HighlightsRare presentation of ruptured hepatic teratoma in an adult.<1% of teratomas are found to originate from liver and predominantly found in pediatric populations.Complete surgical resection is mainstay treatment.Definitive diagnosis is found on histopathological results.
Abdominal wall hernias are prevalent in patients undergoing peritoneal dialysis (PD). Obturator hernias, first described by Arnaud de Ronsil in 1724, are an uncommon type of hernia where intra-abdominal contents protrude through the obturator foramen. The following case highlights a rare presentation of bilateral obturator hernias with right femoral and inguinal hernia in an 82-year-old woman post-PD. This patient presented with 5 months of bilateral thigh pain and swelling and was found to only have a right-sided obturator hernia on computer tomography (CT) scan. Intraoperatively, bilateral obturator hernias were found along with right inguinal and femoral hernias, which were all repaired laparoscopically with polypropylene mesh. Postoperatively, the patient developed a self-limiting port site hematoma and resumed PD 1 month post-surgery. Due to the high morbidity and mortality from obturator hernias, prompt diagnosis and treatment are imperative. Compared with open hernia repair, laparoscopic hernia repairs are associated with quicker return to usual activities and less persisting pain and numbness. This case portrays that laparoscopic approach to bilateral obturator hernias can be considered in patients post-PD.
HighlightsTAMIS can be considered for removal of rectal polyps and early rectal cancers.A potential complication of TAMIS is abdominal entry.Higher risk of entry if the lesion is located above the peritoneal reflection.The use of laparoscopic staplers is a novel approach that should be considered.The resection quality is comparable to the traditional approach to TAMIS.
The St. Paul's Hospital TEM experience suggests patients with peritoneal breach during TEM can be safely managed with outcomes similar to patients without peritoneal entry. Proximal, anterior lesions are at highest risk of peritoneal perforation.
Background:Ethanol-induced tumour necrosis (ETN) is a simple, readily available palliative treatment for patients with inoperable carcinoma of the oesophagus with poor performance status. In India, capital outlay needed for stenting or laser therapy is out of reach. Hence, we took up this study to calculate the effect of intratumoral injection of absolute alcohol in palliation of dysphagia due to carcinoma of the oesophagogastric junction and to monitor the improvement in quality of life (QOL).Methods:A total of 16 patients with a mean age of 56.2 ± 7.5 years with dysphagia due to unresectable malignant oesophageal strictures involving the oesophagogastric junction were included in the study. Six to ten cubic centimetres of absolute alcohol in 1 cc aliquots was injected circumferentially into the tumour at the point of luminal obstruction using disposable sclerosing needles (23G). During each follow up dysphagia grade, QOL score and complications, if any, were noted.Results:The mean alcohol injected per session was 6.9 ± 1.8 cc. The mean dysphagia grade improved from 5.5 ± 0.5 to 2.5 ± 1.1 before and after alcohol injection, respectively (p < 0.001). The time taken for recurrence of dysphagia ranged from 14 to 80 days with a median of 28 days. The mean QOL score assessed by modified EORTC questionnaire improved from a mean of 63.6 ± 6.9 to 92.6 ± 13.9 (p < 0.001). The dysphagia free survival ranged from 23 to 175 days with a mean of 71.2 days. Complications included oesophageal perforation in one patient and death in one patient.Conclusion:The endoscopic intratumoral injection of absolute alcohol significantly improves dysphagia and QOL. It is inexpensive and easy to perform.
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