Backgrounds/AimsGallbladder perforation is a rare but potentially fatal disease. We herein present our clinical experience in diagnosis and management of 32 cases of gallbladder perforation.MethodsThis retrospective study was conducted with inclusion of all cases of gallbladder perforation that presented to our hospital from January 2012 to November 2014. Cases of traumatic gallbladder perforation and patients younger than 12 years of age were excluded from this study.ResultsThis study included 32 patients (13 males and 19 females). The mean age of patients was 55.9 years. Gallbladder perforation was most common in the 5th and 6th decade of life. The mean age of patients with type I, II, and III gallbladder perforation was 57.0 years, 57.6 years, and 49.8 years, respectively. The most common site of perforation was the fundus, followed by the body and Hartmann's pouch (24 : 5 : 2). Most of the type I gallbladder perforations were diagnosed intraoperatively, type II gallbladder perforations were diagnosed by enhanced abdominal computed tomography, and type III gallbladder perforations were diagnosed during laparoscopic cholecystectomy converted to open cholecystectomy for cholelithiasis. Mortality was highest in patients with type I gallbladder perforation. The mean hospital stay was 10.1 days, 6.4 days, and 9.2 days in patients with type I, II, and III gallbladder perforation, respectively. The histopathologic analysis in 28 patients who were operated on showed acute cholecystitis in 19 cases, acute-on-chronic cholecystitis in 4 cases, chronic cholecystitis in 4 cases, and mucinous adenocarcinoma of the gallbladder in a single case.ConclusionsGallbladder perforation represents a special diagnostic and surgical challenge. Appropriate classification and management are essential.

Perforation peritonitis is the most catastrophic complication of peptic ulcer disease. 1 Peptic ulcer perforation occurs in 2-10% of patients with peptic ulcer disease. 2 Perforated peptic ulcer is mostly treated by omentopexy 3. The figure of 8 technique has been described in the literature especially when the patient comes late, that is after two, three or more days, when the edges of the ulcer and the wall of duodenum are very friable. 4 However, there has been no study comparing on this technique. The aim of this study was to study the safety of figure of eight suturing technique in comparison to omentopexy. METHODS The present study was conducted in department of surgery, Vardhman Mahavir medical college & Safdarjung hospital, New Delhi during the period of October 2012 to March 2014. Sixty patients included in the study were divided into two groups after ABSTRACT Background: Figure of 8 techniques has been described in the literature for peptic ulcer perforation repair especially when the patient comes late, when the edges of the ulcer and the wall of duodenum are very friable. Methods: Sixty patients included in the study were divided into two groups after randomization. Study group, patients underwent figure of eight suturing technique and Control group, patients underwent Grahm's technique of omentopexy for peptic ulcer perforation. Results: Only 1 patient from control group developed post-operative bile leak in this study, 3 (10%) patients from study group and 4 (13.33%) patients from control group developed septicaemia, 1 from study group and 2 from control group developed intra-abdominal abscess, 8 (26.66%) in study group and 9 (30%) in the control group developed wound infections, 4 (13.33%) in study group and 7 (23.33%) in the control group developed burst abdomen, 5 (16.66%) from study group and 6 (20%) from control group developed lung complications. Conclusions: The present study is non-inferior than omentopexy in terms of post-operative complications. It can be used as a safe alternative to omentopexy especially when the patient comes late.

Backgrounds/Aims: Additional surgical procedures are often required in patients with chronic pancreatitis (CP) related complications. The present study aims to analyze the type of additional procedures required in patients who underwent Frey's procedure (Frey's plus) and to compare the short-term outcomes and quality of life with patients who underwent only Frey's procedure. Methods: Retrospective analysis of a prospectively maintained database of patients who underwent surgery for CP between January 2012 and February 2018 and completed at least one year of follow-up. Patients who underwent non-Frey's surgical procedures were excluded. Clinical parameters, postoperative pain relief (using Izbicki pain score) and functioning scale score (EORTC QLQ C30) of patients who underwent Frey's plus procedure and only Frey's procedure were compared. Results: Of the 146 patients who underwent surgery for CP during the study period, 100 patients (Frey's procedure-68, Frey's plus procedure-32) were included in this study. Roux-en-Y hepaticojejunostomy was the commonly performed additional procedure (n=12). The demographic and clinical parameters were comparable, except for more patients with jaundice (28.1% vs. 2.9%, p=0.01) and prolonged operative time (374.6 mins vs. 326.3 mins, p=0.01) in Frey's plus group. However, there was no significant difference in mean intraoperative blood loss, postoperative morbidity or duration of hospital stay. At median (range) follow up of 34 (12-86) months, there was no significant difference in the pain control and quality of life between two groups. Conclusions: Frey's plus procedure for chronic pancreatitis can be safely performed wherever indicated without adversely affecting the postoperative outcome or quality of life.

Phyllodes tumors are fibroepithelial tumors of the breast, representing 2-3% of all fibroepithelial tumors, and <1% of all breast tumors. Malignant transformation may occur usually within stromal component of phyllodes tumor. Careful characterization of the stromal compartment is critical, since it is the pathologic features of stromal cells that determine its malignant potential. Primary sarcomas of the breast are extremely rare and account for <0.1% of all malignant tumor of the breast, of which the conversion of a phyllodes tumor to sarcoma of the breast is even very rare and only two cases have ever been reported. We present a case of recurrent phyllodes tumor of the breast transforming to a fibrosarcoma.

Angiosarcomas of the breast are extremely rare, highly aggressive tumors of vascular origin comprising 0.04% of all malignant neoplasms of the breast. They can be classified into primary mammary angiosarcomas and cutaneous (secondary) angiosarcomas. Primary angiosarcomas, owing to their unusual clinical presentation, are diagnosed late. In addition, the available literature to date lacks sufficient evidence to establish standard treatment guidelines for this group of tumors, thereby resulting in poor prognosis. In medical database, most available papers concern secondary angiosarcomas, with only a few case reports of primary angiosarcomas. The aim of this paper is to review what is known hitherto about the presentation, diagnostic tools, and therapeutic modalities for primary mammary angiosarcomas.

No abstract

Cecal leiomyomas are rare benign tumors of smooth muscle arising from the colonic muscularis mucosa or muscularis propria. They are usually asymptomatic in nature and, if symptomatic, may present as pain in the abdomen, intestinal obstruction, or bleeding. In some cases, leiomyoma can cause free perforation leading to peritonitis. Contrast-enhanced computed tomography (CECT) and colonoscopy were the diagnostic modalities used for evaluation. It is extremely unusual for a benign lesion of the cecum to present as a ruptured subcutaneous abscess. A 40-year-old man presented to the surgical emergency with complaints of right loin swelling and dull aching pain for one week. The patient did not have any significant medical history. Examination revealed a 5×5 cm swelling in the right anterior lumbar region. Blood investigations revealed anemia with leukocytosis. An abdominal CECT revealed a 9×6 cm heterogeneous enhancing mass lesion arising from the cecum with hypodense areas abutting the anterior abdominal wall and tracking into the intermuscular plane. The patient underwent surgical exploration, and a 9×6 cm growth arising from the cecum with a localized abscess tracking into the intermuscular plane in the right anterior abdominal wall and forming a subcutaneous abscess was intraoperatively found. A right hemicolectomy with ileocolic anastomosis was done, with external drainage of the subcutaneous abscess. Histopathological examination of the resected specimen revealed a leiomyoma of the cecum with abscess. To the best of our knowledge, this is the first report of a case of cecal leiomyoma to rupture into the subcutaneous space and present as a flank abscess.

Tuberculosis of thyroid gland is a very rare disease. It has variable presentations and may be sometimes associated with autoimmune thyroiditis. We report a case of 45-year-old male, with left sided painless neck swelling, with a purulent discharging sinus over it associated with night sweats and loss of appetite. Thyroid imaging disclosed heterogeneous enhancement of left lobe of thyroid gland with internal vascularity and coarse calcifications. Core needle biopsy revealed caseous necrosis and AFB positivity. Patient had thyroid peroxidase antibody and thyroglobulin antibody positivity and the rest of thyroid function tests were normal. Patient had positive Mantoux test, hepatitis B surface Ag, and low viral DNA. The patient was diagnosed as being a case of tuberculous abscess of thyroid gland and was put on antitubercular therapy for 2 months. Patient subsequently underwent left hemithyroidectomy when there was no response. Histopathological examination revealed tuberculosis of thyroid gland. A final diagnosis of tuberculous abscess of thyroid gland in a background of Hashimoto's thyroiditis in a chronic HBV carrier was made. Therefore, although rare tuberculosis of thyroid should be kept in mind as a differential diagnosis of thyroid swelling.