Journal de chirurgie

Inguinal hernia and lymphadenopathy are the most common causes of the inguinal swelling which can be diagnosed clinically, but the intraabdominal pathologies presenting primarily as an inguinal swelling and masquerading as inguinal hernia are often rare. We report 3 cases of the different primary intraabdominal pathologies presenting atypically as inguinal swelling and causing a diagnostic dilemma. Thorough clinical history, examination and better imaging accurate preoperative diagnosis and plan of management. 1^st case was gallstone related necrotizing pancreatitis presenting with left lumbar pain and left inguinal swelling due to collection tracked into inguinal canal through patent processus vaginalis, managed conservatively with percutaneous drain for collection. 2^nd case was metastatic liposarcoma in the left inguinal region who initially underwent excision of retroperitoneal sarcoma and received adjuvant chemoradiotherapy, he underwent wide local excision. 3^rd case was low grade appendiceal mucinous neoplasm presenting initially as right indirect inguinal hernia followed by left inguinal hernia due to the mucinous material tracking into inguinal canal through processus vaginalis. Managed by herniorrhaphy and right hemicolectomy.

Fournier’s Gangrene is one of the rare, but life-threatening disease. It is a fulminant form of necrotizing fasciitis of the perineal, genital or perianal regions with infective etiology caused by a mixture of aerobic and anaerobic microorganisms. In the present paper the effect of Chedana Karma and Sandhana Karma in a case of Fournier’s gangrene is documented. The study was conducted on a 42 years old male patient who was admitted to Dhanwantri Ayurved Medical College and Hospital, Udgir. In Shalya Tantra IPD, with the complaints of pain and swelling around scrotum, pain in lower abdomen, fever and pus discharge from scrotum for 12 days. The condition was diagnosed as Kotha (Fournier’s gangrene). Chedana Karma (Early and exhaustive debridement) of the scrotal gangrenous tissues was done followed by Shodhana karma (Daily cleaning and dressing) with Panchvalkala and Triphala kwatha. Scrotoplasty was done after 3 weeks of Shodhana karma when Shudha Vrana features were found. Oral medications Panchatiktaghrita guggulu, Gandhaka rasayana and Amlaki churna were given. Significant improvement was observed in the patient in subjective parameters. The patient resumed his routine work and there was no discomfort, side effect or complication or recurrence after treatment and in follow up period.

Kikuchi-Fujimoto Disease (KFD) typically presents as cervical lymphadenopathy in young healthy women. Cervical lymph node involvement has been found in almost all of the previous studies, axillary lymph node involvement, however, was reported only in one out of eight cases reported from Nepal. In the 11 cases reported from India, all of them involved the cervical lymph nodes. In a retrospective study of 195 patients by Cheng et al., only 2.6% only had involvement of axillary lymph nodes. Here we report a case of a 21-year-old male who presented with fever and right-sided axillary lymphadenopathy. Furthermore, in contrast to the typical presentation, the patient had a normal Erythrocyte sedimentation rate, thrombocytopenia and tested negative for EBV.

The fast track process is a directed surgical care pathway with the goal to improve patient recovery following surgery. The implemented fast track protocols in oesophageal surgery were adopted from approved protocols of other surgical disciplines, resulting in a large variation of the used protocols. The published studies have clearly demonstrated the consistent evolution in fast track protocols by showing variations in the protocol components across the published reports. However, an overall improvement in-hospital stay length, anastomotic leak, pulmonary complications, and mortality has been showed over time without influencing the surgical morbidity. Therefore, these positive results in outcomes demonstrated the feasibility of the fast track process without supplementary risk in oesophageal surgery. The variations in the fast track protocols and key components applied following oesophagectomy identify the real need to continually assessing and identifying the areas of improvement. The objective of the review work is to give an overview of the published reports on the evolution and benefits of the fast track process over time in oesophageal surgery.

Malignant tumours of the face are usually seen in the periocular region. Sebaceous gland carcinomas mostly occur on the upper eyelid due to abundance of meibomian glands. Approach for the tumor should be based on its biology. The best treatment for eyelid malignant tumours is the total excision of the lesion with frozen section control. Defects created should be reconstructed judicially taking care that the near-normal anatomical and functional recovery is achieved. Here we present a case of SGC which was excised and the defect was reconstructed wit Cutler-Beard flap procedure which very well restored the anatomy and function of our patient.

Biliary ileus is an infrequent complication of cholelithiasis that occurs in less than 0.5% of cases. It is used more than one study of immunology given its difficult diagnosis. We report the case of a 49-year-old patient admitted for occlusion, in which the triad of biliary ileus was not characteristic.