subtotal pancreatectomy.

CONTEXT: Nesidioblastosis is a rare cause of non insulinoma pancreatogenous hypoglycemic syndrome seen in adults. It is characterized by postprandial hypoglycemia with high insulin and C-peptide levels without any detectable pancreatic lesion. The definitive diagnosis can be made only on histopathological examination of the resected specimen. CASE REPORT: We report a case of a 50-year-old lady presenting with hypoglycemic attacks being misdiagnosed preoperatively as insulinoma and treated with enucleation leading to recurrence of symptoms after 6 months. Later medical therapy was tried which failed and patient needed subtotal pancreatectomy for resolution of symptoms. CONCLUSION: Nesidioblastosis should be suspected in patients with endogenous hyperinsulinemic hypoglycemia without any detectable pancreatic tumor on preoperative imaging.

Rectal adenocarcinoma in an adult with imperforate anus at birth.

A 43-year-old man with imperforate anus surgically corrected at birth presented with bleeding per rectum and constipation. On investigations, there was an adenocarcinoma at 2 cm from anal verge involving mid and lower rectum. He underwent abdominoperineal resection. During surgery, he was found to have a rectourethral fistula. The relationship between imperforate anus, rectourethral fistula and carcinoma of rectum is disclosed.