IntroductionAlthough surgery is the preferred treatment for grade III&IV pancreatic trauma, there is a growing movement for non-operative management. in blunt pancreatic trauma. Very few studies compare operative versus non-operative management in adult patients.MethodsRetrospective analysis of a prospectively maintained database was performed from 2004 to 2013 in the department of gastrointestinal surgery, NIMS, Hyderabad. Comparative analysis was performed between patients who failed versus those who were successfully managed with non-operative management.Results34 patients had grade III/IV trauma out of which 8 were operated early with the remaining 26 initially under a NOM strategy, 10 of them could be successfully managed without any operation. Post-traumatic pancreatitis, Necrotizing pancreatitis, Ileus, contusion on CT, surrounding organ injuries are independently associated with failure of NOM on a univariate analysis. On multivariate logistic regression presence of necrosis& associated organ injury are factors that predict failure of NOM independently. Development of a pseudocyst is the only significant factor that is associated with a success of NOM.ConclusionsNon-operative measures should be attempted in a select group of grade III&IV blunt pancreatic trauma. In hemodynamically stable patients with a controlled leak walled off as a pseudocyst without associated organ injuries and pancreatic necrosis, NOM has a higher success rate.
Solid-pseudopapillary neoplasm is a tumor commonly affecting young females. Loss of membrane expression of β-catenin and E-cadherin with nuclear positivity can be used confirm the diagnosis of SPN.
Introduction: Congenital diaphragmatic hernia usually occurs in childhood. Presentation in adulthood is extremely rare. Surgical repair has been associated with low morbidity and mortality and excellent long term outcomes with low rate of recurrence. Here we present our experience of surgical management of diaphragmatic hernia over the last 10 years. Material and Methods: Records of 40 patients who underwent surgery for adult diaphragmatic hernia between January 2007 to December 2017, were reviewed retrospectively. Results: Median age of presentation was 38 (18-71) years with a male female ratio of 1.6:1. The most common symptom was breathlessness, followed by chest discomfort. Laparotomy and mesh repair was the most commonly performed procedure followed by anatomical repair. No recurrence was reported during the follow-up period ranging from 3 months to 7 years. Conclusion: Congenital diaphragmatic hernia is a rare surgical condition primarily diagnosed in infants and seen rarely in adults. Surgical repair has been associated with low morbidity and mortality and excellent long term outcomes with low rate of recurrence.
Sclerosing angiomatoid nodular transformation of the splenic red pulp has been described quite recently; many of the lesions previously diagnosed as splenic exuberant granulation tissue, multinodular hemangioma, and inflammatory pseudotumor could actually belong to this category. The lesion has been well reported intermittently in the past, but new cases with still newer associations keep appearing from time to time. There are no known risk factors and no inciting triggers have been proven. We report two such cases-one of which has extensive extramedullary haematopoiesis; a feature that has never been reported earlier. Clinico-morphological and radiological features along with pathogenesis are discussed in detail.
Background: The gastroenteropancreatic neuroendocrine tumors (GEPNET) have a characteristic histologic appearance unrelated of the exact site of origin. However the behavior of these tumors are different in each of these sites. In this article we study the clinicopathological features of GEPNET. These tumors were classified and graded according to WHO 2010 criteria. The immunohistochemical (IHC) features were evaluated and the grade of the tumor was correlated with Ki67.Methods: A total of 40 cases of GEPNET diagnosed on biopsies as well as resected specimens were analyzed from January 2012 to June 2015.Results: There were 28 resected specimens and 12 biopsies. Majority of the gastric neuroendocrine tumors (NET) showed classic morphology of cells arranged in islands. There were 3 cases each of grade 1 and grade 2 and one was diagnosed as mixed adenoneuroendocrine carcinoma (MANEC). All the duodenal NET were well differentiated (grade 1). There were 8 cases in colon and rectum, of which 4 cases were grade 3 and 3 cases were grade 2. Majority of the pancreatic tumors were grade 1. The mean mitotic count along with ki67 had good correlation in NET of stomach, duodenum colon and rectum. Conclusions:The most common site was small intestine followed by pancreas. Majority of the tumors were NET G1. Tumors from colorectal region were mostly NEC G3. There was a strong correlation by spearman correlation analysis between Ki67 and mitotic count and moderate correlation between ki67 and tumor grade as well as mitotic rate and tumor grade. Ki67 was helpful in grading these tumors.
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