Cystic hygromas/lymphangiomas are extremely rare malformations in adults. They are usually seen in infants and children under 2 years of age. En bloc resection is difficult due to the adhesive characteristics of the tumours. Inadequate surgical intervention often leads to recurrent disease. We report herein the case of a cystic hygroma/lymphangioma that presented as an uncommon mass on the cervical region in an adult. A 24-year-old male presented with a swelling on the left side of the neck since childhood, noticed to have increased in size for the past six months. It was a solitary 4 cms x 3 cms, soft, non-tender, ovoid swelling at the left submandibular region with a well-defined margin with smooth surface and the overlying skin was normal. There was no intra-oral extension on bimanual palpation. The routine blood investigations are done and were within normal limits. FNAC and CT neck were done. Patient underwent wide excision, where the intraoperative findings showed a superficial cystic swelling with few loculi over the muscle layer of the mylohyoid and the anterior belly of the digastric with few finger-like extensions between the muscle planes. The swelling was excised in toto. Histopathology reports revealed multilocular cystic swelling lined by fibrous stroma and on microscopy was multiple lymph spaces lined by lymphatic epithelium with a diagnosis of lymphangioma of the neck. DISCUSSION OF MANAGEMENT Cystic hygromas/lymphangiomas are rare congenital malformations of the lymphatic system. Most are seen in the head and neck region (75-80%) and usually affect children under 2 years of age. 1 They are quite rare in adults. 2 The aetiology of hygromas in adults is controversial, but they are thought to be due to proliferation of lymphoid vessels in response to head and neck trauma and/or infection. 3
author name "Gurunathan" should be ignored. The correct order is given in this correction.The original article has been corrected.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
BACKGROUNDPeptic ulcer is quite common in our country due to intake of non-steroidal anti-inflammatory drugs, alcohol, spicy diet, smoking and a stressful lifestyle. Almost everybody harbours Helicobacter pylori within them and prone to peptic ulcer. Peptic ulcer can have disastrous complications with one of them being perforation, which is a surgical emergency. Its effects can range from severe abdominal pain to hypotension, sepsis and shock. Hence, timely intervention is absolutely mandatory. Various scoring systems have been developed to prognosticate the morbidity and mortality of perforated peptic ulcer with Boey score being the most commonly followed in various healthcare setup. We tried to determine the role of Boey score in our patients with perforated peptic ulcer and analyse its limitations.
CASE PRESENTATION A 54-year-old moderately built gentleman presented to surgery OPD with complaints of swelling over the left lumbar region for the past 5 months associated with dull aching left sided abdominal pain for the past one month. There was no previous history of trauma, abdominal surgeries, fever, weight loss or any associated bowel or urinary complaints. Patient is a known case of bronchial asthma, diabetes mellitus and systemic hypertension on regular medications. On examination there was 6 X 5 cms soft, swollen, not tender, partially reducible mass with impulse on cough below the left costal margin, lateral to dorsolumbar spine. Opposite side lumbar region and other hernial orifices were normal.
This 39-year-old female patient came to surgical outpatient department with the complaints of non-radiating upper abdominal pain and non-bilious vomiting for 1 week duration. There was history of loss of appetite, loss of weight and melena for past 1 month. 1-3 On examination, the patient was found to be poorly nourished, dehydrated and pale. There was no icterus/ no pedal oedema and no significant supraclavicular lymphadenopathy. Blood investigations showed Hb as 10.3 g/dL, PCV-34%, WBC-6,400 cells/cmm, Platelets-2,13,000 cells/cmm and ESR-02 mm. The blood grouping was A positive. Serum electrolytes assessment showed sodium levels of 135 mEq/L, Potassium-3.9 millimoles/lit, Chloride-103 mEq/L and Bicarbonate levels of 26 mEq/L. Renal function tests revealed Urea level as 27 mg/dL and Serum creatinine level as 0.9 mg/dL. 4,5,6 Upper gastrointestinal scopy done in this patient showed an Ulcerative growth involving the whole circumference of the antrum from the incisura to 1 cm start-up pylorus and lumen appeared narrowed (Figure 1).
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