BackgroundPrimary appendiceal adenocarcinoma is a rare tumor, mucinous variety being common. This case is reported to highlight the unusual presentation and diagnostic difficulty of appendiceal adenocarcinoma.Case presentationPatient presented with acute appendicitis with ill-defined tender lump which responded to conservative management.ConclusionsHigh index of suspicion should be kept in mind for elderly patients presenting with appendicular lump. Every effort should be made during elective appendectomy to remove stump in case of sloughed out appendix.
The unusual location of gastrointestinal tuberculosis, lack of specific signs and symptoms, radiological studies and endoscopy findings makes diagnosis a challenge. The treatment of duodenal tuberculosis is still medical and surgery should be reserved for emergency like gastric outlet obstruction causing nutritional compromise.
Background Long-term catheterisation is frequently necessary for patients with retention of urine or intractable incontinence who are unfit for definitive treatment or being evaluated for definitive treatment. In this study, the important factors influencing the encrustation of indwelling catheters are analysed. Methods A total of 52 patients on catheter drainage for a period ranging from 1 month to 1 year were taken in the study. Patients reported either for problems like catheter block or routine changing of catheter. The catheters were removed, and encrustation was subjected to chemical analysis. Urine was examined for pH, specific gravity, culture sensitivity and appearance. Blood samples were taken for estimation of calcium, phosphorus and uric acid. Results Out of 52 patients, 28 with urea splitting and 15 with non-urea splitting had positive urine culture (43 out of 52). Amongst 28, 27 (96%) had encrustation compared to 10 (50%) out of 15 with non-urea splitting bacteria (p value < .05). Amongst 24 patients having pH > 6, 22 (92%) had encrustation (p value < .05). The encrustation was found to be more common in bedridden patients (91%) when compared to physically active patients (54%) (p value < .05). The encrustation was more common in patients having single catheter for more than 15 days (86%) when compared to patients having catheter for shorter period (43%) (p value < .05). Conclusion This study showed definitive influence of the following factors in encrustation formation: infection with urea splitting organism, alkaline pH, physical activity of patient and duration of keeping a particular catheter.
Background: Cholelithiasis along with other causes of upper abdominal pain, have a similar mode of presentation. Often the cholelithiasis is an incidental finding not causative. Aims and objectives of this study was to determine the role of oesophagogastroduodenoscopy (OGDscopy) in patients presenting with upper abdominal pain and sonographically documented cholelithiasis being considered for cholecystectomy and to eliminate the confounding causes of pain and avoiding cholecystectomy in incidental cholelithiasis. Methods: 200 patients with upper abdominal pain (typical/atypical) and sonographically documented gallstones underwent OGDscopy. Patients with normal OGDscopy underwent cholecystectomy while it was deferred in those with positive OGDs copy findings. These patients were appropriately managed and followed up with a repeat OGDscopy at 6 weeks. All patients were re-assessed for resolution of symptoms at 6 weeks and those with persistence of symptoms in spite of a normal OGDscopy on reassessment were then subjected to cholecystectomy. Pearson's chi-square test was applied to study association between type of pain (typical/atypical) and OGDscopy findings and type of pain (typical/atypical) and requirement for cholecystectomy. Results: Of the 200 patients, 120 presented with typical and 80 with atypical pain. Among those with atypical pain (n = 80), a significant 95% (76/80) had positive findings on OGDscopy while none of those with typical pain had positive finding on OGDscopy (p<0.005). Cholecystectomy to relieve pain was needed in all 120 patients with typical pain while only 17.5% (14/80) of those with atypical pain required cholecystectomy (p<0.005). Conclusions:The study shows that OGDscopy in patients with cholelithiasis can suggest alternative management plan particularly in those with atypical pain.
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