A 36-year-old male patient presented with a mass in abdomen since a month which had come to his notice when he had visited a physician for upper respiratory tract infection. He was a farmer by occupation and belonged to lower middle socioeconomic status of north east Karnataka region. The patient had no other symptoms of gastrointestinal obstruction in form of vomiting, constipation, distension of abdomen or pain abdomen; lower limb oedema or urinary symptoms.After obtaining an informed written consent from the patient for publishing/reporting the case including the pictures, he was examined. Abdomen appeared flat on inspection. A mass was noted in the right side of the abdomen approximately 30X40cm in size, nodular surface, well defined irregular borders and firm in consistency and non-tender. There was no hepatosplenomagaly, no ascites, bowel sounds were normal. Other systemic examination was normal.Ultrasonography of abdomen showed a large, multicystic lesion in the right side of abdomen, displacing the bowel to the left. MR imaging of abdomen revealed, a large multiloculated cystic lesion in the right side of abdomen and in the mid line scalloping the under surface of the right lobe of liver [Table/ Fig-1].Patient was posted for an exploratory laparotomy. It was a multiloculated cystic swelling likely to be lymphangioma, occupying the right side of the abdomen [Table /Fig-2]. The bowel loops were shifted to the other side. The lesion was found to be arising from the retro peritoneum on right side. The kidney and ureter were normal. The lesion was completely excised. The lesion was around 2.5 kilograms in weight. The histopathological examination of the lesion showed large dilated cysts lined by flattened endothelial cells suggestive of cystic lymphangioma [Table/ Fig-3]. Postoperative stay in hospital was uneventful. Patient came for follow-up at 3, 6 and 9 months post-surgery and had no clinical or radiological recurrence. DisCussionLymphangioma are rare benign congenital lesions. They are commonly located in the head and neck region, in paediatric population. Lymphangioma in an adult is an uncommon presentation. Lymphangioma is a congenital lesion of childhood. They usually present in head and neck region. Intra-abdominal lymphangioma in an adult is a rare lesion which poses diagnostic difficulty. Although asymptomatic, they may present with an acute abdomen. Here, we report a rare case of huge asymptomatic retro-peritoneal lymphangioma who underwent complete surgical excision with an uneventful postoperative period.[
Multiple distant nodular cutaneous metastases from carcinoma breast is a very rare entity. In the English literature few references are present about this subject. Here we present a case of distant nodular cutaneous metastasis from carcinoma breast. KEYWORDS: Carcinoma breast, distant cutaneous metastasis. INTRODUCTION:Distant Cutaneous metastasis from carcinoma breast is a very rare entity. Often, the direct invasion of the anterior chest wall and/or local infiltration presenting as skin metastasis, although rarely seen in an area outside of the chest wall. Scalp involvement is very rare in breast cancer. (1,2) We report a case of distant nodular cutaneous metastasis to scalp over frontal region and skin over the neck from carcinoma of left breast without local breast skin or chest wall involvement and without clinically palpable axillary lymph nodes.
BACKGROUND Objectives-Acute appendicitis is the most common cause of acute abdominal pain requiring surgical intervention and it is the most frequently performed emergency operation. [1] The efficacy of antibiotic prophylaxis in patients undergoing appendectomy has been examined in several studies. [2] Without any pre-or peri-operative antibiotic prophylaxis, wound infection rates in patients undergoing appendectomy are 10% or more when the appendix is normal, increasing to 30% when the appendix is phlegmonous or gangrenous. [3] In patients with perforated appendicitis, preoperative administration of antibiotics has proven to be effective in reducing wound complications that result from the heavy intraperitoneal and wound microbial contamination associated with this condition. [4] However, the role of such prophylactic therapy in nonperforated appendicitis is still controversial. [5] As the role of oral antibiotics in the treatment of acute appendicitis following appendectomy has not been adequately addressed in the literature, the objective of the present study is to study the infective complication rate after open appendectomy for non-perforated appendicitis receiving single dose antibiotic therapy as prophylaxis. MATERIALS AND METHODS The Patient attending the department of surgery and also patients referred from other departments of combined hospitals of MCH VIMS, Bellary form the subjects for our study. This study is conducted on patients with the use of single dose preoperative antibiotic therapy in cases of non-perforated appendicitis getting admitted to VIMS, Bellary for treatment during the period of November 2014 to June 2016. Patient of acute appendicitis were subjected to routine blood investigations like CBC, RBS, RFT, serum electrolytes, HIV, HBSAG and radiological investigations like USG abdomen, erect x-ray abdomen and chest x-ray. Single dose of preoperative antibiotic therapy was given for uncomplicated appendicitis. Intraoperative appendix was found to be thickened and inflamed. All uncomplicated appendicitis specimen were subjected to histopathological examination. Postoperative wound infection was noted. RESULTS Among total study subjects, fever was associated with 20% of total study subjects. The incidence of post-operative fever was present in 20% of study subjects. The post-operative wound infection was found in 5% of total study subjects. Hence, incidence of post-operative wound infection was 5%. In this study, 80% of study subjects stayed in hospital for less than 3 days, 20% of them stayed in hospital for more than 3 days. Totally, 5% of study subjects stayed in hospital for more than 5 days. On ultrasonography, 85% of patients had thickened and dilated appendix. Among thickened and dilated appendix, the incidence of post-operative infection was 3.5%, whereas among non-thickened and dilated appendix it was 13.3%; this relation between thickened and dilated appendix and chance of post-operative infection was not found to be statistically significant. Investigation of total WBC count reve...
Hernia is commonly operated in surgical department either emergency basis or as elective case. Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The presence of vermiform appendix in inguinal hernias, referred to as Amyand's hernia, is rare occurring in about 1% of inguinal hernias. This is to present our experience of unusual contents in inguinal hernia sac. Amyand's hernia is not very often seen in the clinical practice and its pre-operative diagnosis is very difficult hence awareness of this disease condition is essential for pre-operative suspicion and even diagnosis of the condition.
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