A 40-year old male presented with rapidly growing swelling in the right parotid region. Based on the fine needle aspiration cytology report of adenocarcinoma not otherwise specified, superficial parotidectomy was performed, which showed the features of salivary duct carcinoma by histopathological examination. The smears were reviewed to identify the potential pitfalls in the cytological diagnosis of salivary duct carcinoma.

INTRODUCTIONPancreaticoduodenectomy (Whipple procedure) is the standard treatment for operable carcinomas of the head of the pancreas, periampullary tumors and in some cases of chronic pancreatitis. Advances in surgical skills and postoperative care have resulted in mortality rates of less than 5%.1 Despite significant improvements in the safety and efficacy of pancreatic surgery, morbidity still remains high in the range of 30% to 65%.2 Delayed gastric emptying (DGE) and Postoperative Pancreatic fistula (POPF) remains the major causes of morbidity.The exact cause of DGE following pancreaticoduodenectomy is not known. It appears to be multifactorial. [3][4][5] Technical factors in the construction of gastroenterostomy have been implicated in the development of DGE. Significant edema or kinking at this anastomosis may be a factor in the development of DGE. 6 ABSTRACT Background: Morbidity following Pancreaticoduodenectomy still remains high. Few studies have shown decrease in morbidity with the addition of Braun Enteroenterostomy (BEE). Aim of the present study was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy. Methods: In this prospective randomized controlled study, all patients who underwent Pancreaticoduodenectomy from June 2012 to July 2016 were included. They were randomized to undergo either standard reconstruction (Group A) or with addition of Braun Enteroenterostomy to standard reconstruction (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of <0.05 was considered significant. Results: 104 patients were included in the study. Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients who had addition of BEE to standard reconstruction. The demographic profile, tumour characteristics, and biochemical profile were similar in 2 groups. Mean operating time and Intra operative blood loss were similar. The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56, 25% in group A versus 8/48, 16.6% in group B; p = 0.42). The incidence of Delayed Gastric Emptying (DGE) was not statistically different in 2 groups (20/56, 35.7% in group A versus 12/48, 25% in group B; p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 days versus 10.7 days; p=0.68). Conclusions:The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun Enteroenterostomy to standard reconstruction.

Background: Postoperative pancreatic fistula (POPF) remains the most serious complication of Pancreaticoduodenectomy. ISGPF defined POPF in 2005 based on drain fluid amylase on or after day 3 and graded the severity. But as Grade A fistulas are not clinically relevant, most of the clinicians do not consider them as POPF. Hence exact incidence of POPF is not known. Our aim is to see weather drain fluid amylase on or after day 5 can define clinically relevant POPF better than day 3.Methods: Prospective study included all patients who underwent Pancreaticoduodenectomy during the period January 2013 to November 2016. Serum and Drain fluid amylase were analyzed on Day 3. Those who met criteria of POPF underwent repeat amylase on Day 5. These patients were divided into 2 groups. Group A includes patients whose Day 5 amylase normalized and Group B where elevated Amylase persisted. Outcomes were compared in 2 Groups in terms of clinically relevant POPF (CRF), DGE, Haemorrhage (PPH), hospital stay and 30 Days mortality. Results were analysed and p value <0.05 was considered significant.Results: On 110 patients, 44 (40%) met ISGPF criteria of POPF. Of 44, 36 (82%) had normalized Amylase on Day 5 (Group A). Only 8 (18%) had persistent elevated amylase (Group B). None in Group A had CRF, whereas in Group B, 6(75%) had CRF and 2(25%) had only biochemical leak (p<0.0001). DGE was significantly higher in Group B (87.5% vs. 33.3%; p=0.013). PPH was seen in only 1 patient (Group A). Duration of hospital stay and 30day mortality were similar.Conclusions: Drain fluid amylase levels on or after Day 5 defines clinically relevant POPF better than levels on or after day 3.

Dermoid cyst is a mature-type teratoma containing sebaceous material and predominantly tufts of hair or teeth along with skin appendages. It is most commonly observed in the ovary but is rare in the testis, and only a few cases have been reported so far. In most of the reports, the cyst tended to be diagnosed in a younger age group. Here, we report a dermoid cyst of the testis in a 72-year-old man.

Conclusion: NOM is the standard of care for blunt hepatic and splenic injury and successful in >80% of patients. The presented clinical algorithm is primarily guided by clinical parameters and is safe with a low mortality rate <2%.

Introduction We aimed to study the prevalence, risk factors, management, and outcome of hernias in end‐stage renal disease (ESRD) patients on peritoneal dialysis (PD) from India. Methods This was a retrospective study of ESRD‐PD patients who developed hernias over 11 years. Results Of 470 PD patients, 21 developed hernias (4.2%). Mean age of patients was 49.9 ± 15.36 years; 15 (66.66%) were males; 18 (85.71%) patients had umbilical hernia, 3 (14.28%) had inguinal hernia. Continuous ambulatory PD (CAPD) versus automated PD (APD) (OR: 11.623, 95% CI: 2.060–65.581, p = 0.005) was the independent risk factor identified. Incarcerated umbilical/inguinal hernia was managed surgically (6 [28.57%]); uncomplicated umbilical hernia (15 [71.42%]) managed conservatively (shift to (APD) [33.33%]; switch to low‐volume APD [20%], switch to low‐volume CAPD [46.66%]). None had postoperative hernia recurrences; 4 (19%) had PD technique failure; median PD survival was 36 (IQR 17–55) months. Conclusion Although complicated hernias in PD require surgical repair, uncomplicated umbilical hernias can be managed conservatively by switching to APD/low‐volume CAPD, with good long‐term PD technique survival.

Background: Pancreatic adenocarcinoma (PC) is an aggressive cancer with a dismal prognosis. Detection at early stage, when surgery is still possible, is essential to improve survival. To achieve this, knowledge on risk factors and populations at increased risk is needed. We investigated the association of acute pancreatitis (AP) with risk of PC. Methods: Using nationwide registries, we identified a cohort of all AP patients admitted to Danish hospitals during 1977-2012. For each patient, we identified up to five age-and sexmatched controls without AP. We excluded patients with chronic pancreatitis. Using Cox proportional hazards regression model, we computed hazard ratio (HR) for PC in patients with AP compared with the matched comparison cohort (MCC). HRs were adjusted for age, gallstone, Charlson Comobidity Index, alcohol-and smokingrelated diseases. Results: We identified 38,618 AP patients; 34,834 had a single admission for AP and 3,784 patients had more than one admission for AP. The MCC included 189,413 persons. Median age was 58.1 and 58.4 years in the AP group and MCC respectively; 52.3% of the study cohort were male. Median follow-up was 8.5 years. During follow-up, 117 pancreatic cancers occurred in the AP group (0.3%) and 643 in the MCC (0.3%). Adjusted HR of PC for patients with one attack of AP was 0.96 (95% CI: 0.76-1.22), and for recurrent AP 1.05 (95% CI: 0.59-1.87). Conclusion: Findings from our large population-based matched cohort study suggest that AP is not a risk factor for pancreatic cancer.

Background: Surgery is the treatment of choice for intractable pain in chronic pancreatitis (CP). Drainage procedures are indicated in large duct disease whereas resectional procedures for small duct disease. Aim of this study was to assess prospectively the feasibility of drainage procedures in patients with CP with small duct disease.Methods: All consecutive patients with CP with small duct disease were included in the study. All patients underwent surgical intervention (lateral pancreaticojejunostomy with head coring). Primary outcome measures were pain relief and morbidity. These outcomes were compared with patients with CP with large duct disease.Results: 114 patients with CP underwent surgery. Of these 24(21.05%) patients had CP with small duct disease and 90(78.95%) patients had large duct disease. Demographic profile of the two groups was comparable. Mean pain scores were similar (47.75±6.85 versus 51.38±7.40; p = 0.14). Patients with large duct disease had higher incidence of diabetes mellitus (44.44% versus 8.33%; p = 0.02), but exocrine insufficiency was similar. All patients had calcifications in both the groups. Mean intraductal pressures measured intraoperatively were significantly high in patients with large duct disease (22.99±5.65 versus 18.33±3.52; p = 0.001). Frequency of complications at presentation were similar in both the groups (p = 0.29). Surgery relieved pain in 21/24 (87.5%) patients with small duct disease and 82/90 (91.11%) patients with large duct disease. Mean post-operative pain scores in small duct disease group (7.50±9.61 versus 51.38±7.40; p <0.001) and large duct disease group (5.14±7.88 versus 47.75±6.85; p <0.001) were significantly reduced when compared to preoperative pain scores. Incidence of postoperative complications was similar in both groups (16.66% versus 14.44%).Conclusions: Drainage procedures (lateral pancreaticojejunostomy with head coring) is a feasible for CP patients with small duct disease with good pain relief.