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   Table of Contents - Current issue
January-April 2022
Volume 5 | Issue 1
Page Nos. 1-17

Online since Monday, September 12, 2022

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Why do we need more women in surgery? p. 1
Shabnam Bashir
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Ileocolic intussusception in an adult: A rare case series and review of literature p. 5
Shardool Vikram Gupta, Jitendra Kumar, Divya Sharma, Siddharth Khemka
Background: Intussusception is commonly presented in children, whereas in adult, it is a rare finding. Classic presentation of ileocolic intussusception seen in children is missing in the adult population. So many times, adult patient of ileocolic intussusception presenting with atypical symptoms becomes a diagnostic dilemma which gets confirmed only after the surgery. Here, we are presenting a rare case series of ileocolic intussusception managed in our tertiary care center during the past 5 years. We are also discussing the available literature in the context of our clinical findings, possible etiopathogenesis, and management of this rare presentation. Materials and Methods: We are reporting here rare seven cases diagnosed with ileocolic intussusception and were managed successfully at our tertiary care hospital over span of the past 5 years. Data of all these cases (n = 7) were collected and analyzed retrospectively. Results: Among the seven patients, six were male (85.71%). The mean age of presentation was 59.1 years of age (range: 45–74 years). Most patients (85.71%) had abdominal pain as main presenting complaint. Three patients (42.85%) were diagnosed primarily on colonoscopy, whereas the rest four were diagnosed on contrast-enhanced computed tomography abdomen. Most patients had pathological lead points such as gastrointestinal stromal tumor (n = 2), carcinoma cecum (n=1), adenovillous adenoma (n=1), and Non-Hodgkin's lymphoma (n = 1). Most of the patients (n=6) needed surgical exploration. Conclusion: Adult ileocolic intussusception is usually associated with pathological malignant lead points. Surgical explorations are mainstay of treatment in these cases.
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Role of donuts and safe resection margins in rectal cancer surgery p. 10
Nisar Ahmad Chowdri, Asif Mehraj
Resection margins in rectal cancer surgery have a pivotal role in assessing the adequacy of surgery as well as playing an important role in determining the prognosis for the patient. With better understanding of tumor biology, more importance is being laid on circumferential resection margin (CRM) rather than distal/proximal resection margin. Positive CRM is an important predictor for increased local recurrence rates. The length of safe distal resection margin in rectal cancer surgery has reduced significantly over the past few decades, with no significant change in the prognosis of patients. To avoid permanent stoma, more and more sphincter saving procedures are being performed, and this has been made possible as a result of more and more use of staplers. While using staplers, donuts are produced from the two resected ends and there is controversy whether these should be sent for histopathological examination or not. In this article, we discuss the importance of resection margins and donuts in rectal cancer surgery.
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Isolated fungating axillary lymph node metastasis in anal canal carcinoma – A rare case report p. 13
Raghav Yelamanchi, Pynroibor Mawblei, Nikhil Gupta, CK Durga
Anal canal cancer is the least common malignancy of the gastrointestinal tract. Main risk factors include infection with human papillomavirus strains, immunosuppression, multiple sexual partners, and receptive anal intercourse. We present a rare case of anal canal carcinoma with fungating right axillary lymph node metastasis. A 65-year-old farmer had presented to the surgical department with complaints of bleeding per rectum and ulceration around the anus for 6 months. He also gives a history of fecal incontinence and right axillary swelling. On examination, there was an ulcer around the anus circumferentially with everted edges and indurated base. There were multiple enlarged bilateral inguinal lymph nodes and fungating right axillary lymph node. Magnetic resonance imaging of the pelvis revealed features suggestive of neoplastic etiology of anal canal. Biopsy of ulcer margin and axillary lymph node was suggestive of squamous cell carcinoma. Positron emission tomography/computed tomography (PET/CT) of the whole body revealed no other site metastatic foci. The patient underwent diversion sigmoid colostomy and was started on chemoradiation (Nigro regimen). The patient had very good response to the regimen, and follow-up PET/CT scan showed no active uptake in the tumor foci.
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Transverse colon diverticulitis: An uncommon cause of a surgical acute abdomen p. 16
Sangeetha Siva, HV Shivaram, Sunilkumar B Alur, Preetej Macwan
Diverticula are small mucosal herniations protruding through the intestinal layers and smooth muscle along the natural openings created by the vasa recta or nutrient vessels in the wall of the colon. Diverticulitis of the transverse colon is a rare disorder which is often confused with other conditions and presents a challenge in diagnosis. We, here, report a case of transverse colon diverticulitis with mesocolic abscess treated surgically. This report increases awareness of this unusual condition.
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