Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma.
Gastrointestinal stromal tumours (GISTs) are infrequently encountered, mesenchymal tumours of the gastrointestinal tract of varying malignant potential. Multiple (in hundreds) small intestinal GISTs have been reported to occur only very occasionally in patients with type 1 neurofibromatosis (NF1). They are mostly silent, often detected incidentally or when complicated by bleeding or other symptoms. Such a case of multiple jejunal GISTs causing small bowel obstruction in a patient with NF1 is described and relevant literatures are briefly discussed.
Acute appendicitis is one of the most common emergencies handled by a surgeon. Various aetiologies of acute appendicitis have been proposed but none have been proved. Trauma too has been proposed as a cause of acute appendicitis. Here we present a case of blunt trauma abdomen which was explored to rule out a perforation of hollow viscous organ and haemoperitoneum, but at the time of exploration a perforated appendicitis was found. The chronological order of events points towards blunt trauma as the probable cause of this appendicitis. This case also highlights the fact that even if trauma was not the cause of acute appendicitis, acute appendicitis should still be kept in the differential diagnosis of a patient presenting with pain in the right lower abdomen and a history of trauma.
BACKGROUND Parotid duct sialocele is a rare entity. Patients presented with mostly painless, cystic swelling over the cheek encroaching to the parotid region. Diagnosis was done by FNAC and MR sialogram which revealed that the swellings were due to parotid duct sialocele. That swelling was due to obstruction to the parotid duct by sialolithiasis, trauma, etc. Some of those patients had h/o chewing of areca nuts and betel quid. We found in those cases oral submucosal fibrosis, but we did not find such association in any literature. Many treatment options available for e.g. repeated aspirations, marsupialisation etc. but mostly all were associated with recurrence. We found in literature that the foolproof treatment is superficial parotidectomy. In our cases also superficial parotidectomy was the best treatment option having no recurrence. MATERIALS AND METHODS We report twenty-two cases who presented with parotid duct sialocele to our OPD at BSMC, Bankura. We examined the cases and diagnosed those cases by several methods. We instituted several treatment options. RESULTS Initially we did aspiration in all patients with parotid duct sialocele, but out of the twenty-two cases recurrence occurred in twenty cases. The patients were disease free for 3-4 weeks. Next, we did repeated aspirations where seventeen cases came with recurrence. Then we opted for marsupialisation with biopsy. These marsupialised patients came back with recurrence after 4-5 months. Out of these seventeen cases, twelve cases were of oral submucosal fibrosis. All the cases with marsupialisation suffered from recurrence who ultimately undergwent superficial parotidectomy with no recurrence for 2-8 yrs. CONCLUSION Oral submucosal fibrosis may be one of causes for parotid duct sialocele which is seen in chronic betel quid and areca nuts chewers. Superficial parotidectomy is the definite treatment for parotid sialocele.
Background: Presence of H. pylori infection was found associated with peptic perforation and gastric carcinoma. Present study tried to estimate the prevalence of H. pylori infection in those patients and to find out the correlates of H. pylori infection.Methods: After matching the inclusion and exclusion criteria, all cases of diagnosed peptic perforation and gastric carcinoma were taken for this prospective, single center, observational study.Results: Among the study population, gastric carcinoma was found in higher age group; whereas peptic perforation was found in lower age group; male and female ratio was 2:1 in both groups of patient. Laborer and housewives were mostly affected in both cases. Gastric carcinoma was more prevalent in urban residents, opposite was seen in peptic perforation. Most patients in two groups had no previous co-morbid condition. Use of NSAIDs was found in high frequency in both groups. Most of the patients were chronic alcoholic and chronic smoker, and most of them had history of taking spicy foods more than twice in a week.Conclusions: H. pylori infection was found in high frequency in both group of patients, and it was higher in peptic perforation. The study establishes the association of H. pylori with the gastric carcinoma and peptic perforation.
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