Anomaly of the biliopancreatic junction with associated hepatic duct anomaly – a rare case report

Pancreaticobiliary maljunction (PBM) or anomaly is defined as an anatomical maljunction of the biliary duct and pancreatic duct outside of the duodenal wall beyond the influence of the sphincter of Oddi. Children with this anomaly can present with choledochal cyst with recurrent attacks of acute pancreatitis, and condition can be worse when not treated appropriately. Pancreaticobiliary maljunction or anomaly is considered to be a major risk factor for biliary tract cancer. In patients with this anomaly, free reflux of pancreatic juice into biliary tract may cause biliary tract damage, resulting biliary malignancy can occur. Therefore, in this condition total excision of the extrahepatic bile duct with hepaticojejunostomy is recommended. Early diagnosis of this condition and early surgical treatment is the mainstay to prevent further complications. Proper follow-up is necessary to detect biliary tract malignancy in early post-operative period, especially in patients demonstrating post-operative complications. Here we are describing a young boy with an abnormal pancreaticobiliary junction (PBM) with choledochal cyst associated with hepatic duct anomaly and biliary and pancreatic stones causing recurrent attack of acute pancreatitis

MRI findings in ruptured ovarian ectopic pregnancy: an unexplored avenue

Ovarian ectopic pregnancy (OEP) is a rare form of ectopic pregnancy (EP) and constitutes approximately 0.5-3% of all ectopic cases. Its presentation mimics the symptoms of tubal ectopic pregnancy, hemorrhagic ovarian cyst/follicle, tubo-ovarian abscess, urinary tract calculi, appendicitis or ovarian torsion. Occasionally determining the anatomic location of an extra-tubal ectopic pregnancy based on ultrasound imaging and presentation alone can be challenging, particularly when it is adherent to the fallopian tube. Although transvaginal ultrasound (TVS) is the primary modality used in the diagnosis, various forms of OEP and its complications may be incidentally detected and further evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) when an alternative diagnosis is suspected. We reported a case of a second gravid para zero, 25 years old lady, who came with pain in the left lower abdomen. Her urine pregnancy test was positive. TVS showed empty uterine cavity, an extremely tender, heterogenous hyperechoic right adnexal mass, but no obvious gestation sac (GS). A large hematoma was detected adjacent to it in the pouch of Douglas (POD). Keeping a high suspicion of ectopic pregnancy, MRI was performed to evaluate the lesion better which revealed a natural, non-assisted, ruptured right ovarian ectopic pregnancy and was subsequently confirmed at laparotomy and proven on histopathology. Patient underwent left oophorectomy and discharged on 4th day with uneventful follow up.

Correlating CT severity score and laboratory parameters in COVID-19 patients: the Indian experience

Background: Patients with COVID-19 infection present with myriad of symptoms to the clinicians. Many of these patients undergo HRCT chest and various lab tests during their treatment. Correlation between various lab parameters and severity of the disease on chest CT would be helpful in management of such patients. In situations where CT is not available, lab parameters may help to predict disease severity. The primary objective was to find out if there was any correlation between CT severity scores and laboratory parameters in patients having COVID-19 and if one can be extrapolated in cases where CT facilities may not be available.Methods: This is a retrospective, descriptive, and observational study. CT severity scores were obtained in all the patients using the 25 point scale. The following lab parameters were assessed: TLC, DLC, SGOT, SGPT, CRP, D-Dimer, IL-6, Serum Ferritin and serum LDH. Correlation was done between the CT score and various lab parameters using Pearson correlation coefficient test.Results: 285 patients with positive COVID-19 RT-PCR test were included in the study. CT score showed statistically significant positive correlation with age, TLC, Neutrophil count, SGOT, SGPT, CRP, D-dimer, IL-6, Ferritin and LDH with p-values less than 0.05. Negative correlation was seen with Lymphocyte count. Severe disease was found to be more common in older patients.Conclusions: In our study, CRP, LDH, Serum ferritin, IL-6 and D-dimer levels were observed to have positive correlation with disease severity on CT.  Thus these measured at the time of admission can be taken into consideration to predict radiological severity

Imaging of tubercular mastitis presenting as recurrent breast nodules and abscesses: a rare case report

Abstract Background Tubercular mastitis could be a rare diagnostic find clinically. It is largely seen in Asian, African and alternative non-developed countries and might occur with coincident primary tuberculosis of the respiratory tract or spine. Primary breast tuberculosis (TB) is even rarer and presents with non-specific clinical signs of continual breast masses, inflammation and sinus tracts. It can be similar to bacterial inflammation/abscess and malignant pathologies on imaging. The key to identification could be a holistic combination of imaging, clinical, biochemical and histopathological analysis. Case presentation We discuss a case of a 41-year-old lady who conferred at the start with tender breast nodules that progressed to continual, multiple abscesses and sinus tract formation. It had been an unusual and unanticipated presentation in breast followed by uncommon events throughout the course of the treatment forcing us to re-evaluate the primary diagnosis. A sequence of multiple diagnostic imaging and histopathological evaluations confirmed the identification of tubercular mastitis. Following prolonged treatment, there was vital reduction within the range and size of nodules and abscesses. Conclusions Such cases imitate bacterial abscess and cancer in their clinical presentation and imaging findings and are imperative to be diagnosed via a myriad of diagnostic tests with histopathology. Such a clinical presentation should warrant a differential of granulomatous inflammation of the breast in cases of non-responders to incision and drainage, prolonged antibiotic medical therapy and prolonged anti-tubercular treatment up to twenty four months after assessment of the individual response

Pressure Ulcer Surveillance in Neurotrauma Patients at a Level One Trauma Centre in India

Objectives: Pressure ulcers are a multifactorial, prevalent, and preventable morbidity. They cause a burden both financially and emotionally, to the individual, their family and doctor, and to society as a whole. Pressure ulcers are extremely difficult to treat; therefore, prevention is key. Methods: We started a Wound Care Surveillance Program in 2012 involving nurses, physiotherapists, and doctors. We intended to prevent the occurrence of pressure ulcers, ensure early detection, and facilitate the healing process. The Braden scale was used to stratify patients’ risk. The number of patients observed in our study was 2,974 over a one-year period. Results: The pressure sore prevalence was 3.1%. Younger and middle-aged patients were most commonly affected; 27% of these patients did not survive. Mortality was not attributed to the pressure ulcer directly. The most common mode of injury was road traffic accidents. Most of our patients had just a single pressure area affected, most commonly the sacrum. Most patients were managed with debridement and dressings while 12% received surgical treatment. Of those with stage one ulcers, 29% healed completely at two months. In stage two and three patients, 17% and 6% healed in two months, respectively, and this number was zero in stage four patients. Conclusion: The Wound Care Surveillance Program has been a very effective strategy for the prevention and management of pressure ulcers. Stage two ulcers were the most common in our setup. Braden scoring, traditionally used to screen these ulcers, can be used as a predictive and prognostic tool to predict healing of pressure ulcers. Poor healing is expected in higher staged ulcers and patients with spinal injury and major solid organ injury and those who need a tracheostomy. Home-based care is not up to mark in our society and accounts for most of the cases in the follow-up

Gastroduodenal artery aneurysm – A rare complication of traumatic pancreatic injury

Aneurysm of gastroduodenal artery (GDA) is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encountered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemoperitoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presentation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique