Chylous ascites following retroperitoneal lymphadenectomy in a patient with recurrent dysgerminoma of ovary: A case report

Chylous ascites is an uncommon condition of accumulation of milky fluid rich in lymph and chylomicrons in the peritoneal cavity. Post-surgical complications following dissection near the base of the mesentery, retroperitoneum, or near the cisterna chyli, malignancies (e.g., pancreatic adenocarcinomas, lymphoma, gastric carcinoma), cirrhosis, and trauma are the prime causes of chylous ascites. Here we report a rare case of chylous ascites following clearance of isolated paraaortic nodal recurrence in a 28-year-old female with dysgerminoma of ovary. The patient developed chylous ascites on the fifth day following surgery, which was confirmed by an increased drain fluid triglyceride level. She was managed conservatively with dietary modification including a high-protein and carbohydrate but low-fat-based diet mainly containing medium-chain fatty acids. Subsequently, she recovered from chylous ascites on the sixteenth day, completed second line chemotherapy, and is now doing well.

Traumatic right testicular amputation with left testicular repositioning: A case report of a farmer from Nepal

Male external genitalia injury with testicular loss is relatively uncommon in civilian practice. Testicular amputation is usually found with military trauma and self-mutilation. However, they do occur while operating machines for domestic purposes. The standard protocols for the management of traumatic testicular amputation are lacking. The management is focused on resuscitation of the patient and restoration of testicular function with acceptable cosmesis. Here, we present a case of a 45-year-old man with traumatic right testicular amputation while he was using a thresher for rice cutting.

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Traumatic testicular amputation is an uncommon entity in civilian practice.

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The testis can be repositioned in an ectopic location due to the laxity of cord structures.

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Testicular injury can occur by machinery due to its inexperience use.

Penile strangulation with a plastic bottle neck: Intervened by an atypical instrument: A case report

INTRODUCTION AND IMPORTANCE

Strangulation of penis, a surgical emergency, is often encountered in patients with psychiatric disorders and patients attempting to increase sexual arousal. Materials ranging from metallic to non-metallic like plastic bottles are used by the patients. The important factors to be considered for the successful treatment include the availability of instruments and the surgical skills of the doctor.

CASE PRESENTATION

A 45 year-old man with a comorbidity of severe depression presented to Emergency with a two months long history of penile strangulation with a plastic bottle neck. The gross appearance of the penis showed edema and proliferative growths. He was intervened with a cable wire cutter as standard instrument failed to do so. The patient was discharged on the same day of intervention. However, he was lost to subsequent follow up.

DISCUSSION

Penile strangulation which is common in people with mental disorders should be considered as a surgical emergency as it can present with devastating complications. No specific methods and tools have been recommended for the removal of those objects. The shame felt by patient is the root cause for late surgical consultation and are prone to develop complications. Simple instruments can be used for the intervention provided good surgical skills are demonstrated.

CONCLUSION

Common in psychiatric patients who deny medical attention due to shame, penile strangulation should be intervened quickly and simple instruments not routinely used in surgical practice can be effectively used to remove the offending objects.

Extended Total Mesorectal Excision (e-TME) for Locally Advanced Rectal Cancer

BACKGROUND

Locally advanced rectal cancer (LARC) can involve surrounding pelvic organs requiring multivisceral resection. Extended total mesorectal excision (e-TME) or multivisceral resection is a complex procedure associated with high morbidity, mortality, and R1 resection rates. However, e-TME in LARC with surrounding organ involvement is the only potential option for cure. The study aims to assess the clinical outcome of patients requiring e-TME for LARC.

METHODS

The study is a retrospective review of all patients with LARC requiring multivisceral resection (2013 to 2019). The database includes clinic-demographic profile, pelvic organ involved, operative details, resection margin status, morbidity, mortality, and survival.

RESULTS

Seven consecutive patients (9.2%) out of 76 LARC (median age 46 years; 5 females) required multivisceral resection. The organs involved were bladder (4); posterior wall of vagina (2); and uterus (1). The en bloc resection included total cystoprostatectomy - 1; partial cystectomy - 3; posterior vaginectomy - 2; and hysterectomy - 1. Additionally, four required abdominoperineal resection. All were adenocarcinoma: stage III, with R0 resection - 76%. The overall complications were seen in 60% of patients, majority being wound related. There was no operative mortality. The median survival was 32.2 months in the entire series, while one died with the disease at a 28-month follow-up.

CONCLUSION

e-TME with curative intent, though a complex procedure, is associated with high wound-related morbidity, R1 resection, but improved median survival benefit.

Diabetes and Pancreatic Anastomosis: Friend or Foe?

Background & Objectives:Pancreaticoduodenectomy (PD) has become a standard operative procedure for both benign and malignant lesions of pancreatic head and periampullary region. Pancreatic Fistula (PF) is the most troublesome complication and heralds the development of other complications. The procedure was associated with high morbidity and mortality in the past but with the identification of various risk factors associated with the development of PF, the management has changed dramatically. Similarly, Diabetes mellitus (DM) and poor glycemic control is associated with various adverse postoperative events. So, the objective of this study was to identify the association between DM and postoperative occurrence of PF.Materials & Methods:This was a prospective cross-sectional study enrolling a total of 72 patients. Patients were screened for the presence or absence of DM based on guidelines by American Diabetes Association in January 2009. After surgery, patients were observed for the development of PF. The association between these two was assessed using Chi-Square test.Results:Out of 72 patients, 12 had DM. All the patients who had DM did not develop PF; in contrast 15 patients who developed PF were non-diabetic.Conclusion:Diabetes Mellitus was found to be protective in preventing the occurrence of PF postoperatively.