Obstruction of common bile duct due to a ‘Forgotten stent’ causing stone formation is a rare entity, which is usually associated with cholangitis. A much rarer presentation is our case with an ERCP stent forming a nidus for stone formation in the common bile duct without any evidence of cholangitis or bile duct obstruction. A 66-year-old female patient with a previous history of laparoscopic cholecystectomy and common bile duct stenting done 2 years back presented with vague abdominal pain, nausea and vomiting without features of jaundice or cholangitis. She was diagnosed on imaging as a case of choledocholithiasis with two stents in the common bile duct. A failed ERCP to extract the stent and relieve obstruction necessitated open choledochotomy, stents removal, common bile duct clearance and choledochoduodenostomy. The rarity of this patient with an ERCP acting as a nidus for common bile duct stones without evidence of obstruction or cholangitis is something to be documented. Although rare, these complications must always be considered and considered a possibility due to which post-operative and post-endoscopic follow up, regular check-ups and timely removal of the stents is necessary to avoid unnecessary complications or a need for repeat procedures and surgery that results in greater morbidity.
Urachal sinus is a rare type of Vitello intestinal duct anomalies. Clinical presentation is that of persistent umbilical discharge. It is usually seen in paediatric age group. Moreover, they have a different course in adults than paediatric age group in which they frequently involute and have a benign course. These remnants are prone to infection and development of malignancy. A proper diagnostic workup by clinical and imaging tools is required. Early removal of urachal remnants at first diagnosis is key for preventing future morbidities. In our case, all the three remnants (Vitello intestinal duct, urachus and ligamentum venosum) were found in a middle-aged patient and hence is unusual and a rare presentation.
NEED FOR STUDYThe present study is to use a simple bedside tool as a scoring system to assess the severity of acute pancreatitis and to predict its risks for morbidity and mortality. The main criteria of this study is to highlight the ease of using this tool to identify the severity of acute pancreatitis as early as possible in order to reduce the complications, risks and to improve the outcome and overall survival. MATERIALS AND METHODSOur study is a single centre, prospective observational study conducted at Rajarajeshwari Medical College Hospital, Bangalore, India from September 2014 to September 2015. Forty six patients, both males and females presenting within 24 hours of onset of symptoms diagnosed with acute pancreatitis were included in the study. Informed consents were obtained from all patients. Cases of chronic pancreatitis and acute on chronic pancreatitis were excluded. Pediatric patients of age less than 14 years and geriatric patients more than 70 years were excluded. RESULTSWe observed that biliary pancreatitis was the most common with male population more affected than females. Pain abdomen was the most common presentation in the entire study population. Necrotizing pancreatitis was most commonly associated with ICU admission and prolonged hospital stay. Patients with organ failure and BISAP score more than 3 were found to have prolonged hospital stay. SIRS was the most common component of BISAP scoring system seen in 91.3%. Elderly patients with age more than 60 years (6 pts.) had high BISAP score (5). All patients with shock had BISAP score of >3. A BISAP score of ≥3 was associated with higher morbidity than scores of <3. CONCLUSIONBISAP is a simple and a quick tool over other scoring systems and is similar to other scoring systems to predict the severity and prognosis of acute pancreatitis. In summary we have studied the ease of BISAP scoring system and its advantage in early recognition of acute pancreatitis, thus taking early steps to provide specific treatment to prevent complications, reduce the risks and to improve the overall survival.
Atypical fibrous histiocytoma is a rare and a distinct variant of cutaneous fibrous histiocytoma which can be misdiagnosed as sarcoma. It is mainly composed of a mixture of fibroblastic and histiocytic cells, especially found in the skin (dermatofibroma), particularly in the limbs. It is quite uncommon and is difficult to distinguish from a malignant lesion. Due to the lack of clear cut predictive morphological patterns and due to the suspicion of malignancy, complete surgical excision is recommended. Provided that atypical fibrous histiocytoma is treated by complete excision, a benign outcome is to be expected in most cases. However, like the cellular and aneurysmal variants of fibrous histiocytoma, atypical fibrous histiocytoma shows a higher tendency to recur locally than ordinary fibrous histiocytoma and may rarely metastasize. Lesions with floridly atypical features represent potential pitfalls for overinterpretation as pleomorphic sarcoma, which would appear to be inappropriate in most cases. Due to its rarity and uncertainty, we report a case of atypical fibrous histiocytoma and discuss its presentation, nature, types and treatment with reference to a brief review of literature.
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