Obturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly woman and a diagnostic challenge for the Doctors. CT scan is valuable to establish preoperative diagnosis. Surgery either open or laproscopic, is the only treatment. The need for the awareness is stressed and CT scan can be helpful.

Abdominal cocoon is a rare condition. It presents as a thick whitish membrane which covers bowel loops. Because of this presentation, it is also called as sclerosing encapsulating peritonitis. It is usually diagnosed intra operatively. Treatment of this condition involves resection of the membrane and release of adhesions. Pre-operatively, patient is investigated for recurrent episodes of small bowel obstructions. However, preoperative diagnosis does not change the treatment and management. Investigations done preoperatively help in expediting the treatment with planned laparotomy.

A 10-year-old female child was referred to the Department of Oral and Maxil lofacial Surgery, Krishna Hospital, Karad, Maharashtra, India for evaluation and management of a painless soft tissue swelling over the left side of face. The parents reportedly first noticed the growth when the child was four-year-old and the swelling had gradually increased to its present size. Patient's medical history was non contributory. There was no previous history of trauma. On examination, a sagging subcutaneous swelling was noted, extending from left commissure of mouth to the preauricular region. The lesion was about 4 X 7 cm in size and caused drooping of the left corner of the mouth. The overlying skin showed a localized area of hyper pigmentation [Table/ Fig-1]. It was soft, non-tender and non-pulsatile. On palpation, the lobulated mass gave a so-called 'bag of worm' feeling. There was no neurological disturbance associated with the lesion. Facial nerve weakness and paresthesia over distribution of mental, infraorbital nerve were ruled out. The patient had no similar lesion or area of pigmentation elsewhere on the body. Ultrasonography (USG) of the lesion showed a hypoechoic mass in the subcutaneous plane of buccal space measuring about 7.6 cm cranio-caudally, resting over the buccinator, masseter and orbicularis-oris muscle. Well defined hypoechoic area was noted within the swelling, suggestive of necrotic foci. Multiple dilated channels were seen within the lesion with minimal vascularity on color doppler [ AbSTRACT Neurofibroma is a rare, benign, neurogenic tumour which may present as multiple lesions as a part of neurofibromatosis syndrome or as a solitary mass. This paper reports a case of large solitary neurofibroma of face in a young female patient. Clinical presentation, imaging characteristics and management of the pathology has been described in detail. The paper also reviews English literature for similar cases.Magnetic Resonance Imaging (MRI) showed a well-defined enhancing lesion (on T2 images) involving the subcutaneous soft tissue plane with contour bulge on left side of the face. Lesion was seen encasing the facial vessels and its branches [ Table/Fig 3a,b]. No haemorrhagic or calcification foci were seen within the lesion. Underlying mandible and maxillary bones showed normal morphology. Head and neck angiogram showed the subcutaneous mass being supplied by facial artery. Large, early draining, dilated torturous venous channels were noted within the lesion draining into the external jugular vein on the left side suggestive of shunting of capillary network. The left carotid artery system, including common carotid cervical segment, carotid bifurcation, external and internal carotid artery were normal [Table/ Fig-3c,d].The above radiological features were suggestive of non-encapsulated subcutaneous mass with slow flow vascular channels and the differential diagnosis included neurogenic tumour, haemangioma and lipoma. An incision biopsy, carried out under local anaesthesia revealed stratified squamous epitheli...

Aim: Peripheral arterial disease (PAD) is chronic arterial occlusive disease of the lower extremities caused by atherosclerosis. Thepresent study was conducted for comparing the efficacy of minimally invasive procedure vs standard open approach for lumbarsympathectomy.Materials & methods: 100 patients were enrolled in the present study (who were scheduled to undergo lumbar sympathectomy) andwere divided broadly and randomly into two study groups: Group 1: Patients undergoing lumbar sympathectomy by minimal invasiveprocedure, and Group 2: Patients undergoing lumbar sympathectomy through standard open approach. Only those patients wereincluded who had Ischemic rest pain that requires continuous analgesia for more than 3 weeks and Ischemic foot ulcers that failed toheal for more than 6 weeks. All the patients underwent surgical procedures according to their respective study groups. All the resultswere recorded in Microsoft excel sheet and were analysed using SPSS software.Results: Mean duration of analgesic consumption for controlling pain postoperatively was 3.9 weeks in group 1 while it was 3.7weeks in group 2. Mean operative time among the patients of group 1 and group 2 was 51 minutes and 83 minutes respectively (pvalue < 0.05). Incidence of complications was significantly higher among the patients of group 2 in comparison to the patients ofgroup 1. Mean recovery time among the patients of group 1 and group 2 was 5.2 days and 7.3 days respectively (p- value < 0.05).Conclusion: Among patients undergoing lumbar sympathectomy, minimally invasive procedure is better in comparison to standardopen procedure.

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