Inflammatory fibroid polyp (Vanek’s tumour) of the bowel

Inflammatory fibroid polyp (IFP) or Vanek’s tumour is a rare benign tumour of the gastrointestinal tract. Lower gastrointestinal IFP’s may present as an acute abdomen in the form of an intussusception in an adult. The surgeon needs to be aware of this entity to avert misdiagnosis. An abdominal CT or an MRI is helpful in diagnosing an acute abdomen due to IFP in an adult. Surgery is the mainstay of treatment. The etiopathology and management of this rare tumour is discussed

Open haemorrhoidectomy revisited: the study of 25 cases

Background: Haemorrhoids continue to be the commonest benign anorectal condition presenting with bleeding and constipation. The presentation may vary depending on the grade of haemorrhoids. Deciding the best therapeutic option is the biggest challenge faced by the attending surgeon in an era where newer therapeutic technologies for treatment continue to evolve. Therefore, revisiting the traditional surgical option of excision and ligation technique for grossly symptomatic piles was evaluated taking into consideration the cost of the procedure. Twenty five consecutive patients of symptomatic grade III and IV haemorrhoids were selected for the study to determine the outcome of the traditional open method (Milligan Morgan technique)Methods: Twenty five patients after having been checked for fitness for anaesthesia underwent the open method of haemorrhoidectomy under spinal anaesthesia. On admission to hospital a detailed proforma which contained demographic details, and comorbidities was completed. All 25 patients underwent the same procedure by ligation excision technique. Details of operative findings including post-operative outcomes were studied prospectively. Results were evaluated.Results: Of the 25 patients, one patient developed bleeding in the immediate post-operative period which required relook surgery and undermining of the oozing stump. Four patients required catheterisation for urinary retention. A six month follow up did not reveal recurrence or any sort of discomfort while passing stools.Conclusions: Open haemorrhoidectomy (Milligan Morgan) continues to be the most optimum method for treatment of symptomatic piles grade III and IV

Anatomical principles of intraperitoneal drain placement

Drain placement after abdominal surgery continues to be a standard practice. However in recent years there has been reluctance amongst surgeons to drain the peritoneal cavity liberally thereby leading to a multitude of septic complications. A brief review of the physical dynamics of intraperitoneal spaces is presented with a view to improve the practice of optimum drain placement

Bowel endometriosis: a surgical red flag

Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.

Surgery for intra-abdominal hydatid disease: a single centre experience

Background: Hydatid cyst is one of the commonly encountered parasitic disease in agricultural countries. Man is an accidental host. However the parasite can cause cystic lesions in various organ systems of the body. Intra-abdominal hydatid cyst continues to be a challenging problem.Methods: Case records of patients diagnosed and surgically treated for intra-abdominal hydatid disease were studied. Demographic details, diagnostic modalities and surgical approach to each patient was studied.Results: Ten cases of intra-abdominal hydatid disease diagnosed and managed in a single surgical centre were studied.  Eight patients had hepatic disease, one had splenic disease and one had disseminated disease which included both hepatic and peritoneal disease. All were treated surgically.Conclusions: Males involved in livestock industry are commonly affected. Liver is the commonest intra-abdominal site for hydatid disease. CT scan is diagnostic. Open surgery still continues to be the safest option for treating this condition

Surgical management of hepatic hydatid disease

Hydatidosis is strictly a zoonosis. Humans are an accidental host. The disease is endemic in rural agricultural areas. However if acquired by humans, it can cause extensive spread affecting a wide range of organs with predilection for the liver. Managing such cases requires a sound fundamental knowledge of the parasite and its pathogenicity. It is essential that surgeons who deal with such cases have a good working knowledge of the disease. The approaches to hepatic hydatids with respect to the principles of surgical treatment are presented in this article

Laparoscopic drainage of sub phrenic abscess

Sub phrenic collections are a common sequel to hepatobiliary surgery. Prompt diagnosis and treatment are necessary to reduce the morbidity and mortality to a bare minimum. Contrast enhanced CT (CECT) scan is the best imaging modality to identify the location and approximate size of the collection. Laparoscopic drainage is the best option for treating sub phrenic abscesses. A case of a sub phrenic abscess drained laparoscopically is presented to highlight the efficacy of this approach

Unusual encounters in a hernia sac

Contents of a hernia sac are always a surprise. In most cases the contents of the sac determine the type of repair. A case of an inguinal hernia sac containing the appendix along with the dislodged end of a ventriculoperitoneal shunt tube is presented in view of its rarity

Isolated tuberculous inguinal lymphadenopathy: a diagnostic challenge

Lymph node is one of the commonest site for extra pulmonary tuberculosis (TB). Cervical lymph nodes are most commonly affected by TB. Whereas tuberculous inguinal lymphadenopathy is quite uncommon. Isolated bilateral tuberculosis of the inguinal lymph nodes is rare and poses a diagnostic challenge to the surgeon. Lymph node biopsy is diagnostic. A case of bilateral tuberculous inguinal lymphadenopathy diagnosed by open biopsy is presented to highlight the diagnostic challenges it poses in addition to creating awareness of its existence as a distinct entity unrelated to tuberculosis of the lung and bowel

Surgical complications of round worm infestation

Round worm infestation is common in the tropical countries. Ascaris lumbricoides can cause a variety of complications in the abdomen ranging from colic to perforative peritonitis. As majority of abdominal complications require surgical intervention awareness of the complications is pivotal to the attending surgeon. The surgical complications of roundworm infestation are discussed in this article