New Indian Journal of Surgery

Pseudo aneurysms of visceral arteries which occur due to blunt abdominal trauma are rare. There are different modalities of blunt abdominal trauma which are seen in seat belt injuries secondary to motor vehicle accidents. We present the case of a 39 year old woman with history of abdominal pain and vomiting following a parachute jump. She was diagnosed with a pseudo aneurysm of superior mesenteric artery. She underwent open exploration and a vein interposition graft was used for the repair of the pseudo aneurysm. The pseudo aneurysm of superior mesenteric artery after a parachute jump has never been reported earlier. This case report highlights the possibility of pseudo aneurysm of superior mesenteric artery even in car seat belt injuries as the mechanism of injury is comparable in both Key words: aneurysm.

Pseudo aneurysms of visceral arteries which occur due to blunt abdominal trauma are rare. There are different modalities of blunt abdominal trauma which are seen in seat belt injuries secondary to motor vehicle accidents. We present the case of a 39 year old woman with history of abdominal pain and vomiting following a parachute jump. She was diagnosed with a pseudo aneurysm of superior mesenteric artery. She underwent open exploration and a vein interposition graft was used for the repair of the pseudo aneurysm. The pseudo aneurysm of superior mesenteric artery after a parachute jump has never been reported earlier. This case report highlights the possibility of pseudo aneurysm of superior mesenteric artery even in car seat belt injuries as the mechanism of injury is comparable in both. 

Keywords:

epigastric, umbilical
and right upper quadrants
 

Diaphragmatic eventration is an abnormally elevated hemidiaphragm in thoracic cavity with poorly developed musculature. This condition can lead to abnormal displacement of intra-abdominal organs. It usually remains asymptomatic in early life. It presents later with respiratory and occasionally gastrointestinal complications. A clinical case of eventration of diaphragm, displacement of the splenic flexure of colon, omentum and spleen into thoracic cavity with gastric volvulus is uncommon. Gastric volvulus occurs when the stomach twists around one of its axis. It is commonly along its long axis (organoaxial volvulus) and less commonly along the vertical axis (mesenteroaxial).Mortality rate of gastric volvulus range from 30%-50%. Hence early diagnosis and prompt intervention prevents development of necrosis and perforation of stomach. We report a case of 30year old male having left sided diaphragmatic eventration associated with organoaxial gastric volvulus and displaced intra-abdominal organs treated with successful surgical intervention. Key words: Eventration; Diaphragm; Gastric; Volvulus; Malrotation; Organo-axial; Mesenteroaxial, Gastric outlet obstruction, Derotation; Gastropexy.

Peutz-Jeghers syndrome is an autosomal dominant hamartomatous polyposis involving gastrointestinal tract associated with mucocutaneous hyperpigmentation involving lips, buccal mucosa ,hand and feet and predisposing the patient to various extraintestinal and intestinal cancers.This article includes case report of a 12 year female diagnosed with intussusception due to Peutz-JeghersSyndrome. This patient underwent emergency exploratory laparotomy followed by resection of about 30 cm necrosed , gangrenous ileum about 50cm proximal to ileocecal junction and then ileoileal anastomosis performed . This patient had pigmented hypermelanotic macules over lower lip ,buccal mucosa and face. This case was thoroughly examined and found to be a rare case of intestinal obstruction in paediatric patients. Key words: Peutz Jeghers syndrome; intussusception; hamartomatous polyposis

Introduction: All abdominal (either laparoscopic or open) surgeries need intra operative monitoring of Oxygen saturation(SpO2), mean blood pressure, End tidal carbon dioxide (ETCO2) and blood loss. This monitoring is vital to prevent intra operative adverse events. Blood loss must be monitored and has to be replaced whenever essential. The objectives of the study is 1. To find the difference in               intra operative factors like SpO2, mean blood pressure, ETCO2 , and blood loss between open and laparoscopic surgeries Materials and methods: This was a prospective observational study was performed over a period of 12 months from October’ 2018 to October 2019. All abdominal surgeries (either laparoscopic or open surgeries) performed at department of surgical oncology, Government Royapettah Hospital, Tamilnadu, Chennai were included in the study. All patients were given anesthesia by ETGA and monitored values recorded intra operatively. ETCO2, Blood Pressure, SPO2 and blood loss were recorded. These factors were compared between open and laparoscopic surgeries. Results were analyzed using standard statistical methods. Results: There were no statistically significant differences noted in SPO2, Mean BP and ETCO2, between all abdominal surgeries. Mean blood loss noted was 160.5ml, 192.7ml; 300.5ml in laparoscopic, lap assisted and open abdominal surgeries respectively.Hypotension was found more among open surgeries (51%) compared to laparoscopic (18%) or lap assisted (18%) abdominal surgeries (p=0.004). ETCO2 values >35 were recorded in 68%, 41%, 38% in laparoscopic, lap assisted and open abdominal surgeries respectively. Conclusions: We concluded that there was no statistical difference noted in intra-operative factors SPO2, Mean BP, ETCO2, between all abdominal surgeries. Mean blood loss, hypotension and blood transfusions were noted more among open than laparoscopic abdominal surgeries. Hypotension was significantly associated with open surgeries compared with laparoscopic abdominal surgeries. Key words: Intra operative factors; ETCO2; laparoscopy Vs open surgeries.

Peutz-Jeghers syndrome is an autosomal dominant hamartomatous polyposis involving gastrointestinal tract associated with mucocutaneous hyperpigmentation involving lips, buccal mucosa ,hand and feet and predisposing the patient to various extraintestinal and intestinal cancers.This article includes case report of a 12 year female diagnosed with intussusception due to Peutz-Jeghers Syndrome. This patient underwent emergency exploratory laparotomy followed by resection of about 30 cm necrosed , gangrenous ileum about 50cm proximal to ileocecal junction and then ileoileal anastomosis performed . This patient had pigmented hypermelanotic macules over lower lip ,buccal mucosa and face. This case was thoroughly examined and found to be a rare case of intestinal obstruction in paediatric patients. Key words: Peutz-Jeghers-syndrome; intussusception; hamartomatous polyposis.

Context: Screening and diagnostic efforts for breast cancer are critical because the disease has a high rate of successful outcomes with early identification and treatment. The mammography (MG) and fine needle aspiration cytology (FNAC) are individually effective diagnostic modalities for detection of breast pathologies. Aim: To compare the efficacy of mammography and FNAC in Cancer Breast. Setting & Design: The prospective study conducted on patients admitted for surgery for Breast lump or symptoms of breast malignancy in surgical wards of JLN Medical College, Ajmer and undergoing surgery for same with an aim to evaluate breast lesions using mammography and FNAC independently and in correlation with gold standard histopathology. Results: A total number of 100 cases of breast lump studied. The mammography, FNAC and histopathology results were collected and analysed. In present study, Mammography shows Sensitivity – 93.846, Specificity – 82.857, Positive Predictive value – 91.045, Negative Predictive Value – 87.87and Accuracy – 90. FNAC shows Sensitivity – 93.8, Specificity – 97.14, Positive Predictive value – 98.38, Negative Predictive Value – 89.474 and Accuracy - 95 Conclusion: This study confirms that the Mammography and FNAC have significantly higher sensitivity and NPV in detecting the both benign and malignant lesions of the breast. In the present study, FNAC has more accuracy in predicting breast cancer than mammogram. Association between FNAC and Mammography result was calculated to be.717 Key words: Breast lesions; fine needle aspiration cytology; mammography; histopathological examination. Key message: for successful treatment outcome of carcinoma breast early diagnosis is must.

The liver is the second most commonly injured organ following blunt abdominal trauma. The stable patient with minimal physical findings with a history of blunt abdominal trauma presents a challenge for diagnosis of liver injury. This study was conducted to determine the usefulness of hepatic transaminases in predicting the presence of liver injury and its severity following blunt abdominal trauma. In this study we included all patients who had sustained blunt abdominal injury and were treated in hospitals attached to bmcri between November 2018 to October 2020. The grading of the liver injury was verified using CT scans or surgical findings. All patiens with blunt abdominal trauma underwent the required blood tests and were included in the study. In patients with blunt abdominal trauma, abnormal hepatic transaminase levels are associated with liver injuries. Patients with ALT >57 U/l and AST >113 U/l are strongly associated with liver injury and require further imaging studies and close management. Key words: Liver injury; Blunt trauma; Transaminase; Computed tomography; Retrospective study.

Aim: The aim of this article is “A clinical study on left-sided indirect inguinal hernia containing sigmoid colon”. In this study, we have projected the incidence and management of sliding inguinal hernia containing a Sigmoid colon. Materials and Methods: A three years retrospective clinical study, was done at the “General Surgery department” at Vydehi Institute of Medical Science and Research Centre, White field Bengaluru-560 066. This Institute is a tertiary hospital attached to a medical college. Results: This analysis contained a total of 189 cases. Sliding sigmoid colon occurrence is very rare and only one case, which is less than one percent, was found in this study (0.52 percent). Conclusion: The sigmoid sliding hernia is a peroperative diagnosis among left-sided indirect inguinal hernia. The surgical management/repair is meticulous and needs gentle dissection after identification of the sigmoid colon. Care must be taken to identify the contents of the hernia to avoid inadvertent injury to the structures. The Lichtenstein repair could be considered to lower recurrence and reoperation rates. Surgeons should function according to these standards and it is of utmost significance to be accompanied by a wide variety of prosthetic materials. Key words: Sliding hernia; Amyand’s hernia; Littre’s hernia; Meckel’s diverticulum; Spermatic cord; Round ligament of uterus; Inguinal (Poupart) ligament; Ilioinguinal nerve; Genital branch of the genito-femoral nerve; Midpoint of the inguinal ligament; EOM External oblique muscle IOM Internal oblique muscle PT-Pubic Tubercle; PS Pubic Symphysis; Hesselbach’s triangle; ASIS=Anterior superior iliac spine.