Hepaticocystic duct and a rare extra-hepatic "cruciate" arterial anastomosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>The variations in the morphological characteristics of the extra-hepatic biliary system are interesting.</p> <p>Case presentation</p> <p>During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis.</p> <p>Conclusion</p> <p>Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.</p

Clinical Characteristics, Surgical Management And Outcomes Of Abdominal Pain Among SARS-COV-2 Infected Patients: A Chart Review

Introduction: A significant proportion of patients with SARS-CoV-2 present with different gastrointestinal manifestations. Abdominal pain is one such. Surgical referrals are frequently done since it mimics sinister abdominal pathology. However, surgical management and follow up guidelines of abdominal pain are still underdeveloped. Surgical interventions without careful clinical judgment may lead to catastrophic outcomes. Our aim is to determine the characteristics of abdominal pain, management and outcome among selected COVID-19 infected patients.Martial and Method: A chart review was conducted among COVID-19 patients with abdominal pain who were referred for surgical opinions in a private hospital from February 2021 to September 2021. Demographic, signs and symptoms, clinical findings, biochemical investigations and outcomes were recorded.  The site of the abnormal pain was classified according to standard nine quadrants surgical demarcation of the abdomen. Results: We collected data on 40 (Male n=22, 55%) referred patients (mild: n= 25 [62.5%], moderate: n=15[37.5%] and no severe cases). The median age was 51years.  Patients were referred for surgical opinion median day of 4 from the illness. The commonest quadrant of abdominal pain was the right iliac fossa (n=30 [75%]). On clinical examination, 87.5 %( n=35) abdomen was soft and non-tender. Supportive therapy and close observations were carried out. Symptoms were remised within two to three days.  Conclusion: Our study shows that the abdominal pain among COVID-19 patient with mild to moderate disease are not associated with sinister abdominal pathologies and can be managed conservatively. Further studies need to develop surgical management guidelines for this category of patients

Primary malignant melanoma of the jejunum. A case report

BackgroundMalignant melanomas in the small intestine are commonly encountered as the metastases from primary cutaneous lesions. Even though it’s rare, it can also develop as a primary mucosal tumour in the gastrointestinal tract. We present a rare case of primary jejunal melanoma.Case presentationA 72-year-old male was investigated for occult gastrointestinal bleeding following three consecutively positive stool occult blood tests and his haematological investigations showed that severe iron deficiency anaemia. Upper gastrointestinal endoscopy and colonoscopy did not revealed any abnormality. Capsular endoscopy was performed and found to have a distal jejunal lesion with ulceration, bleeding and blackish discolouration. It was unsuccessful, even though we attempted single balloon enteroscopy to reach the site to obtain a biopsy and following contrast enhanced CT of the abdomen and pelvis the distal jejunal mass was confirmed with no abnormality found in the rest of the study. Since the CT further revealed that it was approximately 5 cm tumour arising from the jejunal wall and growing in to the lumen of the jejunum, Ultra sound guided Fine needle aspiration cytology attempted and found to have a blackish pigmented aspiration and later it was confirmed melanin pigment rich aspirate during the cytological examination. The mass was confirmed on laparotomy and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. Following the curative resection the patient recovered uneventfully.ConclusionsPrimary intestinal malignant melanoma in jejunum is an extremely rare occurrence. Complete surgical resection is the treatment of choice. The lymph node metastasis have the worse prognosis. 

Endoscopic observations around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux disease in South Asia

Abstract Introduction We studied the inter-relationships of endoscopic findings around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux. Methods Data were collected with regard to hiatus hernia (HH), columnar-lined esophagus (CLE), reflux esophagitis (RE) and gastroesophageal flap valve (GEFV), prospectively from 1,150 patients who underwent diagnostic upper gastrointestinal endoscopy for symptomatic gastroesophageal reflux. Results The frequency of HH, CLE and RE was 14.3% (n=165), 9.5% (n=109) and 13.3% (n=153), respectively. In the CLE group, 48 were histologically proven to have Barrett&apos;s esophagus. Of all RE patients, 94.8% had mild esophagitis (LA-A and B) and this was associated with younger age, male gender, presence of HH, and grade 3 or 4 gastroesophageal flap valve (GEFV). Grades 3 and 4 GEFV were associated with HH, CLE, and RE. Conclusions Substantial proportion of patients with symptoms of GERD has abnormal endoscopic findings around the gastroesophageal junction