Hydatid disease is one of the most complicated and devastating conditions caused by Echinococcus granulosus . This globally distributed disease continues to be an important public health concern in many low- and middle-income countries. The liver and the lungs are the most frequently involved sites, but virtually any organ system can be affected. Osseous hydatidosis is relatively less common, but it is extremely debilitating and difficult to manage due to frequent recurrences. Patients often demonstrate a delayed clinical presentation as bone involvement is predominantly a silent and slowly progressive disease with a long latent period. Radiological investigations play an important role in the diagnosis. Although standard therapeutic guidelines are not available, the treatment of choice is a combination of chemotherapy and surgery. Clinicians should perform a lifelong follow-up for early detection of potential recurrence and sequels. This paper aims to highlight hydatid disease of the pelvic bone as an important differential diagnosis of tubercular hip arthritis, especially in areas with high echinococcosis prevalence.

Hydatid disease is a parasitic zoonosis commonly caused by Echinococcus granulosus . It characteristically involves the liver and the lungs but rare occurrences in other organs have also been reported. Bone involvement is distinctly uncommon, which is predominantly a silent and slowly progressive disease with a long latent period. We conducted a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases. After a comprehensive review of the search results, a total of 31 cases of hydatid disease of the pelvic bone fulfilled the inclusion criteria. The data on patient demographics, epidemiology, lesion site, management, clinical outcomes, and follow-up were collected and analyzed. This review illustrates that hydatid disease should be considered among the differential diagnoses of unusual cystic lesions of the pelvic bone. Prompt diagnosis and appropriate management are of paramount importance to prevent bone destruction and serious complications in these patients. Long-term follow-up should be performed for potential recurrence.

Highlights Hydatid cyst is fairly common in endemic areas & can involve any part of the body. Involvement of Pectoralis major muscle is rare. Ultrasound and CT scan help in diagnosing them. Most of the times, surgery is the usual treatment modality, followed by irrigation with a scolicidal agent. A course of albendazole should be prescribed after surgery. Hydatid cyst is fairly common in endemic areas & can involve any part of the body. Involvement of Pectoralis major muscle is rare. Ultrasound and CT scan help in diagnosing them. Most of the times, surgery is the usual treatment modality, followed by irrigation with a scolicidal agent. A course of albendazole should be prescribed after surgery.

Background and aimVanek's tumor is a rare solitary lesion that is non-neoplastic, and arises from the submucosa of the gut. The most commonly affected sites are the stomach and the ileum [1]. IFP causing intestinal obstruction is uncommon and that ileo-ileal intussusception has been reported in the literature rarely. We present a case of an ileo-ileal intessuception in a patient who presented with acute on chronic pain abdomen and anorexia. CT abdomen & pelvis revealed a 46 × 36 mm intraluminal mass in the left iliac fossa causing ileo-ileal intussusception.Case presentationA 60 years old gentleman was brought to the A&E with a history of intestinal obstruction. He was examined and admitted to the surgical unit. CBC revealed unique feature of reactive thrombocytosis apart from a low hemoglobin and a raised TLC. His CT scan demonstrated findings of ileo-ileal intussusception. After an informed written consent, patient underwent an exploratory laparotomy and had resection and anastomosis of the bowel. Histopathology of the specimen revealed findings compatible with IFP. Patient made an uneventful recovery post-operatively and was sent home in the next few days. On follow-up, the patient was doing well and had no complaints of abdominal pain or anorexia.ConclusionVanek's tumor although a rare entity, should be considered in each case of acute abdomen and physicians and surgeons need to have a high degree of suspicion in such cases. Moreover, IFP can cause reactive thrombocytosis that gets resolved after a post-operative period of 6–8 weeks.

BackgroundCOVID-19 pandemic has globally affected healthcare including the transplantation programmes.Materials and methodsWe retrospectively studied the impact of COVID-19 on live liver donor (LLD) programme at liver transplant centre in Gambat, Pakistan. Standard operative procedures (SOPs) including COVID-19 nasopharyngeal swab PCR, CT scans, personal protective equipment use, 6-feet distancing were developed for LLD and transplant team to mitigate COVID-19 exposure. We compared the complications, healthcare utilisation (hospital stay, readmission) and mortality between two LLD cohorts—before and during COVID-19 pandemic from March 2019 to December 2020.ResultsDuring study period 300 LLD surgeries were performed. There was an increase in rate of LLDs from 132 (44%) in pre-COVID to 168 (56%) during COVID-19 era. Average numbers of transplants per month performed during pre-COVID and during COVID-19 era were 10.1 and 14, respectively. No donor has developed COVID-19 infection during hospitalisation. Rate of all LLD complications (32 (21.47%) and 49 (29.16%), p=0.43), uneventful discharges (120/168 (71.4%) and 88/132 (66.6%), p<0.05), mean hospital stay (6±2 days and 5±2 days, p=0.17) and readmission (5 (4%) and 3 (1.8%), p=0.43) were similar during the pre-COVID and COVID-19 era. No donor mortality was observed during study period.ConclusionWith the implementation of mindful SOPs, rate of LLD increased without any case of COVID-19 infection. Our SOPs were helpful in continuation of LLD programme in a developing country during COVID-19 pandemic.

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Background The literature lacks data on World Health Organization (WHO) class II and III deficient liver donors who underwent right hepatectomy during living donor liver transplantation (LDLT). Methods In this prospective cohort study, we compared the perioperative outcomes of 15 glucose‐6 phosphate dehydrogenase (G6PD) deficient living liver donors with a matched cohort of 39 nondeficient living liver donors undergoing right lobe donation. Results Out of 15 G6PD deficient donors, four (26.67%) donors had class II, and 11 (73.34%) had class III G6PD deficiency. The mean postoperative trough hemoglobin level was significantly lower in the deficient group than the nondeficient group (9.38 ± 1.59 g/dL vs. 10.27 ± .91 g/dL, p = .046). The mean peak indirect bilirubin level was significantly higher in the deficient group than the nondeficient group (2.22 ± 1.38 mg/dL vs. 1.40 ± .89 mg/dL, p = .047), and a similar trend was observed in total serum bilirubin (3.99 ± 2.57 mg/dL vs. 2.99 ± 1.46 mg/dL, p = .038). Biochemical evidence of hemolysis was found only in three (20%) deficient donors, but none of them needed a blood transfusion. No mortality was observed in either group. All other parameters, including demographics, operative parameters, graft characteristics, and hospital stay were comparable between both groups (p > .05). Conclusion G6PD deficiency with WHO class II and above should not be considered a contraindication for right lobe donation.

Background: Umbilical and paraumbilical herniae are the most common ventral herniae occurring at or around the umbilical ring.Umbilical hernia accounts for almost 6-10% of all abdominal wall herniae. A ventral hernia is abnormal protrusion of peritoneal sacthrough the musculo-aponeurotic abdominal wall defect. Females are affected five times more as compared to males. The variousrisk factors include obesity, chronic cough and constipation, ascites and pregnancy in females.Objective: To determine the outcome of mesh plug repair of umbilical and paraumbilical hernias in terms of operative time andpostoperative complications.st Material and Methods: This study was conducted at surgical department of Khyber Teaching Hospital, Peshawar from 1 Januaryst 2012 to 31 December 2016. Total of 131 patients with umbilical and Para umbilical hernias were studied. Patients were operatedusing mesh plug technique and operative time and postoperative complications were recorded.Results: There were 91 female patients compared to 40 male patients (M/F ratio 2.2:1). The overall mean age was 41±19.3 years.The mean operative time was 23±9.2minutes. In the early postoperative period 3 patients had superficial surgical site infection.Seroma was observed in 2 patients. Mesh plug infection was observed in 1 patient while chronic pain was observed in 2 patients.None of the patients had recurrence on 24 months follow up.Conclusion: Mesh plug for small umbilical and paraumbilical hernias in adults is a safe, convenient, fast and minimally invasivetechnique with a lower rate of postoperative complications and recurrence.