New Indian Journal of Surgery

Bezoars are foreign bodies in the lumen of the digestive tract. If a foreign body comprises of hair, it is known as Trichobezoar. Rapunzel syndrome is an uncommon presentation of trichobezoar in which the swallowed hairs extend as a tail through the small intestine, beyond the stomach. Till now, cases of isolated bezoars in the bowel and those of Rapunzel syndrome have been reported but in the present case, there was double impaction of trichobezoar, one in the stomach and another in the ileum, which has rarely been reported in the literature.  

Keywords: Trichobezoar; Terminal ileum; Rapunzel syndrome. 

Xanthogranulomatous cholecystitis (XGC) is a rare type of gallbladder inflammation. Unlike other cholecystitis, it can be easily misdiagnosed as gallbladder cancer based on radiological images.[1] Xanthogranulomatous cholecystitis is a rare but severe form of cholecystitis.In this gall bladder is thickened and irregular with extension of yellow xanthogranulomatous inflammation to adjacent organs. It is extremely difficult to diagnose pre operatively as it macroscopically resembles carcinoma of gall badder. We report an unusual case of xanthogranulomatous cholecystitis at our institute. 

Keywords: Xanthomatosis; Xanthogranulomatous cholecystitis; Cholecystectomy. 

Benign multicystic peritoneal mesothelioma is a rare tumor, common in females and known for recurrence. It is characterized by the formation of multiple, thin-walled cysts that frequently produce large, intra-abdominal masses.Our case is 55 year old female with history of lump in left side of abdomen, of 6 months duration with no history of exposure to asbestos. Ultrasound suggested of a large multicystic lesion in the left lumbar region. CECT suggestive of cystic microadenoma of pancreas. Laparotomy performed to excise the tumour with spleen and histopathology report suggested of benign multicystic peritoneal mesothelioma. Immunopositivity to calretinin and WT-1 suggested of mesothelial cells. 

Keywords: Benign multicystic peritoneal mesothelioma; Tail of pancreas; Female. 

Ventriculoperitoneal (VP) shunt is very effective and commonly used procedure for treating hydrocephalus. The complications of VP shunt are many, and one of these is intraperitoneal migration of catheter. In our case it was a 55 years male patient, who sustained road side accident two years ago. He was operated for temporal contusion at a different hospital. Evacuation of the hematoma was performed but he remained in disoriented state and required assistance in his routine activities. Almost three months after the injury, VP shunt was performed for hydrocephalus on follow up CT Scans. A revision of the shunt was performed at 2 months and the chamber of previous shunt was removed. Patient improved and subsequent CT scans over next one and a half years showed decompression of the ventricles. Two weeks ago, patient presented at our hospital in a drowsy condition of 2 day duration. CT scan of the brain showed shunt tube in situ but enlarged ventricles. Clinically shunt tube was not palpable along the tract. X-ray of the abdomen performed after revision of VP shunt showed shunt lying in the pelvis. The shunt was removed by laparoscopic surgery from pelvic region, there was no injury to any intraabdominal organ on laparoscopy. So, dangerous complications of migration of VP shunt were averted by early intervention with least invasive methods.

Keywords: Ventriculoperitoneal shunt; Laparoscopic surgery; Hydrocephalus.

Incisional hernia remains the most common complication after median laparotomy, with reported incidences varying between 5-15%. Recent clinical and experimental data showed a continuous suture technique with many small tissue bites in the aponeurosis only, is possibly more effective in the prevention of incisional hernia when compared to the commonly used large bite technique or mass closure. The length of the suture used must be at least four times the length of the wound. The suture length to wound length ratio must be at least four. An adequate ratio should be achieved by placing many stitches into aponeurosis. The high tension on the suture should be avoided. The aim of this prospective comparative study was to study the effect of stitch length on surgical site infection and incisional hernia in closed midline incision.

Keywords: Incisional hernia; Wound infection; Suture length; Suture technique.