Type II perforation of the body of the gallbladder in acalculous cholecystitis: a rare complication of enteric fever

Gallbladder perforation is a rare but potentially life-threatening complication of acute cholecystitis with or without gallstones. Enteric fever leading to small bowel perforation is rare, and gallbladder perforation is extremely rare. It requires early and accurate diagnosis. If left untreated, it is associated with high mortality. Clinical diagnosis is often difficult. The most common site of perforation is the fundus; perforation in the body is rare. We report a case of gallbladder perforation as a complication of enteric fever, which presented as acute abdomen and responded very well after cholecystectomy. Although rare and unusual, this case report shows that gallbladder perforation should be considered in patients presenting with acute abdomen and a history of enteric fever.Keywords: Enteric fever; Acalculous cholecystitis; Perforation; Cholecystectom

Laparoscopic colorectal cancer surgery - a prospective study of short-term outcomes of consecutive cases over 3 years

This study was carried out with the objectives to study the feasibility of laparoscopic colorectal cancer resection, to observe short term outcome such as recovery parameters, oncologic safety, morbidity and mortality, and to analyze the experience of laparoscopic colorectal surgery in a teaching hospital. Between January 2007 and July 2009, all consecutive adult cases admitted to our department for colorectal cancer were assessed for eligibility. The ethical committee approved the protocol at the Sterling Hospital. Out of 31 patients,17 were males and 14 females. The mean age was 59 years. The most common clinical presentation was weight loss and altered bowel habits. Rectum (51.61%) was the most commonly involved organ followed by cecum (22.58%). - median time to liquid diet was two days (range 1-22), and a solid diet was three days (range 3-30). The median time to first flatus was two days (range 1-5), and the first stool was five days (range 3-7). The postoperative stay was eight days (range 6-30) median time to mobilization was 2.5 days. The postoperative stay is cumulative and includes patients who underwent reoperation for the anastomotic leak. The median operating time was 240 mins (range 116 – 520). The median length of incision was 6 cm (range 4 – 10 cm). The median blood loss was 170 ml. Blood loss was higher in patients with hemorrhage and tumor adhesions, and both of them were converted to open. These patients incidentally had a more extended hospital stay. The laparoscopic technique for colorectal cancer is feasible and safe. Laparoscopic colorectal surgery (LCS) is associated with short term benefits like the earlier return of gastrointestinal function and shorter length of hospital stay. From the oncologic point of view, tumor resections are adequate, taking into context numbers of lymph nodes retrieved and resectional margins in context to oncologic safety. The decreased postoperative wound infections and early recovery facilitate appropriate adjuvant therapy. Advanced laparoscopic surgery requires a team approach with proper case selection. Transvaginal delivery of specimens can give scar-less surgery and the option for assisted natural orifice surgery

Lipemic serum: A quick clue to diagnose hyperlipidemic acute pancreatitis

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Neuroendocrine tumor of the hepatic flexure: a rare colonic tumor

Neuroendocrine tumors (NETs) are rare, particularly common in the rectum. NETs of the colon (not including the appendix and rectum) are most commonly found in the cecum, and hepatic flexure involvement is rather infrequent. The clinical presentation of colonic NETs is dependent on the primary site. Many are discovered either at the time of screening or during the investigation of abdominal pain or anemia. Here we present a challenging case of a hepatic flexure colonic NETS of 26 -year-old male treated by laparoscopic right hemicolectomy.Keywords: Neuroendocrine tumors; Colonoscopy; Surgery; Immunohistochemicaltes

A clinical study on etiology, prognosis, outcome and role of endoscopy in upper gastrointestinal bleed in a tertiary care center

Upper gastrointestinal bleed is defined as bleeding proximal to the ligament of Treitz. The aim of this study was to know the cause of upper GI bleed, prognosis of the patients and role of upper gastrointestinal endoscopy (UGIE) in the management of upper gastrointestinal bleed (UGIB). A study of 140 cases was carried out in the Shree Krishna Hospital and Pramukh Swami Medical College, Karamsad in India between January 2014 and June 2015. All patients were selected by the detailed history and physical examination. Patients with signs and symptoms suggestive of upper GI bleeding such as hematemesis, melena, blood in the nasogastric tubes, and profuse hematochezia were included in the study. Endoscopy was performed in all patients. Rockall scoring system was used to predict the mortality in patients with upper GI bleeding. We use descriptive statistics for analysis. It was found that upper GI bleed was more common in males than females, and was more prevalent in elderly individuals. The most common symptom was found to be hematemesis followed by abdominal pain. The most common cause was portal hypertension, which has a direct correlation with alcohol addiction. UGIE has both diagnostic as well as therapeutic role in UGIB. This study showed that upper GI bleeding was more common in male patients with the most common cause being portal hypertension. We observed that Mallory-Weiss tear had a particular association with NSAIDs. In our study, the Rockall scoring system was seen to predict the mortality in patients with upper GI bleeding. Endoscopy was both diagnostic and therapeutic and endoscopic variceal ligation (EVL/Glue) was performed for esophageal and/fundic varices and adrenaline injection for peptic ulcer bleeding and Mallory-Weiss tear.Keywords: Upper GI bleeding; Endoscopy; Endoscopic variceal ligation; Mallory-Weiss tea

Post-colonoscopy appendicitis: a rare entity

A 35-year-old woman was admitted to the surgical ward complaining of right-sided lower abdominal pain. She had undergone colonoscopy a week previously. She was diagnosed with acute appendicitis following colonoscopy and laparoscopic appendectomy was performed via the 2-port technique. Post colonoscopy appendicitis is very rare with 14 cases reported since 1988