Basaloid squamous cell carcinoma (BSSC) is a rare and aggressive variant of squamous cell carcinoma (SCC). It has predilection for the upper aero digestive tract with common metastasis to regional lymph node and common distant metastasis to lungs. While metastasis to scalp has rarely been reported, primary occurrence of BSCC arising from scalp has hardly ever been reported. We are reporting a case of 70 year female patient, who presented with an ulceroproliferative growth in posterior scalp. Biopsy from the edge of growth was reported as malignant adnexal tumor. A wide local excision was done and that biopsy was reported as Basaloid squamous cell carcinoma. We intend to present this case, considering its rarity and its primary presentation in an very unusual and unique location for this variant.
Enterocutaneous fistula is an abnormal communication between two epithelialized surfaces, one of which is a hollow viscous organ. It most commonly occurs as a surgical complication. Other causes are trauma, malignancy, inflammatory bowel disease, ischemia. The great majority of enterocutaneous fistula are iatrogenic (75-85%) and rest (15-25%) occur spontaneously. Enterocutaneous fistula is the one of the most challenging conditions managed by General surgeon. The mortality rates vary in different series for patients, with enterocutaneous fistula and remains 5% to 15%.Here we report a rare presentation of enterocutaneous fistula.
Background: Proper documentation of the surgery done in the form of operative notes is a very important aspect of surgical practice. The aim of this clinical audit was to identify the existing standard of the operative notes written in a general surgical unit in a quaternary care hospital; and to compare it with the recommendations given by Royal College of Surgeons, England (in Good Surgical Practice, 2014) and if needed, to improve the standard of practice.Methods: In the first loop of this prospective audit, 75 consecutive operative notes which were written were compared with the RCS guidelines and the areas which had missing data were identified. These areas were informed to the residents, who are primarily involved in the documentation of the operative notes. The second loop of the audit was conducted after a gap of 4 months involving 75 consecutive operative notes again.Results: The areas which were initially deficient were better documented when analysed in the second loop.Conclusions: Documentation of operative notes does not always comply with the set guidelines as highlighted in the first loop of our audit. But by employing a clinical audit it is possible to identify the existing deficiencies and thereby improving the standards of practice. Also, operative note writing should be taught as part of surgical training. Definitions should be clearly provided, and specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety.
Background: The aims of the study were to find whether a decrease in absolute eosinophil count was a reliable prognostic marker in patients with perforative peritonitis and to determine whether the levels of Absolute eosinophil count had any correlation with the type of perforation.Methods: A total of 104 patients with perforative peritonitis presented consecutively to Madras Medical College, Rajiv Gandhi Government General Hospital from October 2017 to October 2018 were chosen and were allocated into two groups based on the outcome as mortality or survival. 88 patients were in the survival group and 16 patients were in the mortality group. The Absolute eosinophil count distribution in both these groups were recorded along with the type of perforation.Results: Data were processed using SPSS software. All values were expressed as mean±standard deviation / median. Comparison of absolute eosinophil count between the two groups was done using student ‘t’ test and prognostic accuracy of the parameters were done using ROC curve analysis. It was found that a decrease in absolute eosinophil count was associated with adverse outcome in perforative peritonitis patients.Conclusions: From this study, we conclude that Absolute Eosinophil Count is a reliable marker of survival. It allows timely identification of high-risk patients and can be used as a marker for risk stratification and hence can be considered a reliable prognostic marker in perforative peritonitis patients. It can also be concluded that there is no correlation between the Absolute eosinophil count levels and the type of perforation.
Inguinal hernia in females is relatively uncommon as compared to males. It is interesting to note that 1 male in 5 and 1 female in 50 will eventually develop an inguinal hernia in a lifetime. The hernia sac may contain unusual structures such as the vermiform appendix, acute appendicitis, ovary, fallopian tube and, urinary bladder. Here we present a case of 20-year-old female presented with complaints of swelling in the right inguinal region. Diagnosed as a case of right inguinal hernia with Broad ligament cyst as content. Managed by laparoscopic excision of cyst and then right Lichtenstein repair for inguinal hernia.
A traumatic diaphragmatic hernia is uncommon which accounts for 0.8 to 1.6%. In Blunt or penetrating abdominal injury, the patient presents as early or delayed respiratory distress or intestinal obstruction. We present the 55-year old female with a road traffic accident (pedestrian versus two-wheeler) with left-sided chest pain and breathlessness, left shoulder and leg pain referred to our institute. On examination, left hemithorax decreased breath sound and bowel sound was present, chest compression test positive, normal bowel sound in the abdomen, restricted left shoulder movement and abnormal mobility of shaft of left tibia and fibula. A plain X-ray of the chest and abdomen showed bowel shadow in the left hemithorax up to the apex. Computed tomography (CT) of thorax and abdomen shows herniation of stomach, transverse colon, omentum in the left hemithorax with collapsed left lung. A plain X-ray of the left shoulder shows neck of scapula fracture, left leg both bone fracture. Suggesting traumatic diaphragmatic hernia took emergency surgery, laparotomy was made intact stomach, transverse colon, omentum reduced with no injuries, radially placed diaphragmatic rent of size 10 cm × 5.5 cm through which left lung inferior lobe visualized, medial edge of rent close to the pericardial pad of fat. Other solid organs normal, left thoracic drain was fashioned. Rent was closed with interrupted polypropylene with intraabdominal drain. Left leg both bone fracture was done with tibial nailing and left neck of scapula fracture managed conservatively. Abdominal approach is sufficient rather than a thoracoabdominal approach given associated intraabdominal injuries, nowadays minimal access approaches preferred.
Intussusception is the telescoping of the proximal segment of the intestine within the lumen of the adjacent segment. Adult intussusception is rare and its aetiology differs from paediatrics. Surgery is highly recommended and challenging considering the possibility of carcinoma. Post-operative intussusception is a rare and bizarre complication. We report an 18-year old male who had undergone uncomplicated appendectomy outside the institute with missed histopathological examination (HPE) report, presented with abdominal pain for 1 week, vomiting 4 days, obstipation 1 day. On examination ovoid mass of size (12×7 cm) in right hypochondrium. A plain abdomen radiograph shows dilated bowel loops. Contrast-enhanced computed tomography (CECT) abdomen and pelvis showed telescoping of small bowel into the caecum. Suggestive of post-appendectomy intussusception causing intestinal obstruction, emergency laparotomy revealed telescoping of ileum into caecum, acting as the leading point of intussusception, proceeded with right hemicolectomy and ileo-transverse anastomosis. With blindsiding HPE defining high grade diffuse large B cell lymphoma, immunohistochemistry stains nuclear positivity for cluster of differentiation-20 (CD-20) >80%, and Ki-67 >90%. Surgery plus chemotherapy is warranted being a high-grade tumour. Surgery must be restricted to the primary tumour, with mesenteric lymph node involvement based on oncological principles. Laparoscopic approach is preferred nowadays.
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