New Indian Journal of Surgery

Background: Acute pancreatitis is a common condition, frequently attributed to gallstones or alcohol consumption. Interestingly, while hypocalcemia is typically associated with acute pancreatitis, hypercalcemia-induced pancreatitis is a rare clinical picture. Even more uncommon is the role of hyperparathyroidism as the underlying cause.This case challenges the conventional understanding of pancreatitis and its etiology, highlighting an atypical presentation that rose from hyperparathyroidism, through sustained hypercalcemia, emerged as the unexpected culprit for acute pancreatitis, shedding light on a rare interplay between endocrine dysfunction and pancreatic inflammation. Case Description: We present a case of middle age patient, who developed acute pancreatitis with no history of alcohol use or gallstone disease. Lab Investigations revealed elevated serum calcium levels prompting further evaluation. Imaging studies confirmed the presence of parathyroid adenoma, implicating primary hyperparathyroidism as underlying cause of hypercalcaemia and subsequent pancreatitis. The patient underwent surgical excision of aroma with normal normalisation of calcium levels and resolution of symptoms thereafter. Clinical relevance: This case highlights a rare, but critical association between hyperthyroidism and acute pancreatitis, emphasising the importance of investigating parathyroid pathology in patients presenting with hypercalcaemia and pancreatitis. Early diagnosis and targeted management can prevent recurrent episodes and associated complications.

Hemorrhoidectomy remains a common surgical procedure for treating advanced hemorrhoidal disease. This systematic review aims to compare the post-operative outcomes of stapled hemorrhoidectomy (SH) and conventional open hemorrhoidectomy (OH) based on recent literature published within the last decade. By analyzing comparative studies, we evaluate key parameters including pain, healing time, complications, and patient satisfaction to provide a comprehensive assessment of both surgical techniques.

Background: Overall 10% of the world’s population is infected with Entamoeba histolytica (E. histolytica) but out of this only 1% becomes symptomatic. Nearly 20% of the Indian population show manifestations of the disease. Liver abscess complicating a pregnancy is very rare and most common organism responsible for this complication is Escherichia Coli and Bacteroides spp.1 Case Description: Here we are presenting a case of high risk pregnancy who was diagnosed as a case of perinatal liver abscess with multiple large collection. She was admitted in ICU and was given Non-invasive and High flow nasal cannula support as per her need. After detailed evaluation and consultation with other department, pig-tail catheterization was done. Patient was managed conservatively and was later on discharged under satisfactory condition but lost to follow-up. Literature Review: Amoebic liver abscess (ALA) is the most common extra-intestinal manifestation of invasive amoebiasis. Pregnancy has been described as a risk factor for development of invasive amoebiasis and management of these patients is especially complex.3 The American College of Obstetricians and Gynecologists (ACOG) guidelines recommend ultrasound and MRI as the modalities of choice.3 Metronidazole is the treatment of choice for pregnant women for amoebic liver abscess. Metronidazole is a US Food and Drug Administration (FDA) pregnancy category B drug, is generally well tolerated and although it crosses the placenta it seems to have no significant embryo toxic effects.3 Clinical Relevance: Here the case of amebic liver abscess concurrent with twin pregnancy possess a challenge for clinician. Detailed analysis and discussion with other department is main approach in dealing such high risk cases.

Context: Genitourinary fistulas present significant challenges in surgical management, often causing considerable distress. In developing countries, these are commonly linked to obstetric trauma, while in developed regions, they often result from gynecologic or pelvic surgeries. Aims: This retrospective study aims to analyze the etiology, diagnostic methods, surgical approaches, and outcomes of genitourinary fistulas treated over four years at a tertiary care center. Settings and Design: The study is a single-center retrospective review of 30 cases treated surgically from 2020 to 2023. Methods and Material: Patient data on demographics, etiologies, diagnostic methods, and surgical techniques were gathered from medical records. Statistical analysis used: Descriptive statistics were applied to summarize demographics, fistula types, and surgical outcomes, with success rates calculated for each technique. Results: Vesico-vaginal fistulas were the most common, often following abdominal hysterectomies. Trans-abdominal repairs, especially with omental repair, showed high success rates. There was a decline in obstetric-related fistulas and an increase in cases linked to gynecologic surgeries, especially hysterectomies. Conclusions: The study identifies a shift in genitourinary fistula etiologies, with a decline in vesico-vaginal fistulas (VVF) due to better obstetric care and an increase in uretero-vaginal fistulas (UVF) linked to rising hysterectomy rates. Trans-abdominal repair techniques showed high success rates, emphasizing the importance of surgical principles for optimal outcomes.

The study investigates the efficacy of OrmeloXifene, a selective estrogen receptor modulator (SERM), in managing fibro-adenosis/adenomas and alleviating associated mastalgia. Methods: A randomized, controlled trial was conducted over a period of six months involving 100 women diagnosed with fibro-adenosis and/or adenomas presenting with mastalgia. Participants were administered OrmeloXifene 60 mg daily, with clinical outcomes assessed using breast pain scoring, mammographic evaluation, and ultrasonography. Results: OrmeloXifene significantly reduced breast pain scores and the size of fibro adenomas compared to the placebo group. No significant adverse effects were observed. Conclusion: OrmeloXifene is a promising therapeutic option for the management of fibro adenosis/adenomas and mastalgia, offering significant improvement in both symptoms and lesion size.