Pradeep Saxena - Academia.edu (original) (raw)

Papers by Pradeep Saxena

Research paper thumbnail of Recurrent phyllodes tumour of breast infiltrating the latissimus dorsi reconstruction flap

BMJ Case Reports, 2020

Phyllodes tumour is a rare breast tumour with potential of malignancy. Recurrence in phyllodes tu... more Phyllodes tumour is a rare breast tumour with potential of malignancy. Recurrence in phyllodes tumour may also be suggestive of malignant transformation. We report a case of 29-year-old woman with recurrent phyllodes tumour infiltrating the latissimus dorsi reconstruction flap. Re-excision of the tumour along with excision of latissimus dorsi flap was done. Histopathology confirmed malignant phyllode tumour. A significantly higher incidence of recurrence is seen in phyllodes tumour of large size, tumours with infiltrative borders, increased mitotic activity, malignant histology and positive margins. Surgeons should always take into consideration the risk factors for recurrence before planning reconstructive breast surgery in recurrent phyllodes tumour. A preoperative MRI imaging and incisional biopsy are essential in planning surgery for these patients.

Research paper thumbnail of Adenoid Cystic Carcinoma Breast: a Rare Entity

Indian Journal of Surgical Oncology, 2020

Research paper thumbnail of Nonrotation Of Midgut Loop - A Rare Cause Of Recurrent Intestinal Obstruction In Adults: Case Report And Review Of Literature

The Internet Journal of Surgery, 2010

Rotational abnormalities are a well-known cause of obstruction in neonates and children and may p... more Rotational abnormalities are a well-known cause of obstruction in neonates and children and may present as midgut volvulus. This is very infrequently seen in the adults and may present as vague intermittent abdominal pain or sometimes acutely as upper GI obstruction or ileocecal volvulus with strangulation or gangrene. We present a case of nonrotation of midgut loop in an adult female who presented with recurrent abdominal pain, vomiting and features suggestive of intestinal obstruction. Abnormal rotation with deficient fixation of gut predisposes the patient to cecal volvulus with threat of strangulation of bowels and all its dreaded complications. The diagnosis of malrotation and volvulus should always be kept in mind when evaluating adult patients with symptoms of vomiting and pain, even when clinical findings are featureless, diarrhea is present, or even with normal abdominal radiographs. Surgical intervention is mandatory to avoid or reverse ischemic insult and Ladd's procedure remains the accepted procedure. The purpose of this description is to recall the pathogenesis and the surgical implications of intestinal nonrotation in adults and to review the literature.

Research paper thumbnail of A prospective study of fistula in ano with reference to clinicopathology, imaging and management

International Surgery Journal, 2019

Background: The aim was to study and review clinical presentation, pathological aspects & prevale... more Background: The aim was to study and review clinical presentation, pathological aspects & prevalent modalities of investigation and treatment for fistula in ano.Methods: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulography was done as a preliminary investigation in 72 cases and MR Fistulography was done for complex and recurrent fistula (16 cases). Patients were operated and histopathology of fistula tract was done. In patients with clinical suspicion of tuberculosis smear examination of pus with ziehl neelsen staining for acid fast bacilli (AFB) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on pus/slide was used to find out tuberculosis in patients of anal fistula. The clinical presentation, operation performed, pathological findings were recorded & a descriptive analysis was done.Results: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulogr...

Research paper thumbnail of A rare case of malignant pancreatic non-functional neuroendocrine tumor presenting as huge abdominal lump

International Surgery Journal

We present a case of an exceptionally large size non-functioning pancreatic neuroendocrine tumor ... more We present a case of an exceptionally large size non-functioning pancreatic neuroendocrine tumor (PNET) in a young female. The tumor occupied the whole abdomen and pelvis and was clinically masqueraded as an ovarian tumor. Imaging with contrast enhanced CT scan and magnetic resonance imaging of the abdomen aided in preoperative diagnosis of origin of the tumor from the pancreas. Distal pancreatectomy with splenectomy and left hemicolectomy was done. Primary colocolic anastomosis was done for reconstruction. Postop course was uneventful, and patient was discharged with advice to undergo adjuvant chemotherapy. Surgical excision of large size locally advanced non-functional PNET should be done with curative intention/ to treat symptoms and improve patient survival

Research paper thumbnail of A prospective study on suture ligation of internal hemorrhoids without Doppler guidance for the treatment of symptomatic hemorrhoid disease

International Surgery Journal, 2017

Background: Hemorrhoids or piles are one of the most common afflictions of human being, affecting... more Background: Hemorrhoids or piles are one of the most common afflictions of human being, affecting both sexes & can occur at any age. The aim of the study was to study the effectiveness of suture ligation of hemorrhoids and mucopexy as an outpatient treatment for symptomatic hemorrhoids.Methods: This prospective observational study was carried out in the department of surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India on 64 adult patients of hemorrhoids treated by suture ligation of hemorrhoid pedicle without Doppler guidance and mucopexy from July 2012 to December 2014. The patients were managed as outpatient or day care cases. The observations and follow up data were recorded and descriptive analysis was done to study the clinical presentation of hemorrhoid disease and effectiveness of hemorrhoid ligation and mucopexy in an ambulatory, outpatient or day care setting.Results: Total 64 patients of hemorrhoids who underwent suture ligation of hemorrhoids and mucopexy were ...

Research paper thumbnail of Intra peritoneal ascending colon in parastomal hernial sac

International Journal of Research in Medical Sciences, 2014

Patient was resuscitated in high dependency unit for 4 hours. Nasogastric tube and urinary cathet... more Patient was resuscitated in high dependency unit for 4 hours. Nasogastric tube and urinary catheter were placed. Abdominal roentgenogram suggested multiple air fluid levels. Decision of surgery was taken and patient was explored in operation theatre. There was dilated small

Research paper thumbnail of A prospective comparative study of Lichtenstein's mesh hernioplasty performed under local and spinal anesthesia

International Surgery Journal, 2016

Background: The present study was designed to compare Lichtenstein's hernioplasty performed under... more Background: The present study was designed to compare Lichtenstein's hernioplasty performed under local anesthesia and spinal anesthesia in terms of intra operative and short term post-operative events. Methods: In this study total 244 adult patients (236 male & 8 female) of primary uncomplicated unilateral inguinal hernia operated for open tension free mesh hernioplasty were included. 114 patients were operated under local anesthesia and 130 under spinal anesthesia. The two groups were compared for intra operative & short term (30 days) post-operative events, hospital stay and return to activity. Results: The two groups were similar in terms of intra operative events like nausea, vomiting, hypotension & arrhythmias. Local wound complications like edema, ecchymosis, infection and seroma formation were comparable in both groups and clinically insignificant. However there was advantage for the local anesthesia group in terms of less post-operative pain, less anesthesia related complications, less urinary retention, faster discharge from hospital, faster return to activity and lesser cost of treatment. Conclusions: The study comparing local anesthesia with spinal anesthesia showed advantage for the local anesthesia group in terms of less post-operative pain, less anesthesia related complications, less urinary retention, faster discharge from hospital, faster return to activity and lesser cost of treatment. Thus open inguinal hernioplasty performed under local anesthesia is well suited for our smaller community-based, regional, and teaching hospitals.

Research paper thumbnail of Practice of antimicrobial stewardship in a government hospital of India and its impact on extended point prevalence of antibiotic usage

Journal of Family Medicine and Primary Care, 2021

Background: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Amo... more Background: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Among many proven measures of decreasing AMR, practice of antimicrobial stewardship is the lowest hanging which can be adapted with negligible financial implications. Methods: This is a case record based extended cross-sectional type of observational operation research study conducted at an institute of national importance established by Government of India. Point prevalence of antibiotic usage among the patients admitted in the hospital, on four different days in four different quarters of a year was done to study the impact of antimicrobial stewardship program (AMSP). Results: A cumulative 711 patients were exposed on antibiotics among 1396 study participants. There was a significant decrease in antibiotic consumption across the 1 st and 4 th quarter. The average antibiotic usage was 50.9% (61.75, 60%, 48.4%, and 39% respectively in the 1 st to 4 th quarter). Among the total number of patients, intravenous antibiotic usage was 47.9% (60.71%, 58.4%, 44.9%, and 34.2% respectively in 1 st to 4 th quarter). Among the newly admitted patients, the consumption of antibiotic usage decreased from 45.9% to 25.7%. Among the intravenous antibiotics, the top 10 consumed antibiotics were 3 rd generation cephalosporin (39.8%), aminoglycoside (14.8%), amoxicillin/amoxy-clav (12.5%), piperacillin-tazobactum (8.5%), carbapenams (6.6%), cefuroxime (6.4%), quinolones (4.3%), vancomycin/linezolid (4.1%), colistin (0.8%), and others (0.8%). Conclusion: Government run hospitals can run low budget antimicrobial stewardship program with sustainable impact on antibiotic consumption. For a successful AMSP, it requires change in attitude, commitment, and administrative support rather than a huge financial support.

Research paper thumbnail of The role of laparoscopy in diagnosis of patients with chronic abdominal pain

International Surgery Journal, 2016

Background: Chronic abdominal pain still remains one of the leading clinical problems presenting ... more Background: Chronic abdominal pain still remains one of the leading clinical problems presenting to physicians. Reaching a definitive diagnosis and prompt management is usually delayed because invasive investigations are frequently required to come to a conclusive diagnosis. The aim was to study the varied clinical picture of chronic abdominal pain and evaluate the role of laparoscopy in reaching a conclusive diagnosis in these patients.Methods: A prospective and retrospective study of 142 patients of chronic abdominal pain who underwent diagnostic laparoscopy in our surgery department from June, 2006 to December, 2015 was done. A descriptive analysis of data collected from case records of these patients was done to study the varied clinical picture, laboratory reports, radiological findings, laparoscopic findings and histological reports. The usefulness of laparoscopy to confirm the diagnosis and in clinical management of these patients of chronic abdominal pain was evaluated.Resul...

Research paper thumbnail of A rare presentation of a Leiomyosarcoma of the Stomach

The Internet Journal of Surgery, 2007

Gastrointestinal stromal tumors {GIST} are very rare tumors of GIT [0.5-3% of all stomach maligna... more Gastrointestinal stromal tumors {GIST} are very rare tumors of GIT [0.5-3% of all stomach malignancies] evenly distributed between stomach and small intestine. They commonly present with bleeding, abdominal pain, abdominal fullness and discomfort, anemia, palpable abdominal mass, ulceration etc. Tumor perforation is very rare. Here we are reporting a case, which presented in emergency with gas under diaphragm. On exploration a very huge tumor mass arising from stomach with areas of necrosis and gas bubbles was found. There was no perforation of any hollow viscus. Histopathology revealed epitheliod leiomyosarcoma with degeneration cysts.

Research paper thumbnail of A clinical study of intestinal stomas: its indications and complications

International Journal of Research in Medical Sciences, 2013

The word "Stoma" comes from the Greek word meaning mouth or opening. 1 An intestinal stoma is an ... more The word "Stoma" comes from the Greek word meaning mouth or opening. 1 An intestinal stoma is an opening of the intestine on anterior abdominal wall made surgically. 2 Stomas are used to divert the fecal stream away from distal bowel in order to allow a distal anastomosis to heal as well as to relieve obstruction in emergency situation. It may be temporary or permanent; depending on their role. 3 Though a life saving procedure, it may result in significant number of complications. Complications are divided into early complications (up to 30 days after operation) and late complications (more than 30 days after operation). Littre of Paris was the first to make a ventral colostomy in 1710 for a baby with imperforate anus. 4 An ileostomy was first advocated in ulcerative colitis in 1912 but was not widely used until Brooke demonstrated his everted ileostomy in 1952. 5 Various Indications for which intestinal stomas are formed: ulcerative colitis, bowel obstruction, cancer of colon & rectum, crohn's disease, congenital bowel defects, uncontrolled bleeding from large intestine, injury to the intestinal tract, inflammatory bowel disease, ischemic bowel disease, carcinoma urinary bladder and spinal cord injury. 6 Stoma, though it is a life saving procedure, it carries significant number of complications. Despite extensive ABSTRACT Background: Intestinal stoma is an opening for fecal diversion. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it. Methods: This is a prospective study was carried out in a surgical unit of Hamidia Hospital, Gandhi Medical College, Bhopal from January, 2012 to December,2012. Data was collected by meticulous history taking including age, gender, indication, type of stoma, type of surgery, careful clinical examination, appropriate operative findings and follow up of the cases. The results were collected, analyzed and compared with other studies. Results: A total of 100 patients were evaluated age ranged between 12-85 years (50.5 ± 29.01 years) Male to female ratio was 7:3. Of the 100 patients 97 were admitted in emergency while 3 in outpatient department. The most common type of stoma made was loop ileostomy (64%) followed by sigmoid colostomy (11%) and transverse loop colostomy (9%). Main indication for a stoma formation was enteric perforation (38%) followed by Koch's abdomen (18%). Of the various complications encountered with intestinal stoma, peristomal skin irritation (36%) was the most consistent complication followed by laparotomy wound infection (13%). Conclusions: Inspite of vast exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone.

Research paper thumbnail of An atypical presentation of a multiloculated giant pseudocyst of pancreas

International Surgery Journal, 2021

Giant pseudocysts of the pancreas are rare and difficult to manage. Pseudocysts are usually treat... more Giant pseudocysts of the pancreas are rare and difficult to manage. Pseudocysts are usually treated by cystogastrostomy but dependent drainage for giant pseudocysts may require alternative methods like cystojejunostomy. We report here a rare case of a multiloculated giant pseudocyst of pancreas which presented atypically with protrusion through the lesser omentum. The pseudocyst protruding through the lesser omentum filled the whole upper abdomen up to umbilical region and displaced the stomach inferiorly. The stomach which is usually displaced anteriorly by pseudocysts was unusually displaced and splayed on the inferior aspect of the pseudocyst. The anterior wall of the fundus and body of the stomach was adherent to the inferior aspect of the pseudocyst. The pseudocyst was managed by draining into the stomach in a different way by performing a cystogastrostomy to the anterior wall of the stomach. Giant pseudocysts are difficult to manage, and good imaging studies are helpful in sel...

Research paper thumbnail of Recurrent phyllodes tumour of breast infiltrating the latissimus dorsi reconstruction flap

BMJ Case Reports, 2020

Phyllodes tumour is a rare breast tumour with potential of malignancy. Recurrence in phyllodes tu... more Phyllodes tumour is a rare breast tumour with potential of malignancy. Recurrence in phyllodes tumour may also be suggestive of malignant transformation. We report a case of 29-year-old woman with recurrent phyllodes tumour infiltrating the latissimus dorsi reconstruction flap. Re-excision of the tumour along with excision of latissimus dorsi flap was done. Histopathology confirmed malignant phyllode tumour. A significantly higher incidence of recurrence is seen in phyllodes tumour of large size, tumours with infiltrative borders, increased mitotic activity, malignant histology and positive margins. Surgeons should always take into consideration the risk factors for recurrence before planning reconstructive breast surgery in recurrent phyllodes tumour. A preoperative MRI imaging and incisional biopsy are essential in planning surgery for these patients.

Research paper thumbnail of Adenoid Cystic Carcinoma Breast: a Rare Entity

Indian Journal of Surgical Oncology, 2020

Research paper thumbnail of Nonrotation Of Midgut Loop - A Rare Cause Of Recurrent Intestinal Obstruction In Adults: Case Report And Review Of Literature

The Internet Journal of Surgery, 2010

Rotational abnormalities are a well-known cause of obstruction in neonates and children and may p... more Rotational abnormalities are a well-known cause of obstruction in neonates and children and may present as midgut volvulus. This is very infrequently seen in the adults and may present as vague intermittent abdominal pain or sometimes acutely as upper GI obstruction or ileocecal volvulus with strangulation or gangrene. We present a case of nonrotation of midgut loop in an adult female who presented with recurrent abdominal pain, vomiting and features suggestive of intestinal obstruction. Abnormal rotation with deficient fixation of gut predisposes the patient to cecal volvulus with threat of strangulation of bowels and all its dreaded complications. The diagnosis of malrotation and volvulus should always be kept in mind when evaluating adult patients with symptoms of vomiting and pain, even when clinical findings are featureless, diarrhea is present, or even with normal abdominal radiographs. Surgical intervention is mandatory to avoid or reverse ischemic insult and Ladd's procedure remains the accepted procedure. The purpose of this description is to recall the pathogenesis and the surgical implications of intestinal nonrotation in adults and to review the literature.

Research paper thumbnail of A prospective study of fistula in ano with reference to clinicopathology, imaging and management

International Surgery Journal, 2019

Background: The aim was to study and review clinical presentation, pathological aspects & prevale... more Background: The aim was to study and review clinical presentation, pathological aspects & prevalent modalities of investigation and treatment for fistula in ano.Methods: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulography was done as a preliminary investigation in 72 cases and MR Fistulography was done for complex and recurrent fistula (16 cases). Patients were operated and histopathology of fistula tract was done. In patients with clinical suspicion of tuberculosis smear examination of pus with ziehl neelsen staining for acid fast bacilli (AFB) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on pus/slide was used to find out tuberculosis in patients of anal fistula. The clinical presentation, operation performed, pathological findings were recorded & a descriptive analysis was done.Results: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulogr...

Research paper thumbnail of A rare case of malignant pancreatic non-functional neuroendocrine tumor presenting as huge abdominal lump

International Surgery Journal

We present a case of an exceptionally large size non-functioning pancreatic neuroendocrine tumor ... more We present a case of an exceptionally large size non-functioning pancreatic neuroendocrine tumor (PNET) in a young female. The tumor occupied the whole abdomen and pelvis and was clinically masqueraded as an ovarian tumor. Imaging with contrast enhanced CT scan and magnetic resonance imaging of the abdomen aided in preoperative diagnosis of origin of the tumor from the pancreas. Distal pancreatectomy with splenectomy and left hemicolectomy was done. Primary colocolic anastomosis was done for reconstruction. Postop course was uneventful, and patient was discharged with advice to undergo adjuvant chemotherapy. Surgical excision of large size locally advanced non-functional PNET should be done with curative intention/ to treat symptoms and improve patient survival

Research paper thumbnail of A prospective study on suture ligation of internal hemorrhoids without Doppler guidance for the treatment of symptomatic hemorrhoid disease

International Surgery Journal, 2017

Background: Hemorrhoids or piles are one of the most common afflictions of human being, affecting... more Background: Hemorrhoids or piles are one of the most common afflictions of human being, affecting both sexes & can occur at any age. The aim of the study was to study the effectiveness of suture ligation of hemorrhoids and mucopexy as an outpatient treatment for symptomatic hemorrhoids.Methods: This prospective observational study was carried out in the department of surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India on 64 adult patients of hemorrhoids treated by suture ligation of hemorrhoid pedicle without Doppler guidance and mucopexy from July 2012 to December 2014. The patients were managed as outpatient or day care cases. The observations and follow up data were recorded and descriptive analysis was done to study the clinical presentation of hemorrhoid disease and effectiveness of hemorrhoid ligation and mucopexy in an ambulatory, outpatient or day care setting.Results: Total 64 patients of hemorrhoids who underwent suture ligation of hemorrhoids and mucopexy were ...

Research paper thumbnail of Intra peritoneal ascending colon in parastomal hernial sac

International Journal of Research in Medical Sciences, 2014

Patient was resuscitated in high dependency unit for 4 hours. Nasogastric tube and urinary cathet... more Patient was resuscitated in high dependency unit for 4 hours. Nasogastric tube and urinary catheter were placed. Abdominal roentgenogram suggested multiple air fluid levels. Decision of surgery was taken and patient was explored in operation theatre. There was dilated small

Research paper thumbnail of A prospective comparative study of Lichtenstein's mesh hernioplasty performed under local and spinal anesthesia

International Surgery Journal, 2016

Background: The present study was designed to compare Lichtenstein's hernioplasty performed under... more Background: The present study was designed to compare Lichtenstein's hernioplasty performed under local anesthesia and spinal anesthesia in terms of intra operative and short term post-operative events. Methods: In this study total 244 adult patients (236 male & 8 female) of primary uncomplicated unilateral inguinal hernia operated for open tension free mesh hernioplasty were included. 114 patients were operated under local anesthesia and 130 under spinal anesthesia. The two groups were compared for intra operative & short term (30 days) post-operative events, hospital stay and return to activity. Results: The two groups were similar in terms of intra operative events like nausea, vomiting, hypotension & arrhythmias. Local wound complications like edema, ecchymosis, infection and seroma formation were comparable in both groups and clinically insignificant. However there was advantage for the local anesthesia group in terms of less post-operative pain, less anesthesia related complications, less urinary retention, faster discharge from hospital, faster return to activity and lesser cost of treatment. Conclusions: The study comparing local anesthesia with spinal anesthesia showed advantage for the local anesthesia group in terms of less post-operative pain, less anesthesia related complications, less urinary retention, faster discharge from hospital, faster return to activity and lesser cost of treatment. Thus open inguinal hernioplasty performed under local anesthesia is well suited for our smaller community-based, regional, and teaching hospitals.

Research paper thumbnail of Practice of antimicrobial stewardship in a government hospital of India and its impact on extended point prevalence of antibiotic usage

Journal of Family Medicine and Primary Care, 2021

Background: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Amo... more Background: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Among many proven measures of decreasing AMR, practice of antimicrobial stewardship is the lowest hanging which can be adapted with negligible financial implications. Methods: This is a case record based extended cross-sectional type of observational operation research study conducted at an institute of national importance established by Government of India. Point prevalence of antibiotic usage among the patients admitted in the hospital, on four different days in four different quarters of a year was done to study the impact of antimicrobial stewardship program (AMSP). Results: A cumulative 711 patients were exposed on antibiotics among 1396 study participants. There was a significant decrease in antibiotic consumption across the 1 st and 4 th quarter. The average antibiotic usage was 50.9% (61.75, 60%, 48.4%, and 39% respectively in the 1 st to 4 th quarter). Among the total number of patients, intravenous antibiotic usage was 47.9% (60.71%, 58.4%, 44.9%, and 34.2% respectively in 1 st to 4 th quarter). Among the newly admitted patients, the consumption of antibiotic usage decreased from 45.9% to 25.7%. Among the intravenous antibiotics, the top 10 consumed antibiotics were 3 rd generation cephalosporin (39.8%), aminoglycoside (14.8%), amoxicillin/amoxy-clav (12.5%), piperacillin-tazobactum (8.5%), carbapenams (6.6%), cefuroxime (6.4%), quinolones (4.3%), vancomycin/linezolid (4.1%), colistin (0.8%), and others (0.8%). Conclusion: Government run hospitals can run low budget antimicrobial stewardship program with sustainable impact on antibiotic consumption. For a successful AMSP, it requires change in attitude, commitment, and administrative support rather than a huge financial support.

Research paper thumbnail of The role of laparoscopy in diagnosis of patients with chronic abdominal pain

International Surgery Journal, 2016

Background: Chronic abdominal pain still remains one of the leading clinical problems presenting ... more Background: Chronic abdominal pain still remains one of the leading clinical problems presenting to physicians. Reaching a definitive diagnosis and prompt management is usually delayed because invasive investigations are frequently required to come to a conclusive diagnosis. The aim was to study the varied clinical picture of chronic abdominal pain and evaluate the role of laparoscopy in reaching a conclusive diagnosis in these patients.Methods: A prospective and retrospective study of 142 patients of chronic abdominal pain who underwent diagnostic laparoscopy in our surgery department from June, 2006 to December, 2015 was done. A descriptive analysis of data collected from case records of these patients was done to study the varied clinical picture, laboratory reports, radiological findings, laparoscopic findings and histological reports. The usefulness of laparoscopy to confirm the diagnosis and in clinical management of these patients of chronic abdominal pain was evaluated.Resul...

Research paper thumbnail of A rare presentation of a Leiomyosarcoma of the Stomach

The Internet Journal of Surgery, 2007

Gastrointestinal stromal tumors {GIST} are very rare tumors of GIT [0.5-3% of all stomach maligna... more Gastrointestinal stromal tumors {GIST} are very rare tumors of GIT [0.5-3% of all stomach malignancies] evenly distributed between stomach and small intestine. They commonly present with bleeding, abdominal pain, abdominal fullness and discomfort, anemia, palpable abdominal mass, ulceration etc. Tumor perforation is very rare. Here we are reporting a case, which presented in emergency with gas under diaphragm. On exploration a very huge tumor mass arising from stomach with areas of necrosis and gas bubbles was found. There was no perforation of any hollow viscus. Histopathology revealed epitheliod leiomyosarcoma with degeneration cysts.

Research paper thumbnail of A clinical study of intestinal stomas: its indications and complications

International Journal of Research in Medical Sciences, 2013

The word "Stoma" comes from the Greek word meaning mouth or opening. 1 An intestinal stoma is an ... more The word "Stoma" comes from the Greek word meaning mouth or opening. 1 An intestinal stoma is an opening of the intestine on anterior abdominal wall made surgically. 2 Stomas are used to divert the fecal stream away from distal bowel in order to allow a distal anastomosis to heal as well as to relieve obstruction in emergency situation. It may be temporary or permanent; depending on their role. 3 Though a life saving procedure, it may result in significant number of complications. Complications are divided into early complications (up to 30 days after operation) and late complications (more than 30 days after operation). Littre of Paris was the first to make a ventral colostomy in 1710 for a baby with imperforate anus. 4 An ileostomy was first advocated in ulcerative colitis in 1912 but was not widely used until Brooke demonstrated his everted ileostomy in 1952. 5 Various Indications for which intestinal stomas are formed: ulcerative colitis, bowel obstruction, cancer of colon & rectum, crohn's disease, congenital bowel defects, uncontrolled bleeding from large intestine, injury to the intestinal tract, inflammatory bowel disease, ischemic bowel disease, carcinoma urinary bladder and spinal cord injury. 6 Stoma, though it is a life saving procedure, it carries significant number of complications. Despite extensive ABSTRACT Background: Intestinal stoma is an opening for fecal diversion. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it. Methods: This is a prospective study was carried out in a surgical unit of Hamidia Hospital, Gandhi Medical College, Bhopal from January, 2012 to December,2012. Data was collected by meticulous history taking including age, gender, indication, type of stoma, type of surgery, careful clinical examination, appropriate operative findings and follow up of the cases. The results were collected, analyzed and compared with other studies. Results: A total of 100 patients were evaluated age ranged between 12-85 years (50.5 ± 29.01 years) Male to female ratio was 7:3. Of the 100 patients 97 were admitted in emergency while 3 in outpatient department. The most common type of stoma made was loop ileostomy (64%) followed by sigmoid colostomy (11%) and transverse loop colostomy (9%). Main indication for a stoma formation was enteric perforation (38%) followed by Koch's abdomen (18%). Of the various complications encountered with intestinal stoma, peristomal skin irritation (36%) was the most consistent complication followed by laparotomy wound infection (13%). Conclusions: Inspite of vast exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone.

Research paper thumbnail of An atypical presentation of a multiloculated giant pseudocyst of pancreas

International Surgery Journal, 2021

Giant pseudocysts of the pancreas are rare and difficult to manage. Pseudocysts are usually treat... more Giant pseudocysts of the pancreas are rare and difficult to manage. Pseudocysts are usually treated by cystogastrostomy but dependent drainage for giant pseudocysts may require alternative methods like cystojejunostomy. We report here a rare case of a multiloculated giant pseudocyst of pancreas which presented atypically with protrusion through the lesser omentum. The pseudocyst protruding through the lesser omentum filled the whole upper abdomen up to umbilical region and displaced the stomach inferiorly. The stomach which is usually displaced anteriorly by pseudocysts was unusually displaced and splayed on the inferior aspect of the pseudocyst. The anterior wall of the fundus and body of the stomach was adherent to the inferior aspect of the pseudocyst. The pseudocyst was managed by draining into the stomach in a different way by performing a cystogastrostomy to the anterior wall of the stomach. Giant pseudocysts are difficult to manage, and good imaging studies are helpful in sel...