Umbilical Region Research Articles

Clinicopathological Evaluation of Pandu from Grahani Roga with special references to Haematological Parameters

Ayurveda means wisdom or knowledge of life, is the natural holistic system of medicine. The disease Grahani is signified by its nomenclature i.e., incomplete digestion, malabsorption and mal formation of stool. In Ayurveda, Grahani Roga (malabsorption syndrome) is a chronic disease of Annavaha srota (GI tract) vividly explained in our classics. Above the umbilical region Grahani is located, is the seat of Agni (digestive enzyme). Main function of Grahani is to hold undigested food and after digestion it releases the food through the sides of its lumen. But the main cause behind Grahani roga is poor digestive fire and Amadosa (products of impaired digestion and metabolism) as per Caraka Samhita. It is important symptoms are Sukta pakam (fermentation), Muhu baddha muhu dravam (alternate pass of hard and loose stool), Adhman (flatulence), Manasa sadanama (mental frustration) etc. In modern it is correlated to Mal-Absorption Syndrome (MAS). In Grahani Roga the Pittadhara kala fails to recognize the digested and undigested food, often release the undigested food towards small intestine. The insufficient digested food is unable to yield the required Poshak Rasa (plasma) for transformation of Rakta (blood). The person suffers from diminished blood in the system. Hence Grahani patients suffer from Pandu (anaemia). In this present study 60 cases of Grahani roga along with symptoms of Pandu were divided into two groups. Group A (30 patients) were treated with Bhunimba churna. Group B (30 patients) were treated with Pippali churna. The statistical analysis reveals that Bhunimba churna statistically more significant than Pippali churna in the management of Grahani roga and Pandu.

Acute Appendicitis situs inversus totalis, Case Report

Acute appendicitis with situs inversus totalis is a rare type of acute abdominal pathology, with a prevalence of 1 in 10,000 births in the population. It has several embryological causes, with the most common being intestinal antirotation due to the involvement of the gene on chromosome 14. This clinical report describes the case of a 15-year-old adolescent patient who experienced 12 hours of abdominal pain, initially starting in the umbilical region and then migrating to the left iliac fossa. The pain was accompanied by an elevated temperature, nausea, and vomiting. During clinical examination, right cardiac auscultation, uncertain appendiceal signs, and peritoneal irritation were noted. Additionally, there was evidence of leukocytosis with neutrophilia. Tomography confirmed the complete dextroposition of abdominal and thoracic organs. An exploratory laparoscopy was performed, revealing macroscopic evidence of dextroposition of abdominal organs and uncomplicated appendicitis in the suppurative phase. The diagnosis of Acute Appendicitis with situs inversus totalis can be challenging due to its low prevalence and the presence of uncertain clinical signs. Therefore, the use of complementary examinations, such as computed axial tomography, is of utmost importance, along with visualization through diagnostic laparoscopy.

Intestinal Tuberculosis with Enterocutaneus Fistula: A Rare Case

Introduction: Enterocutaneous fistula is a common postoperative complication. The incidence of enterocutaneous fistula as a complication of intestinal tuberculosis is quite rare, so we are interested in reporting this case. Case Report: 32-year-old male presented with history of abdominal pain and fecal matter coming out from an opening in umbilical region for the past 1 month. Patient have history of laparotomy exploration 7 months ago and histopathology showed intestinal tuberculosis. Currently, patient was undergoing TB treatment with anti-tubercular treatment (ATT) for the seventh month. Physical examination showed fistulous opening 2x2 cm over the scar of previous laparotomy. Laboratory examination revealed leukocytosis shift to the left and hypoalbuminemia. Chest X-ray showed active pulmonary tuberculosis. Abdominal CT with with contrast showed localized ileus consist of sentinel loop and suggestive intestinal tuberculosis. Diagnosis of tubercular enterocutaneus fistula arising of as a post-operative complication was made. Patient was given intravenous fluids, antibiotics, antitubercular treatment, and wound care. Patient responded well to conservative management. Discussion: Intestinal tuberculosis (TB) is the sixth most common site of extrapulmonary tuberculosis which can occur primary or secondary. Enterocutaneus fistula (ECF) is a rare complication of intestinal TB and can be managed based on whether the output is low or high. Conservative management can be done through administration of intravenous fluids, antibiotics, antitubercular treatment, and wound care

A RARE CASE OF ADENOSQUAMOUS VARIANT OF GALLBLADDER CARCINOMA

The most prevalent cancer of the extrahepatic biliary tract is gallbladder carcinoma with adenocarcinoma as the most common variant while adenosquamous carcinoma of the gallbladder represents the rare variant of gallbladder cancers. We are presenting the instance of a 61-year-old woman who has complained of abdominal pain from umbilical and epigastric region and radiating towards the back since 7 days. Ultrasonography showed heterogeneously hyperechoic collection in gallbladder fossa and CECT whole abdomen showed a well defined rounded heterogenous enhancing mass lesion arising from fundus of gallbladder with adjacent liver bed suspecting neoplastic etiology. Laproscopic cholecystectomy was done under general anaesthesia. The sample was forwarded to the pathology department for histopathological analysis and diagnosis ofAdenosquamous carcinoma of gallbladder was made.

Effects of Hot Pack Therapy on Post-Colonoscopy Pain: A Prospective, Randomized, Controlled Study

BackgroundPost-colonoscopy pain (PCP) is a negative condition that causes physical and psychological distress to patients and may lead to noncompliance with treatment and follow-up. The most common hypothesis for the cause of PCP is the inflation of the lumen with air to examine the mucosa. There are no previous studies that have examined the effects of thermal therapy in patients with PCP. AimsIn this study, we aimed to investigate the effects of the Hot Pack (HP) method in patients with PCP. DesignRandomized, controlled, prospective study. MethodsPatients were randomized 1:1 into 2 groups of HP and control. In the HP group, hot packs of 40-45°C, kept in a hydrocollator heating unit for 30-35 minutes and wrapped in towels, were applied to the umbilical and hypogastric region of patients in the supine position for 30 minutes. Visual analog scale (VAS) scores were used to measure the pain after colonoscopy. Visual analog scores at 1, 6, and 24 hours were recorded and compared in both groups. ResultsThere was a significant difference in the presence and severity of pain between the two groups at 1 and 6 hours after colonoscopy (p < .001 and p = .004, respectively). There was no significant difference in pain scores at 24 hours between two groups. ConclusionsThis study showed that the application of HP to patients after colonoscopy is effective in reducing pain in the early period.

Surgical Anatomy of Transversus Abdominis Muscle for Transversus Abdominis Release: A CT-Based Study in Three Patient Groups.

The anatomy of the transversus abdominis muscle and its aponeurosis is important in transversus abdominis release surgery. We studied the CT anatomy of the transversus abdominis muscle medial to the linea semilunaris at different levels in the abdomen and measured the thickness of this muscle. In this retrospective study, we analysed 150 abdominal computed tomography at L1, L3, and L5 vertebral levels corresponding to subxiphoid, umbilical, and suprapubic regions, respectively. The patients were divided into three groups based on age and sex: women aged 15-20 years (nulliparous), women aged 30-60 years (multiparous), and men aged 15-60 years, with each group having 50 patients. We compared the thickness of the TA muscle at the L1 level between men and women and between nulliparous and multiparous women. Transversus abdominis muscle was consistently present medial to the linea semilunaris at L1 vertebral level in the subxiphoid region (150/150). At the L3 vertebral level in the mid-abdomen, only eight patients had the transversus abdominis muscle there (8/150, 5%). At the L5 vertebral level in the suprapubic region, no patient had the transversus abdominis muscle medial to the linea semilunaris. The mean thickness of the transversus abdominis muscle at the L1 level was 3.4 mm, and at the L3 level, it was 1.6 mm. There was no statistically significant difference in the transversus abdominis muscle thickness between the men and women; however, a significant difference was found between the nulliparous and multiparous women, with thinner TA muscle in later. There is good transversus abdominis muscle bulk medial to the linea semilunaris for doing transversus abdominis muscle division in the upper abdomen. However, as we move towards the mid-abdomen, we have TA aponeurosis or rarely TA muscle of little bulk.

Tramadol vs. Lidocaine Administered Intraperitoneally and in Incisional Lines for the Intraoperative and Postoperative Pain Management of Romifidine-Telazol-Anesthetized Swine Undergoing Umbilical Hernia Repair.

The aim of the study was to compare the analgesic efficacy of tramadol and lidocaine for local anesthesia during umbilical hernia repair in swine. The study was performed on 66 large white crossbred swine. The swine received a mixture of tiletamine/zolazepam at 5 mg/kg and romifidine at 80 µg/kg, administered intramuscularly. Then, they were divided into three groups (n = 22) that received different treatments with lidocaine at 4 mg/kg and tramadol at 4 mg/kg. The LL group received lidocaine both by infiltration of the surgical planes and intraperitoneally. The LT group received lidocaine by infiltration of the surgical planes and tramadol intraperitoneally. The TT group received tramadol both by infiltration of the surgical planes and intraperitoneally. In all groups, the infiltration of the surgical planes into the umbilical region involved both the skin and muscle planes. Heart rate, noninvasive arterial blood pressure, and respiratory frequency were recorded during surgery. The response to the surgical stimulus was evaluated using a cumulative pain scale (the cut-off point for rescue analgesia was set to 10). Postoperative pain was assessed using the UNESP-Botucatu pig composite acute pain scale (the cut-off point was set to 4). The trend of physiological variables was adequate for patients under anesthesia. No subject required intraoperative and postoperative rescue analgesia. Tramadol could therefore be used for pain management in livestock.

Midterm results of intra-articular stromal vascular fraction injection for the treatment of knee osteoarthritis.

This study aimed to evaluate the safety and efficacy of intra-knee stromal vascular fraction (SVF) injection in patients with symptomatic knee osteoarthritis at the midterm (3-year) follow-up. SVF injection was applied to 25 knees of 20 patients. Eighteen patients (90%) were female, and the means ± standard deviations of age was 61.9 ± 7.8 (range, 50-76) years. Patients who received conservative treatment for at least 6months and had radiographic Kellgren-Lawrence (K-L) grades 2 and 3 varus gonarthrosis were included in the study. SVF was obtained from the umbilical region by liposuction using local anaesthesia. Patients were followed-up for 36months. Their visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm scores were evaluated before and at 6, 12, 24 and 36months post-SVF injection. A statistically significant improvement (p < 0.05) was observed in VAS, WOMAC and Lysholm scores at the first 2-year follow-up compared to baseline. However, no statistically significant difference (n.s.) was observed in VAS, WOMAC and Lysholm scores at the 3-year follow-up compared with baseline. Intra-articular SVF injection decreased pain and significantly improved the functional outcomes in the first 2years in knees with grade 2-3 osteoarthritis; however, these positive effects of the injection disappeared in the 3rd year. Although short-term successful results of SVF have been reported in the literature, prospective studies are needed for medium- and long-term results.

307 Intraluminal Migration of Gossypiboma and rectal expulsion an unusual Case- Case Report

Abstract Background Gossypiboma refers to foreign body retained in the body at the end of operation and can be in the form of gauze, sponge or any form of textile resulting in grave consequences for both the patient and the surgeon. Case Summary A 23-year-old female presented with complain of generalized abdominal pain along with non-bilious vomiting since 10 days. She also had relative constipation since four days. Her past surgical history was unremarkable except for three elective lower segment caesarean sections at another hospital. Upon abdominal examination, she had a scar of pfannenstiel incision along with 3x4 cm swelling in umbilical region with positive cough impulse. Her bowel sounds were exaggerated. DRE was unyielding. Clinical diagnosis of subacute intestinal obstruction was made and she was managed conservatively. Ultrasound abdomen showed dilated gut loops with hyperperistalsis. It also revealed a defect measuring 8.5 cm in the supraumbilical region of anterior abdominal wall through which fat content was seen protruding. She was advised contrast enhanced CT abdomen, developed diarrhoea and later on expelled the surgical sponge per rectally. After passage of surgical sponge, condition of patient improved and symptoms resolved. Discussion Diligent efforts are required to prevent this human error by ensuring meticulous sponge count, use of radio-opaque sponges, adjunctive use of WHO safety checklist and introduction of new advancements like tagging system in our healthcare system. Conclusion Gossypiboma is under-reported due to reluctance of institutions to report it to governing body. Reporting of such dreadful complications of surgery and analysis of their root cause should be done to prevent such events from happening.

Importance of Grahani and Its Physiological Aspects

Almost in all Ayurvedic classics, the organ Grahani is described as an organ of digestion. These descriptions of various Acharyas are based on different criterions. Some Acharyas defined Grahani considering its functional aspects, while few others considered anatomical peculiarities. According to Acharya Charaka, Grahani is the seat (Adhisthana) of Agni and is located above Nabhi (umbilical region). It is supported and nourished by the strength of Agni. Normally, it receives the ingested food, which is retained by it by restraining the downward movement (Grahanati). After digestion it releases the food through sides of lumen to next Ashaya i.e., Pakwashaya. According to Acharya Susruta, the sixth Kala described as Pitta Dhara Kala is situated between Amashaya and Pakwashaya, and it is stated to be Grahani. In Astanga Hridaya, it is quoted that Grahani is the organ of Mahasrotasa, which is a seat of Agni (i.e., Pachaka Pitta) and it receives and retains food.

Ventral Hernias in Kalyana Karnataka Teaching Hospital: A Prospective Study.

A ventral hernia is a protrusion of the abdominal viscus through the anterior abdominal wall occurring at any site other than the inguinal and femoral areas and is a common problem encountered by surgeons.&#x0D; Aims &amp; Objective: Due to the lack of prospective cohorts to determine the natural history of untreated ventral hernias, most surgeons recommend that these hernias be repaired as soon as they are discovered. The purpose of this study was to determine the proportion of ventral hernias occurring in both sexes, various age groups, various risk factors, and complications, as well as their clinical presentations and treatment.&#x0D; Material and Methods: During the period August 2020 to August 2021 (12 months), a prospective study was conducted at our tertiary care hospital. The study included 50 cases of anterior abdominal hernias excluding groin hernias and posterior abdominal wall hernias. A detailed history and a thorough clinical examination were used to collect data. In the proforma, data was entered, tabulated, and analyzed using statistical software (SPSS 2015).&#x0D; Results: Ventral hernias accounted for 5% of surgical admissions. Among the ventral hernias, para umbilical hernias were the most prevalent (48%). An infra umbilical midline herniation accounted for 36% of cases, followed by an umbilical region herniation in 18% of cases. Constipation and obesity were found to be the major risk factors. Most defects are small (&gt;2cm). 48% of inlay mesh repairs were made.&#x0D; Conclusion: 50 cases of ventral hernias were studied in the present study, which was conducted in our tertiary care hospital. Five percent of all admissions to the surgical ward were due to ventral hernias. The females to males ratio was 1:17, and the mean age was 41. The mean total duration for surgery in sublay group was 75.4±9.23 minutes compared to 63.7±10.58 minutes in onlay group, which was statistically significant (p&lt;0.05).&#x0D;

Heterotopic gastric mucosa of the umbilicus

Abstract Umbilical discharge is a commonly encountered problem in infants, with common causes being omphalitis and umbilical granuloma. Unusual causes of persistent umbilical discharge are remnants of the omphalomesenteric duct and the urachus. Heterotopic or ectopic tissues at the umbilicus are rare events that cause umbilical discharge and these mandate a surgical intervention. Gastric heterotopia at the umbilical region is such an unusual entity causing persistent discharge and chemical dermatitis around the region, which needs surgical intervention. We hereby report a rare case of gastric heterotopia of the umbilicus in an 8-month-old male baby.

Prevalence of Diastasis Recti Abdominis in a Gynecological Population: A Cross-Sectional Study

Background: Diastasis recti is the divarication of rectus abdominal muscles due to the splitting of the mid-line collagen structure called the linea alba. It results in poor body biomechanics and alteration in the center of gravity of the body. It occurs mostly in multiparous females and in those who have poorly toned abdominal musculature. Physical activity and maternal care are significant to resolve this condition. Objective: The purpose of the study is to substantiate the prevalence of diastasis recti in a sample of immediate post-partum females attended by the Allied Hospital of Faisalabad. The aim is to create awareness of DRAM in clinical settings and the general population. Study design: This is a cross-sectional study that included 90 samples of females in the immediate postpartum period. Methodology: Specific assessment was done by finger-width method manually and confirmed the presence of DRAM. The umbilical region was the set point from which measurements were taken. Results and Conclusions: The separation was present and mostly affected the multiparous females. The study showed 63.3% prevalence and normal rectus abdominis is 36.7%. It also verified that 42.2% of females suffered from DRAM above the navel out of 63.3% and the rest are below the umbilicus. DRAM was prevalent to be in the majority of post-partum females. It was more present in the supra-umbilical region. Keywords: Pregnancy, rectus abdominis, multiparous, primiparous, physiotherapy.

The Hyper-Reactive Malarial Splenomegaly- A Rare and Severe Form of Chronic Plasmodial Infection: About A Case

Introduction: Hyper-reactive malarial splenomegaly is a leading cause of large tropical splenomegaly in endemic zones. Here, we report a case diagnosed in a young woman living in Guinea, a malaria-endemic area. Clinical observation: A 32-year-old Guinean woman with a history of repetitive malaria infection episodes presented to the internal medicine outpatient clinic with 5-months history of voluminous mass of the left flank extending to the umbilical region, with no pain and progressive onset, and a sensation of early satiety accompanied by eructation and epigastralgia worsened with eating. Digestive examination revealed a large, firm, smooth-surfaced, painless splenomegaly with a splenic size 20 centimeters below the left costal margin on the mid-clavicular line and measuring 28 centimeters in its long axis. The initial complete blood count showed a normocytic normochromic anemia with lymphocytosis, neutropenia and thrombocytopenia. The erythrocyte sedimentation rate (ESR) was 65 mm at the first hour. Malaria rapid diagnostic test (RDT) was positive for Plasmodium. The thick blood smear had come back negative. Serum protein electrophoresis demonstrated a decrease in albumin to 36.5 g/l and an increase in gamma globulins to 19.1 g/l. Immunoelectrophoresis of serum proteins showed a polyclonal increase in IgG. Abdominal ultrasound revealed enormous homogeneous splenomegaly (180 millimeters). The diagnosis of Hyper-reactive malarial splenomegaly was made on the basis of diagnostic criteria established by Fakunle et al in 1981. Our patient presented with enlarged splenomegaly, negative thick smear, positive RDT for plasmodium, elevated erythrocyte sedimentation rate, lymphocytosis, pancytopenia, and a good therapeutic response. Atovaquone-proguanil 250mg/100 mg at a dose of 1000mg/400 mg, i.e. 4 tablets taken as a single dose over three days, was initiated, then relayed by alternance of doxycycline 100 mg (100 mg once daily) for 1 month and nivaquine 100 mg ..........

Histopathological Findings in Hernia Sacs: A Clinical and Pathological Review.

Routine histopathological examination of hernia sac in adults remains a controversial topic. We undertook a retrospective study to assess possible clinical benefits of pathological examination of hernia sac specimens. Our pathology database between 1992 and 2020 was searched for adult specimens submitted as hernia sac. The clinical and pathological data of patients with abnormal histopathological findings were reviewed. There were 5424 hernia sac specimens (3722 inguinal, 1625 umbilical, and 77 femoral), 32/5424 (0.59%) with malignancies (28 epithelial and 4 lymphoid) and 25/32 were located in the umbilical region. Twelve out of twenty-five malignancies (48%) presented as primary clinical manifestations of the diseases (5 GI tract carcinomas, 5 gynecological tract carcinomas, and 2 lymphoid neoplasms); and 13/25 (52%) specimens were involved by previously known tumors (8 gynecological carcinomas, 3 colon carcinomas, 1 breast carcinoma, and 1 lymphoma). Among the 7 inguinal hernia sacs with malignancies, 3 (42.9%) were primary presentations of the tumors (2 prostatic carcinomas, 1 pancreatic carcinoma), and 4 (57.1%) were previously known tumors (2 ovarian carcinomas, 1 colon carcinoma, 1 lymphoid). Benign lesions were 12/5424 (0.22%), including 7 adrenal rests, 4 endometriosis, and 1 inguinal sarcoidosis. The incidence of hernia sacs with malignancies was 32/5424 (0.59%), most commonly from nearby organs in gynecological tract. However distant metastases from breast were also present. Near half of the hernia sac with malignancies (15/32, 47%) presented as the first clinical manifestation. Routine histopathological examination of hernia sac in adults is recommended, since it may provide important clinical information.

Laparoscopy-assisted percutaneous correction of abdominal wall defects in the umbilical region in a cadaveric model of bovine fetus.

Abdominal wall defects in calves are commonly diagnosed and treated via laparotomy. This technique has witnessed several advancements in the management of these disorders. This study aimed to create a study model and evaluate the feasibility of video-assisted percutaneous correction of abdominal wall defects in bovine fetuses (corpses) compared with the conventional technique. Sixteen bovine fetuses from pregnant cows slaughtered in slaughterhouses were included in this study. The fetuses were categorized into the control group (CG, n = 8), which was subjected to umbilical abdominorrhaphy via laparotomy, and the video-surgical group (VG, n = 8), which received video-assisted percutaneous sutures with two lateral accesses on the right flank. An abdominal wall defect was created in the VG group to generate a study model, which was corrected using the laparoscopic technique. The procedures were performed in two steps. The first step consisted of creating an abdominal wall defect in the umbilical region by laparoscopic approach in an iatrogenic manner (Step 1: E1). The second stage consisted of conventional abdominorrhaphy of the umbilical region wall defect in the CG group and video-assisted percutaneous suturing of the edges of the iatrogenic abdominal wall defect in the VG group, until reversal of the laparoscopic accesses (Step 2: E2). Step 1 showed no statistically significant difference between the two groups. However, a significant statistical difference (p < 0.0001) was observed between the two groups in step 2. The surgical time of step 2 was longer in the CG group (33.10 ± 0.43 minutes) than that in the VG group (10.13 ± 0.68 minutes, p < 0.0001), and the total surgical time was also longer in the CG group (38.48 ± 0.35 minutes) than that in the VG group (15.86 ± 0.67 minutes). The proposed laparoscopic technique allowed the creation of a study model for video-assisted percutaneous suturing with two portals and reduced the surgical time compared with the conventional technique. However, this method needs to be studied further in live animals.

Preoperative visualization of midline-crossing subcutaneous arteries in transverse abdominal flaps using photoacoustic tomography

Photoacoustic tomography is a noninvasive vascular imaging modality that uses near-infrared pulsed laser light and ultrasound to visualize vessels. We previously demonstrated the utility of photoacoustic tomography for anterolateral thigh flap surgery involving body-attachable vascular mapping sheets. However, it was not possible to obtain clear separate images of arteries and veins. In this study, we tried to visualize subcutaneous arteries that cross the midline of the abdomen, since these arteries are known to be important for obtaining large perfusion areas in transverse abdominal flaps. Four patients scheduled to undergo breast reconstruction with abdominal flaps were examined. Photoacoustic tomography was performed preoperatively. The tentative arteries and veins were traced according to the S-factor, an approximate hemoglobin oxygen saturation parameter calculated using 2 laser excitation wavelengths (756 and 797nm). Intraoperatively, arterial-phase indocyanine green (ICG) angiography was performed after abdominal flap elevation. Images of vessels speculated to be arteries by preoperative photoacoustic tomography were merged with those of intraoperative ICG angiography and analyzed in an 8×4-cm2 area below the umbilical region. The S-factor was used to visualize the midline-crossing subcutaneous arteries in all 4 patients. A matching analysis compared preoperative tentative arteries according to photoacoustic tomography with ICG angiography results in the 8×4-cm2 area below the umbilical region and indicated a 71.3-82.1% match (average: 76.9% match). This study demonstrates that the S-factor, a noninvasive, label-free imaging modality, can be used to successfully visualize subcutaneous arteries. This information can aid in selecting perforators for abdominal flap surgery.

Comparison of volume-controlled and pressure-controlled ventilation during laryngeal mask airway anesthesia in cataract surgery

Introduction: Most patients undergoing eye surgery are elderly adults with underlying cardiovascular diseases. One of the complications during recovery is gastric insufflation, which can cause detrimental effects on cardiovascular patients. The present study compares two methods of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Methods: The study enrolled 81 patients undergoing cataract surgery (41 in the PCV group and 40 in the VCV group). According to the American Society of Anaesthesiologists (ASA) classes I and II received general anaesthesia and laryngeal mask airway (LMA) ventilation using VCV or PCV. Maximum pressure (Ppeak), dynamic compliance, expiratory tidal volume, Spo2, non-invasive blood pressure, heart rate, and pain in the epigastrium and umbilical region were monitored at intervals of 1, 5, 10, and 20 minutes after the initiation of anaesthesia and the results of two groups were compared. Results: The means of Ppeak and tidal volume in the PCV group as well as the means of dynamic compliance and end-tidal carbon dioxide (EtCO2) in the VCV group were significantly high. The mean diastolic blood pressure was significantly different between two groups at 20th minute. There were no significant differences in heart rate, mean systolic blood pressure, arterial oxygen saturation, or abdominal pain between two study groups. Conclusion: VCV had a lower Ppeak and a higher dynamic compliance, but PCV had a larger tidal volume and lower EtCO2. There were no differences in terms of abdominal and umbilicus pain, as well as hemodynamic parameters, between two groups.

Pancreatic Mucinous Cystic Neoplasm with Associated Invasive Carcinoma: A Case Report and Literature Review

Background. Pancreatic mucinous cystic neoplasm (PMCN) with associated invasive carcinoma is a rare entity. According to the World Health Organisation (WHO) 2010, PMCN with associated invasive carcinoma is referred to the malignant lesions of the pancreatic epithelial tumour. Case report. A 52-year-old female patient presented with pain in the umbilical and epigastric regions for 5 months and noticed a solid visible tumour on the left side of the abdomen 3 months ago when she lied down. The level of the CA125 was 47.64 U/ml (normal value &lt;35 U/ml). Abdominal and pelvic magnetic resonance imaging (MRI) showed a cystic multiseptal mass in the left iliac region, defined as a left ovary tumour, while Computed tomography scan revealed a cystic tumour of the pancreatic tail. The patient underwent a resection of the pancreatic tail with a 20 cm cystic solid tumour, splenectomy and left hemicolectomy. Histopathology report confirmed mucinous cystic neoplasm of the pancreatic tail with associated invasive carcinoma (combined badly differentiated (G3) ductal (40%) and undifferentiated (G4) anaplastic (60%) carcinoma) pT1bN0. Postoperative course complicated with wound infection. The patient was discharged on postoperative day 10. The patient is still alive 2 years on follow-up. Conclusions. PMCN with associated invasive carcinomas are rare lesions of pancreas with relatively benign course. This malignant pancreatic tumour displays morphologies as pleomorphic epithelial cells and relatively mononuclear spindle cells, and not always tends to have underlying ovarian type stroma. The comprehensive histopathological examination of the tumour is necessary in order to cure most MCN patients with minimally invasive types.

A case report on surgeon’s perseverance: post ileal type appendicular perforation with concealed abscess-laparoscopic appendectomy

In humans, the vermiform appendix is not a vestigial organ, but rather a lymphoid structure that, when inflamed, causes major problems. Acute appendicitis is characterized by pain and soreness in the right iliac fossa, along with nausea and anorexia. Depending on the location of the appendix, it may appear in an unusual manner. In post-ileal type appendicitis, pain is more concentrated around the umbilicus, and pain shifting may be absent. In this scenario, an ultrasound of the abdomen may not be particularly useful, but a CT scan of the abdomen may aid in the diagnosis. A delay in diagnosing and treating acute appendicitis can have disastrous consequences. We now present the case report of a 20-year-old male patient with chief complaints of sudden onset of abdominal pain over umbilical region, squeezing type radiating to right lumbar region, for 3 days. On clinical examination, the patient had presence of tenderness at McBurney’s point over the right iliac fossa and periumbilical area. The diagnostic investigations of GI endoscopy report showed grade A esophagitis and hemorrhagic gastropathy. CT report shows acute appendicitis with contained perforation and appendiceal abscess. Post ileal appendicular perforation with concealed abscess was treated with laparoscopic appendectomy under general anesthesia.