Demographic and clinico-pathological profile of carcinoma stomach in a tertiary referral centre of Eastern India

Objectives: This prospective study was done to assess the incidence, clinical presentations, histopathological subtypes of gastric adenocarcinoma in a referral institute of Eastern India. Methods: The patients admitted with diagnosis of gastric carcinoma in a tertiary referral hospital in Eastern India between January2006 to December2010 were included in this study. Data were compiled and analyzed with regards to their age, sex, socioeconomic status, their clinical presentations, site of lesion & histopathological subtypes. Results: 150 patients were included in this study of which 50 patients were of ≤50 years age. The median age group was 57 years. The male: female ratio was 2.3:1. Most of the patients were from lower socioeconomic strata (55.33%). Anemia (41.33%) and weight loss (38%) were the predominant presenting features irrespective of age, whereas gastric outlet obstruction due to antral growths was the commonest presentation in patients of ≤50 years age group. The most common histopathological type was adenocarcinoma; patients of≤50 years of age group presented with well differentiated and moderately differentiated adenocarcinoma while those in >50 years age group with poorly differentiated growth. Most (82.66%) of the patients presented with advanced growth(T3/T4). Conclusion: 1) The incidence of gastric carcinoma in patients younger than 50 years was more common than Western world. 2) Patients are presenting more with lesion in distal stomach than Western world. 3) Gastric outlet obstruction and metastatic disease are commoner than abdominal lump and upper GI bleeding. The latter being the commoner presentations in Western world. 4) Regarding the histological type, adenocarcinoma are commoner than in Western world and 5) Patients with signet cell subtype are much less than Western world

Male circumcision: An overview

Circumcision is one of the common operations performed worldwide, for various reasons. Controversy exists as to whether circumcision is an operation. This literature review discusses the indications of circumcision, benefits and complications of circumcision, and alternatives to circumcision. Relevant articles on the benefits, complications, indications and alternative to circumcision from 1964 to 2005 were reviewed, from National Library of Medicine′s Pubmed database. Additional articles were obtained from the reference lists of key articles and recent reviews

Longitudinal pancreatico-gastrostomy: An effective means of pain control in chronic pancreatitis

Aim: To assess the effectiveness of longitudinal pancreatico-gastrostomy (LPG) in relieving intractable abdominal pain in patients of chronic pancreatitis (CP) with dilated main pancreatic duct (MPD). Materials and Methods: This prospective study was conducted from 1997-2005 at two university-affiliated hospitals in India. Ductal decompression by LPG was performed in 30 patients (26 males, 4 females) suffering from intractable pain due to CP. The operative outcomes were classified as satisfactory and unsatisfactory according to whether the patients were completely / almost completely relieved of pain or continued to be troubled by pain. Main outcome measures: The main outcome measures were pain-relief, postoperative morbidity, and mortality. Results: There was no postoperative mortality. Morbidity included pancreatic fistula in one patient, which closed spontaneously, gastric hemorrhage in two, prolonged ileus in one and wound infection in another. Twenty eight patients (93%) patients could be followed up till the end, the mean follow-up period being 23.8 (range 3-96) months. Operative result was satisfactory (no pain or mild pain) in 23 (82%) and unsatisfactory (moderate to severe pain) in 5 (18%) patients. Complete pain relief was seen in 14 (50%) patients. The functional results, in terms of pain relief, were better in patients who had abstained from alcohol postoperatively. Conclusion: LPG is a good operative procedure to relieve intractable pain in patients of CP with an MPD diameter of at least 7 mm

Review Article-Bile duct injuries: Mechanism and prevention

Operative bile duct injury is one of the serious complications of hepato-biliary surgery. It is feared because of the substantial morbidity, occasional mortality, additional expenditure and frequent litigation that accompany it. With the introduction of laparoscopic cholecystectomy (LC) there was an increase in the incidence of such injuries and their pattern also changed to more complicated varieties. The popularity of LC and various percutaneous endoscopic procedures for bile duct pathologies have made the younger generation of surgeons less familiar with open cholecystectomy and open operative approaches to bile duct injuries. A review of the literature pertaining to the mechanism of bile duct injuries, during both open and LC, and the techniques of their prevention, was carried out by Medline search; with the aim of helping surgeons in optimising their efforts of preventing these tragic accidents

Dermoid cyst of the mesentery in an infant

7 months old male child presented with abdominal distension since birth. On examination there was a lobulated, tense cystic mass occupying almost 2/3 of the abdominal cavity. Ultrasonography (USG) revealed a predominantly hypoechoic mass measuring 17cm x 14cm x15cm. CT scan of abdomen showed a multiseptate cystic mass with eccentrically located areas of fat and calcification. Exploration of the abdomen revealed a huge thick walled cyst within the leaves of the mid ileal mesentery which could be enucleated out entirely after careful dissection. Histopathology suggested it to be a benign cystic teratoma (Dermoid cyst)

Distal ureteric atresia presenting as an abdominal lump in an adult

A 26-year-old female, presented with discomfort and a lump in the left side of abdomen. Examination showed a non-tender cystic mass in the left lumbar region extending down to the pelvis, the lower limit being palpable through the left fornix. Investigations revealed a cystic mass extending from the left renal area to the pelvis and a non-visualized left kidney. Cystoscopy could not identify the left ureteric orifice. Surgical exploration showed a blind ending left ureter as a cystic mass, containing clear fluid capped by a hypoplastic left kidney. The mass extended from the left renal area to the pelvis. Left sided nephroureterectomy was performed

Distal ureteric atresia presenting as an abdominal lump in an adult

A 26-year-old female, presented with discomfort and a lump in the left side of abdomen. Examination showed a non-tender cystic mass in the left lumbar region extending down to the pelvis, the lower limit being palpable through the left fornix. Investigations revealed a cystic mass extending from the left renal area to the pelvis and a non-visualized left kidney. Cystoscopy could not identify the left ureteric orifice. Surgical exploration showed a blind ending left ureter as a cystic mass, containing clear fluid capped by a hypoplastic left kidney. The mass extended from the left renal area to the pelvis. Left sided nephroureterectomy was performed

Case Report - Spontaneous rupture of rectum with prolapse of small gut through the anus - a case report

A 72-year-old lady presented with prolapsed loops of small bowel through the anus without any history of local trauma or instrumentation. The event followed excessive straining during defecation. Exploratory laparotomy revealed a deep pouch of Douglas, and rent on the anterior wall of the rectum, through which the bowel had prolapsed. The eviscerated small gut was reduced after proper cleansing and the rent on the rectal wall repaired without diverting colostomy. The patient had an uneventful recovery