Anal canal malignant melanoma is an uncommon malignancy. It is a highly aggressive tumor that tends to spread early in the course and present with distant metastasis. Due to the rarity of the condition, treatment is yet to be standardized. We report a case of a 47-y ear-old male patient who presented with the history of mass coming out of anus for 6 months, which was misdiagnosed as a case of hemorrhoids. Abdominoperineal resection was done based on tissue biopsy which suggested it to be a primary anal canal malignant melanoma. The diagnosis was later confirmed by histopathological and immunohistochemistry studies, which was strongly positive for HMB 45 AND Melan-A.
Background Splenic flexure mobilization has been considered the standard of practice in cases of low anterior resection;however,it has been observed in southern Indian state population, splenic flexure mobilization is may not be necessary for all patients of Dravidian ethnicity. Methods We evaluated the 26 patientswho underwent Laparoscopic Reconstituting Subtotal cholecystectomy during July 2019 to Jan 2022. Preoperative parameters (Age, Gender, diagnosis,location of tumor and Neoadjuvant therapy) and postoperative parameters (Duration of surgery,Hospital Stay, complications, recurrence of malignancy) were compared.Aim of the study was to evaluate the outcome of Low anterior rection without splenic flexure mobilization. Results There was no statistically significant difference in terms of intraoperative,postoperative complications and oncological outcome when splenic flexure mobilization not done.The operative time was similar in the both groups (P>0.05).The Postop complication rate was lower after robotic than after laparoscopic (9% vs. 25.5%, P=0.07). Post operative complications observed in 6 patients (23%) including wound infection, wound dehiscence, anastomotic leak and anastomotic stricture. 5 post op complications were seen in laparoscopic cases;however,this was not statistically significant.On a median 24 month follow-up,the local recurrence rates did not differ significantly between the 2 groups (5 for LAP vs. 1 for Robotic). Conclusion Resection of rectal cancers by minimally invasive approach (Lap and Robotic) without the routine use of SFM do not increase postoperative morbidity or oncologic risk in our subset of patients all of whom belong to the same Dravidian ethnicity. Compared to robotic surgery, patients with laparoscopic surgery had more postoperative complications though the oncologic clearance was comparatively similar.Hence,we suggest that Splenic flexure mobilization need not be done for patients of Dravidian ethnicity as they possess small to medium stature, genetically. This needs to be validated by larger randomized studies.
Colorectal cancer [CRC] generally presents in adults > 50 years of age, it is relatively uncommon for these cancers to present in adolescents. Moreover, the presentation is of advanced stage, with poor outcome in younger age groups. Due to non-specific symptoms and relative rarity in children and adolescents high degree of suspicion is required in managing these patients. As the majority of these cases are sporadic in origin and due to limited knowledge of molecular pathogenesis, screening guidelines are yet to be defined. We here report a case of 18-year male that presented with per rectal bleed and mass felt on digital rectal examination with no genetic predisposition. Biopsy confirmed it to be a mucinous adenocarcinoma. The patient was managed by Abdomino-perineal resection and post-operative chemotherapy.
Snake bite in India is a common yet neglected public health issue, with an estimated death rate of 50,000 per year. Symmetrical peripheral gangrene (SPG) has varied aetiology, but it is an unusual complication after snake bites. SPG is important as it causes significant morbidity and mortality, and early intervention may improve the outcome. Hereby, we report a case of SPG in young female with history of snake bite. The patient developed gangrene of bilateral foot and distal part of legs with necrotising fasciitis of right leg. In the literature, there are only few reported cases of SPG as a complication of snake bite.
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