No abstract

Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.

Background: The incidence of contralateral occult hernia (COH) varies from 4.2% to 57.5%. Total extraperitoneal (TEP) gives us opportunity to visualize contralateral groin for occult hernia and its simultaneous repair. Ultrasonography (USG) helps to diagnose occult hernia preoperatively with detection rate of 96.6% with specificity 84.4%. Objective: The aims of this study were to identify the incidence of contralateral occult inguinal hernia in clinically diagnosed unilateral inguinal hernia patients using USG as diagnostic modality and to compare the clinical outcomes of unilateral TEP vs. bilateral TEP with respect to pain, duration of hospital stay, time for return to normal work, and postoperative complications. Setting and Design: This was a prospective observational, single-center study. Materials and Methods: A total of 30 male patients were included in the study who was having clinically diagnosed unilateral hernia. All patients were assessed by USG for contralateral occult inguinal hernia. Results: Incidence of COH was 10%, two (6.7%) had indirect defect, and 1 (3.3%) had direct defect. Two (6.7%) patients underwent bilateral TEP and 28 (93.3%) underwent unilateral TEP. No significant difference was observed in terms of mean duration of hospital stay, duration of surgery, and visual analog scale score for pain in both unilateral and bilateral TEP. The mean for resuming daily work in unilateral TEP was 4.86 ± 0.833 days and in bilateral TEP the mean was 7.50 ± 0.70 days and this showed statistically significant difference ( P < 0.001). Conclusion: Patients with COH should be counselled for synchronous repair as there is no significant difference in clinical outcomes of unilateral and bilateral TEP. On the basis of this pilot study, it can be concluded that preoperative USG is mandatory for diagnosis and simultaneous management of preexisting contralateral hernia.

Eustachian tube extends from the anterior wall of the middle ear to the lateral wall of the nasopharynx at the level of inferior nasal choncha. It maintains the equilibrium of air. It is an important landmark for endoscopic evaluation in patients with chronic otitis and also for the transnasal approach to the infratemporal fossa. MATERIALS AND METHODSStudy was carried out, 50 sagittal sections (25 right side and 25 left side) of head and neck specimens from adult formalin fixed cadavers from the Department of Anatomy, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India. The pharyngeal opening of Eustachian tube was observed for its shape, size and important measurements taken with the help of sliding vernier calliper. The mean and standard deviation of these parameters were calculated. RESULTSThe vertical length and A-P length was taken and shape was observed. Oval shape more common on right side (52%) and triangular on left (48%). The A-P length on right side was 8.7 mm on right and 7.6 mm on left side, which was statistically significant. The height was more on right side than on left side. CONCLUSIONIn the present work, the exact position of auditory tube can be located by various measurements. So the study will be helpful for radiologist for differential diagnosis and ENT surgeons for endoscopic evaluation in patients with chronic otitis media.