Ashwath Ramji | Kempegowda Institute of medical sciences (original) (raw)

Papers by Ashwath Ramji

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2019

Ranula are swellings arising from the sublingual or submandibular salivary glands either due to m... more Ranula are swellings arising from the sublingual or submandibular salivary glands either due to mucus extravasation or the formation of mucus retention cysts. They are located on the floor of the mouth, generally have an insidious course and remain asymptomatic unless they grow very large or develop secondary complications. Occasionally, by dividing through cervical facial planes, they present as swellings in the neck, aptly called plunging ranulas. Plunging ranulas, therefore, have an intra-oral component and an extra-oral component; however rarely, the intra-oral component resolves leaving behind an isolated swelling in the neck, making the diagnosis a clinical challenge.

Research & Humanities in Medical Education, 2019

As scientists we look for intellectual advancement through every encounter, yearn for new knowled... more As scientists we look for intellectual advancement through every encounter, yearn for new knowledge, and search for ways to further our learning. We are programmed by our nurturing to identify, analyse, and solve. Horses with blinders, we are obtuse in our ignorance; however, our nature, if we allow it, will find emotional growth - some encounters will compel us to introspect, so the learning becomes about ourselves, even as we may struggle to align our (unrealistic and idealistic) views with the (subjectively bleak) reality.

Archives of Medical & Surgical Pathology, 2019

Branchial cleft cysts are common swellings in the neck in children and represent a congenital abn... more Branchial cleft cysts are common swellings in the neck in children and represent a congenital abnormality arising due to failure of obliteration of a branchial cleft, most commonly, the second branchial cleft. Complications include infection and suppuration with abscess or fistula formation, but if uninfected they may remain as painless swellings. They are unusual in adults, and diagnosis is often not as straightforward as in children, due to the consideration of more varied differential diagnoses including malignancy. Here we discuss the case of a 25-year-old male patient, with a clinical diagnosis of tubercular scrofula where histopathology revealed a branchial cleft cyst.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019

Fistulas are communicating tracts between two surfaces, linking structures and planes that should... more Fistulas are communicating tracts between two surfaces, linking structures and planes that should, under normal circumstances, not be in dialogue. They may be congenital or acquired and are most commonly associated with the gastrointestinal and ano-rectal territories, where they link two different organ systems internally, or track outwards, creating a communicating channel between the internal viscera and the skin surface. Vaginal fistulas on occasion result from perineal tears due to traumatic delivery, or less commonly, infection or non-healing of the episiotomy wound, and are of the rectovaginal or vesicovaginal variety. Very rarely, the channel from the vagina tracks to an opening in the skin. This is the report of a patient who developed the rare vagino-cutaneous fistula following a normal vaginal delivery with episiotomy, and review of the limited literature available about the peculiar entity, so rare that
no previous reports of vagino-cutaneous fistulas developing after vaginal delivery with episiotomy could be found.

Indian Journal of Basic and Applied Medical Research, 2019

Acute Appendicitis remains the most common surgical emergency of the abdomen, and though it can p... more Acute Appendicitis remains the most common surgical emergency of the abdomen, and though it can present at any age, usually occurs in children and young adults. Despite tremendous advancements is surgical technique, the peritonisation of the stump of the appendix remains a challenge and is especially more so when the base is perforated, gangrenous, or sloughed out. In these conditions, surrounding tissues are compromised and cannot be relied upon to heal thoroughly, with a high rate of morbidity, including the dreaded fecal fistula. The adjacent cecum, thickened and indurated by the inflammatory process is also liable to ischemia, making the management challenging when the base of the appendix is involved in the pathology, which fortunately is a rare occurrence. Here is reported the case of a young male patient with appendicitis with a sloughed base, and a review of literature regarding the ideal management of the condition.

International Journal of Contemporary Medical Research, 2019

Introduction: Inguinal hernias are among the most common surgical problems worldwide. Hernias, de... more Introduction: Inguinal hernias are among the most common surgical problems worldwide. Hernias, defined as the protrusion of a whole or part of an organ through the containing wall, along with difficult childbirth and problematic bowel evacuation are thought to be the price we pay for adopting the bipedal gait from previously crawling on all fours. The aim of this study was to analyse the anthropological characteristics of patients with inguinal hernias, so as to determine the influence of behavior, evolutionary development and flawed physiology of their pathogenesis, and thereby identify potential domains for risk reduction. Material and Methods: This was a non-interventional, retrospective study. 100 consecutive patients electively operated for inguinal hernias were included and their clinical profiles studied. The details of their demography and presentation were tabulated and analyzed. Results: Inguinal hernia had an overwhelmingly male preponderance, with 99% of patients being male. The mean age of patients at presentation was 56.5±13.27 years. In 93% of patients the condition was unilateral, where as it was bilateral in 7%. Right sided hernia was more common with 49% of cases, left side was involved in 44%. 49% were found to be direct hernias, 36% were indirect and 8% were pantaloons hernias, with the remainder being bilateral hernias. Right sided direct hernias were the most commonly encountered, accounting for 28% of the cases, followed by left indirect hernias which were seen in 24%. Conclusions: The epidemiological profile of inguinal hernias in the study population translate to statistically significant findings with respect to demographic features and risk factors for inguinal hernias, well elucidating the anthropology of the condition. This study showed statistically significant association between inguinal hernia and high BMI, older age and positive family history, rather than the conventional suggestion that increased intra-abdominal pressure is the major risk factor. Thus, the role of anthropology and physiography in the development of inguinal hernias cannot be overlooked.

International Journal of Research in Medical Sciences, 2019

Chronic pelvic pain is a common yet difficult problem to manage, plaguing the gynecologist as wel... more Chronic pelvic pain is a common yet difficult problem to manage, plaguing the gynecologist as well as the gastroenterologist and general surgeon. Highlighted by increased visceral hypersensitivity, endometriosis and irritable bowel syndrome (IBS) are the most common causes or chronic unrelenting pelvic pain. Recently, the similarities between the two conditions has begged the question as to whether there is any common denominator between the two conditions and their likely co-existence and mismanagement. Further, the association of polycystic ovary syndrome (PCOS) in this cohort remains definitively uncharacterized. This report details a young female patient with the triad of POCS, IBS and endometriosis presenting with chronic pelvic pain.

International Journal of Surgery Science, 2019

Proptosis or exophthalmos is the forward protrusion of eye and maybe unilateral or bilateral, may... more Proptosis or exophthalmos is the forward protrusion of eye and maybe unilateral or bilateral, may occur spontaneously or after trauma and may be due to some underlying pathology or it could be isolated without systemic involvement. When proptosis occurs following trauma, it may be due to orbital hemorrhage, orbital edema or herniation of brain parenchyma as an encephalocoele through an orbital roof fracture; the latter condition having potential for emergent crisis requiring urgent surgery and can be life-threatening. Often encephalocoele (which requires surgery) and orbital hemorrhage (which can be managed conservatively) cannot be differentiated on CT, making the condition unpredictable and precarious. This case report is regarding a young male patient who developed subacute proptosis days after trauma, with subsequent resolution with conservative management.

International Surgery Journal, 2019

Background: Though relatively uncommon compared to diseases of the female breast, diseases of the... more Background: Though relatively uncommon compared to diseases of the female breast, diseases of the male breast do occur, but are poorly studied. These range from benign lesions to malignant disease. The purpose of this study was to enumerate the various disorders of the male breast encountered in our practice, so as to develop a better understanding of the clinicopathological profile of these conditions.
Methods: This was a retrospective study conducted in the Department of Surgery, KIMS Hospital, Bangalore, from September 2017 to September 2018. Male patients treated for disorders of the breast were included in the study. The clinical profile of the patients and the disease conditions were studied.
Results: 21 patients were included in the study. The most common presentation was due to swelling, pain or lump in the breast. The most commonly encountered condition was gynaecomastia (66.66%). Primary malignancy of the breast was encountered in 2 cases.
Conclusions: The male breast is subjected to various disease conditions. Most presentations are due to aesthetic defects. Rarely, primary malignancy can develop in the male breast. The breast is an often-neglected part of the male anatomy, and hence patients often present late with complications.

Indian Journal of Cancer Education and Research, 2019

While it is the most common malignancy in women, breast cancer is rare in men and thus often igno... more While it is the most common malignancy in women, breast cancer is rare in men and thus often ignored or overlooked, which leads to delayed diagnosis for the already fulminant condition. Bone is the most common location for metastasis from breast cancer, and there is a particular affinity for the spine. Despite the high incidence of spinal metastasis from breast cancer, only around 10 cases of breast cancer with spinal secondaries in male patients have been reported. Management of spinal metastases is palliative, with treatment aimed at restoring or preserving neurological function and relief of symptoms such as pain and incontinence. Here we report the case of a male patient with breast cancer and extensive metastasis to the axial skeleton and review the relevant literature.

International Journal of Surgery Sciences, 2019

Inguinal hernia repair is among the most commonly performed surgeries across the globe. Lichenste... more Inguinal hernia repair is among the most commonly performed surgeries across the globe. Lichenstein's tension-free technique of open hernioplasty remains the gold-standard, and laparoscopic techniques have gained popularity over recent decade. Giant inguinal hernias that extend below the midpoint of the inner thigh are uncommon, challenging to manage and are more prone for post-operative complications. There is no standard treatment protocol or surgical procedure designated for the management of giant hernias which are associated with grossly disrupted local tissue architecture and compromised tissue integrity and dynamics. Large volumes of omentum and bowel make up the contents of the hernia sac, which with the natural pathological processes involved, further complicate the management. This care report and review of literature aims to elucidate a clear management protocol for Giant Inguinal Hernias.

International Surgery Journal, 2019

The vulva is a rare site for extra-intestinal manifestation of Crohn’s disease, and is usually a... more The vulva is a rare site for extra-intestinal manifestation of Crohn’s disease, and is usually a late feature of severe, fulminant, unrelenting disease. These islands of granulomatous tissue in the female genitalia are considered “metastatic” deposits as they are separated from the intestinal lesions by healthy tissue. Very rarely, Crohn’s disease may manifest first in an extra-intestinal site, without any bowel lesions. In extremely rare cases, the genitalia is the site of isolated primary Crohn’s disease and serves as a harbinger for bowel lesions.

International Surgery Journal, 2019

“Acute abdomen” is a clinical diagnosis which defines the emergent nature of the condition, rathe... more “Acute abdomen” is a clinical diagnosis which defines the emergent nature of the condition, rather than the condition itself, and the true diagnosis is often only made after laparotomy or laparoscopy. On occasion, the final diagnosis is drastically different from what was clinically suspected. Diseases such as diverticulosis can have multiple possible pathological outcomes as a consequence of their inflammatory nature, such as stricture formation, adhesions, acute diverticulitis, diverticular abscess, perforation and even malignant transformation. Usually one of these complications will be the presenting factor with rarely another complication discovered during management, which may or may not have been symptomatic. Extremely rarely, will multiple pathological outcomes of a condition be present together. Here we report the case of a male patient who underwent laparotomy for a suspected hollow viscus perforation, with the resulting findings a bewildering surprise.

International Surgery Journal, 2019

Cutaneous horns are conical, circumscribed projections formed by desquamation and layering of ker... more Cutaneous horns are conical, circumscribed projections formed by desquamation and layering of keratin. Although they can appear on the skin anywhere on the body, they are most commonly seen on the sun-exposed surfaces, and are often associated with solar keratosis. Cutaneous horns are most often benign, however they are a potential site of malignancy and may harbor premalignant or malignant lesions, the most common being squamous cell carcinoma, the causal relationship being straightforward and both squamous cell carcinoma and cutaneous horns can be equated with the common epithelial maker keratin. Other histological types of malignancies are not usually noted in conjunction with cutaneous horns. Here we describe a patient with a cutaneous horn over the volar aspect of the right forearm, a sun-protected site, harbouring basal cell carcinoma, an infrequent finding.

International Surgery Journal, 2019

Bardet-Biedl syndrome is a rare ciliopathy with a wide array of clinical features, including cong... more Bardet-Biedl syndrome is a rare ciliopathy with a wide array of clinical features, including congenital blindness, obesity, neuroendocrine disturbance, hypogonadism and renal dysfunction. The association of Hirschsprung’s disease with Bardet-Biedl syndrome has been published earlier, however, there is no literature regarding patients with Bardet- Biedl syndrome presenting later in life due to complications associated with Hirschsprung’s disease. Bardet-Biedl Syndrome is exceedingly rare, with only around 15 case reports published from India. Here we present the case of a 55-year-old male patient with Bardet-Biedl syndrome who presented with intestinal obstruction, raising the question as to whether his emergency presentation was a complication of his flawed genotype or serendipity.

Journal of Medical Science and Clinical Research, 2019

Inflammatory breast carcinoma is a rare and highly aggressive malignancy. Clinically, the present... more Inflammatory breast carcinoma is a rare and highly aggressive malignancy. Clinically, the presentation is rapid and macroscopic appearance may be mistaken for a benign inflammatory lesion, showing characteristic pathological signs of inflammation, and prominent peau d’orange appearance. The aggressiveness of the condition automatically grants a T4 status in the AJCC TNM staging system. Here we report a case of 45-year-old female with inflammatory carcinoma of the right breast and briefly discuss relevant literature.

International Surgery Journal, 2018

Background: Despite recent technical advances, reconstruction of lower third of leg wounds with s... more Background: Despite recent technical advances, reconstruction of lower third of leg wounds with soft tissue defects remains a challenge to the Plastic Surgeon. This is due to the inherent anatomical and structural configuration, including the limited vascularity of the skin of the lower third of the leg. Maintaining maximal function without compromising the aesthetic appearance of the leg is the goal of reconstruction.
Methods: This was a retrospective study conducted in the Department of Plastic Surgery, KIMS Hospital, Bangalore, from January 2016 to January 2018. Patients with soft tissue defects involving lower third of leg requiring flap cover were included in the study. Orthopedic intervention was done as required. All patients underwent loco-regional or free flap cover as clinically indicated. Outcomes were studied.
Results: Total of 20 patients were included in the study. Most common presentation was due to road traffic accidents (RTA). Right leg was involved in 12 cases and left in 8 cases. Fracture was present in 7 cases, exposed bone without fracture in 11 cases, exposed tendons alone in 1 case and exposed implants in 1 case. 3 Patients required orthopaedic intervention along with the flap procedure, and 4 had already undergone orthopaedic stabilisation. Most commonly performed procedure was muscle flap (45%), followed by perforator-based fascio-cutaneous flap (25%). No major complications were observed in the post-operative period.
Conclusions: Lower third of leg reconstruction is a challenge, but a wide variety of options ranging from loco- regional to free flaps can be employed, depending on the situation. In present study, various types of flap cover were adopted to cover the lower-third of leg defects, depending on the nature of the wound. Present study delineated that muscle flaps - particularly the reverse hemi-soleus flap, are an ideal flap for lower third of leg defects with fracture site exposed and wound infected. Local muscle flaps have the advantage of being single-staged, faster to perform and technically easier, compared to free flaps, which have long been considered the gold standard.

International Surgery Journal, 2018

Indian Journal of Case Reports, 2018

Mesenteric lymphatic cysts are rare congenital benign malformations of the lymphatic system. Rare... more Mesenteric lymphatic cysts are rare congenital benign malformations of the lymphatic system. Rarely, the wall of the lymphatic cyst can undergo calcification mimicking other conditions. In the literature, about six cases of calcified lymphatic cyst have been reported. Here, we present the case of a 3-year-old child who presented with vague abdominal pain and diagnosed to have an intra-abdominal calcified cyst. On exploration, the cyst was arising from the mesentery and the child required excision of the cyst with the involved intestine. The biopsy was suggestive of a mesenteric lymphatic cyst.

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2019

Ranula are swellings arising from the sublingual or submandibular salivary glands either due to m... more Ranula are swellings arising from the sublingual or submandibular salivary glands either due to mucus extravasation or the formation of mucus retention cysts. They are located on the floor of the mouth, generally have an insidious course and remain asymptomatic unless they grow very large or develop secondary complications. Occasionally, by dividing through cervical facial planes, they present as swellings in the neck, aptly called plunging ranulas. Plunging ranulas, therefore, have an intra-oral component and an extra-oral component; however rarely, the intra-oral component resolves leaving behind an isolated swelling in the neck, making the diagnosis a clinical challenge.

Research & Humanities in Medical Education, 2019

As scientists we look for intellectual advancement through every encounter, yearn for new knowled... more As scientists we look for intellectual advancement through every encounter, yearn for new knowledge, and search for ways to further our learning. We are programmed by our nurturing to identify, analyse, and solve. Horses with blinders, we are obtuse in our ignorance; however, our nature, if we allow it, will find emotional growth - some encounters will compel us to introspect, so the learning becomes about ourselves, even as we may struggle to align our (unrealistic and idealistic) views with the (subjectively bleak) reality.

Archives of Medical & Surgical Pathology, 2019

Branchial cleft cysts are common swellings in the neck in children and represent a congenital abn... more Branchial cleft cysts are common swellings in the neck in children and represent a congenital abnormality arising due to failure of obliteration of a branchial cleft, most commonly, the second branchial cleft. Complications include infection and suppuration with abscess or fistula formation, but if uninfected they may remain as painless swellings. They are unusual in adults, and diagnosis is often not as straightforward as in children, due to the consideration of more varied differential diagnoses including malignancy. Here we discuss the case of a 25-year-old male patient, with a clinical diagnosis of tubercular scrofula where histopathology revealed a branchial cleft cyst.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019

Fistulas are communicating tracts between two surfaces, linking structures and planes that should... more Fistulas are communicating tracts between two surfaces, linking structures and planes that should, under normal circumstances, not be in dialogue. They may be congenital or acquired and are most commonly associated with the gastrointestinal and ano-rectal territories, where they link two different organ systems internally, or track outwards, creating a communicating channel between the internal viscera and the skin surface. Vaginal fistulas on occasion result from perineal tears due to traumatic delivery, or less commonly, infection or non-healing of the episiotomy wound, and are of the rectovaginal or vesicovaginal variety. Very rarely, the channel from the vagina tracks to an opening in the skin. This is the report of a patient who developed the rare vagino-cutaneous fistula following a normal vaginal delivery with episiotomy, and review of the limited literature available about the peculiar entity, so rare that
no previous reports of vagino-cutaneous fistulas developing after vaginal delivery with episiotomy could be found.

Indian Journal of Basic and Applied Medical Research, 2019

Acute Appendicitis remains the most common surgical emergency of the abdomen, and though it can p... more Acute Appendicitis remains the most common surgical emergency of the abdomen, and though it can present at any age, usually occurs in children and young adults. Despite tremendous advancements is surgical technique, the peritonisation of the stump of the appendix remains a challenge and is especially more so when the base is perforated, gangrenous, or sloughed out. In these conditions, surrounding tissues are compromised and cannot be relied upon to heal thoroughly, with a high rate of morbidity, including the dreaded fecal fistula. The adjacent cecum, thickened and indurated by the inflammatory process is also liable to ischemia, making the management challenging when the base of the appendix is involved in the pathology, which fortunately is a rare occurrence. Here is reported the case of a young male patient with appendicitis with a sloughed base, and a review of literature regarding the ideal management of the condition.

International Journal of Contemporary Medical Research, 2019

Introduction: Inguinal hernias are among the most common surgical problems worldwide. Hernias, de... more Introduction: Inguinal hernias are among the most common surgical problems worldwide. Hernias, defined as the protrusion of a whole or part of an organ through the containing wall, along with difficult childbirth and problematic bowel evacuation are thought to be the price we pay for adopting the bipedal gait from previously crawling on all fours. The aim of this study was to analyse the anthropological characteristics of patients with inguinal hernias, so as to determine the influence of behavior, evolutionary development and flawed physiology of their pathogenesis, and thereby identify potential domains for risk reduction. Material and Methods: This was a non-interventional, retrospective study. 100 consecutive patients electively operated for inguinal hernias were included and their clinical profiles studied. The details of their demography and presentation were tabulated and analyzed. Results: Inguinal hernia had an overwhelmingly male preponderance, with 99% of patients being male. The mean age of patients at presentation was 56.5±13.27 years. In 93% of patients the condition was unilateral, where as it was bilateral in 7%. Right sided hernia was more common with 49% of cases, left side was involved in 44%. 49% were found to be direct hernias, 36% were indirect and 8% were pantaloons hernias, with the remainder being bilateral hernias. Right sided direct hernias were the most commonly encountered, accounting for 28% of the cases, followed by left indirect hernias which were seen in 24%. Conclusions: The epidemiological profile of inguinal hernias in the study population translate to statistically significant findings with respect to demographic features and risk factors for inguinal hernias, well elucidating the anthropology of the condition. This study showed statistically significant association between inguinal hernia and high BMI, older age and positive family history, rather than the conventional suggestion that increased intra-abdominal pressure is the major risk factor. Thus, the role of anthropology and physiography in the development of inguinal hernias cannot be overlooked.

International Journal of Research in Medical Sciences, 2019

Chronic pelvic pain is a common yet difficult problem to manage, plaguing the gynecologist as wel... more Chronic pelvic pain is a common yet difficult problem to manage, plaguing the gynecologist as well as the gastroenterologist and general surgeon. Highlighted by increased visceral hypersensitivity, endometriosis and irritable bowel syndrome (IBS) are the most common causes or chronic unrelenting pelvic pain. Recently, the similarities between the two conditions has begged the question as to whether there is any common denominator between the two conditions and their likely co-existence and mismanagement. Further, the association of polycystic ovary syndrome (PCOS) in this cohort remains definitively uncharacterized. This report details a young female patient with the triad of POCS, IBS and endometriosis presenting with chronic pelvic pain.

International Journal of Surgery Science, 2019

Proptosis or exophthalmos is the forward protrusion of eye and maybe unilateral or bilateral, may... more Proptosis or exophthalmos is the forward protrusion of eye and maybe unilateral or bilateral, may occur spontaneously or after trauma and may be due to some underlying pathology or it could be isolated without systemic involvement. When proptosis occurs following trauma, it may be due to orbital hemorrhage, orbital edema or herniation of brain parenchyma as an encephalocoele through an orbital roof fracture; the latter condition having potential for emergent crisis requiring urgent surgery and can be life-threatening. Often encephalocoele (which requires surgery) and orbital hemorrhage (which can be managed conservatively) cannot be differentiated on CT, making the condition unpredictable and precarious. This case report is regarding a young male patient who developed subacute proptosis days after trauma, with subsequent resolution with conservative management.

International Surgery Journal, 2019

Background: Though relatively uncommon compared to diseases of the female breast, diseases of the... more Background: Though relatively uncommon compared to diseases of the female breast, diseases of the male breast do occur, but are poorly studied. These range from benign lesions to malignant disease. The purpose of this study was to enumerate the various disorders of the male breast encountered in our practice, so as to develop a better understanding of the clinicopathological profile of these conditions.
Methods: This was a retrospective study conducted in the Department of Surgery, KIMS Hospital, Bangalore, from September 2017 to September 2018. Male patients treated for disorders of the breast were included in the study. The clinical profile of the patients and the disease conditions were studied.
Results: 21 patients were included in the study. The most common presentation was due to swelling, pain or lump in the breast. The most commonly encountered condition was gynaecomastia (66.66%). Primary malignancy of the breast was encountered in 2 cases.
Conclusions: The male breast is subjected to various disease conditions. Most presentations are due to aesthetic defects. Rarely, primary malignancy can develop in the male breast. The breast is an often-neglected part of the male anatomy, and hence patients often present late with complications.

Indian Journal of Cancer Education and Research, 2019

While it is the most common malignancy in women, breast cancer is rare in men and thus often igno... more While it is the most common malignancy in women, breast cancer is rare in men and thus often ignored or overlooked, which leads to delayed diagnosis for the already fulminant condition. Bone is the most common location for metastasis from breast cancer, and there is a particular affinity for the spine. Despite the high incidence of spinal metastasis from breast cancer, only around 10 cases of breast cancer with spinal secondaries in male patients have been reported. Management of spinal metastases is palliative, with treatment aimed at restoring or preserving neurological function and relief of symptoms such as pain and incontinence. Here we report the case of a male patient with breast cancer and extensive metastasis to the axial skeleton and review the relevant literature.

International Journal of Surgery Sciences, 2019

Inguinal hernia repair is among the most commonly performed surgeries across the globe. Lichenste... more Inguinal hernia repair is among the most commonly performed surgeries across the globe. Lichenstein's tension-free technique of open hernioplasty remains the gold-standard, and laparoscopic techniques have gained popularity over recent decade. Giant inguinal hernias that extend below the midpoint of the inner thigh are uncommon, challenging to manage and are more prone for post-operative complications. There is no standard treatment protocol or surgical procedure designated for the management of giant hernias which are associated with grossly disrupted local tissue architecture and compromised tissue integrity and dynamics. Large volumes of omentum and bowel make up the contents of the hernia sac, which with the natural pathological processes involved, further complicate the management. This care report and review of literature aims to elucidate a clear management protocol for Giant Inguinal Hernias.

International Surgery Journal, 2019

The vulva is a rare site for extra-intestinal manifestation of Crohn’s disease, and is usually a... more The vulva is a rare site for extra-intestinal manifestation of Crohn’s disease, and is usually a late feature of severe, fulminant, unrelenting disease. These islands of granulomatous tissue in the female genitalia are considered “metastatic” deposits as they are separated from the intestinal lesions by healthy tissue. Very rarely, Crohn’s disease may manifest first in an extra-intestinal site, without any bowel lesions. In extremely rare cases, the genitalia is the site of isolated primary Crohn’s disease and serves as a harbinger for bowel lesions.

International Surgery Journal, 2019

“Acute abdomen” is a clinical diagnosis which defines the emergent nature of the condition, rathe... more “Acute abdomen” is a clinical diagnosis which defines the emergent nature of the condition, rather than the condition itself, and the true diagnosis is often only made after laparotomy or laparoscopy. On occasion, the final diagnosis is drastically different from what was clinically suspected. Diseases such as diverticulosis can have multiple possible pathological outcomes as a consequence of their inflammatory nature, such as stricture formation, adhesions, acute diverticulitis, diverticular abscess, perforation and even malignant transformation. Usually one of these complications will be the presenting factor with rarely another complication discovered during management, which may or may not have been symptomatic. Extremely rarely, will multiple pathological outcomes of a condition be present together. Here we report the case of a male patient who underwent laparotomy for a suspected hollow viscus perforation, with the resulting findings a bewildering surprise.

International Surgery Journal, 2019

Cutaneous horns are conical, circumscribed projections formed by desquamation and layering of ker... more Cutaneous horns are conical, circumscribed projections formed by desquamation and layering of keratin. Although they can appear on the skin anywhere on the body, they are most commonly seen on the sun-exposed surfaces, and are often associated with solar keratosis. Cutaneous horns are most often benign, however they are a potential site of malignancy and may harbor premalignant or malignant lesions, the most common being squamous cell carcinoma, the causal relationship being straightforward and both squamous cell carcinoma and cutaneous horns can be equated with the common epithelial maker keratin. Other histological types of malignancies are not usually noted in conjunction with cutaneous horns. Here we describe a patient with a cutaneous horn over the volar aspect of the right forearm, a sun-protected site, harbouring basal cell carcinoma, an infrequent finding.

International Surgery Journal, 2019

Bardet-Biedl syndrome is a rare ciliopathy with a wide array of clinical features, including cong... more Bardet-Biedl syndrome is a rare ciliopathy with a wide array of clinical features, including congenital blindness, obesity, neuroendocrine disturbance, hypogonadism and renal dysfunction. The association of Hirschsprung’s disease with Bardet-Biedl syndrome has been published earlier, however, there is no literature regarding patients with Bardet- Biedl syndrome presenting later in life due to complications associated with Hirschsprung’s disease. Bardet-Biedl Syndrome is exceedingly rare, with only around 15 case reports published from India. Here we present the case of a 55-year-old male patient with Bardet-Biedl syndrome who presented with intestinal obstruction, raising the question as to whether his emergency presentation was a complication of his flawed genotype or serendipity.

Journal of Medical Science and Clinical Research, 2019

Inflammatory breast carcinoma is a rare and highly aggressive malignancy. Clinically, the present... more Inflammatory breast carcinoma is a rare and highly aggressive malignancy. Clinically, the presentation is rapid and macroscopic appearance may be mistaken for a benign inflammatory lesion, showing characteristic pathological signs of inflammation, and prominent peau d’orange appearance. The aggressiveness of the condition automatically grants a T4 status in the AJCC TNM staging system. Here we report a case of 45-year-old female with inflammatory carcinoma of the right breast and briefly discuss relevant literature.

International Surgery Journal, 2018

Background: Despite recent technical advances, reconstruction of lower third of leg wounds with s... more Background: Despite recent technical advances, reconstruction of lower third of leg wounds with soft tissue defects remains a challenge to the Plastic Surgeon. This is due to the inherent anatomical and structural configuration, including the limited vascularity of the skin of the lower third of the leg. Maintaining maximal function without compromising the aesthetic appearance of the leg is the goal of reconstruction.
Methods: This was a retrospective study conducted in the Department of Plastic Surgery, KIMS Hospital, Bangalore, from January 2016 to January 2018. Patients with soft tissue defects involving lower third of leg requiring flap cover were included in the study. Orthopedic intervention was done as required. All patients underwent loco-regional or free flap cover as clinically indicated. Outcomes were studied.
Results: Total of 20 patients were included in the study. Most common presentation was due to road traffic accidents (RTA). Right leg was involved in 12 cases and left in 8 cases. Fracture was present in 7 cases, exposed bone without fracture in 11 cases, exposed tendons alone in 1 case and exposed implants in 1 case. 3 Patients required orthopaedic intervention along with the flap procedure, and 4 had already undergone orthopaedic stabilisation. Most commonly performed procedure was muscle flap (45%), followed by perforator-based fascio-cutaneous flap (25%). No major complications were observed in the post-operative period.
Conclusions: Lower third of leg reconstruction is a challenge, but a wide variety of options ranging from loco- regional to free flaps can be employed, depending on the situation. In present study, various types of flap cover were adopted to cover the lower-third of leg defects, depending on the nature of the wound. Present study delineated that muscle flaps - particularly the reverse hemi-soleus flap, are an ideal flap for lower third of leg defects with fracture site exposed and wound infected. Local muscle flaps have the advantage of being single-staged, faster to perform and technically easier, compared to free flaps, which have long been considered the gold standard.

International Surgery Journal, 2018

Indian Journal of Case Reports, 2018

Mesenteric lymphatic cysts are rare congenital benign malformations of the lymphatic system. Rare... more Mesenteric lymphatic cysts are rare congenital benign malformations of the lymphatic system. Rarely, the wall of the lymphatic cyst can undergo calcification mimicking other conditions. In the literature, about six cases of calcified lymphatic cyst have been reported. Here, we present the case of a 3-year-old child who presented with vague abdominal pain and diagnosed to have an intra-abdominal calcified cyst. On exploration, the cyst was arising from the mesentery and the child required excision of the cyst with the involved intestine. The biopsy was suggestive of a mesenteric lymphatic cyst.