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Mesh Hernioplasty is the gold standard for Inguinal hernia.However, it is not free of complications. Mesh migration causing intestinal obstruction, albeit rare, is a serious and complications. Timely surgical intervention is very important in the management of this condition. We report a rare case of an elderly male patient with mechanical bowel obstruction due to mesh migration 9 years after a right inguinal hernia meshplasty.

Background: Biliary obstruction can present with distressing symptoms and increased morbidity which leads to liver fibrosis, cholestasis, portal inflammation and ductular proliferation. Experimental studies showed reversal of histological findings in liver after biliary decompression surgery; however only a limited data is available regarding the same. Methods: Prospective observational study of 28 liver biopsies from 14 patients of obstructive jaundice, who underwent decompression surgery and showed clinical deterioration at 6 weeks with normal HIDA scan. Patients were clinically evaluated. Both intra (1 st bx) and postoperative (2 nd bx) liver biopsies were studied for fibrosis, cholestasis, ductular proliferation and portal inflammation. Result: Patient’s age ranged from 24 to 75 years (8 Males and females 6), commonest symptom being jaundice. In 1 st bx, most of the patients showed histological evidence of obstruction, which improved at least partially after surgery. There was no definite correlation of fibrosis with etiology. Fibrosis was less commonly seen with shorter duration of symptoms and younger males had higher prevalence. Increase/static grades of fibrosis were seen in 35.71% patients each, while 28.57% showed regression. No correlation of age and etiology with status of fibrosis was observed. Regression was more common in males and with absence of cholangitis while progression was more common in females and with presence of cholangitis. Conclusion: We wonder whether younger males are more prone for fibrosis but males in general have better prognosis regarding the reversal. Also, cholangitis could be an important factor for deciding the further course of fibrosis. However we require larger data with multivariate analysis for the confirmation of the same. DOI: 10.21276/APALM.1223

A case of isolated localised mucormycosis of the bile duct in an immuno-competent 54 year old female patient is described. Mucormycosis is rare in immuno-compet ent patients. Isolated localised mucormycosis of the bile duct has not yet been described in the literature.

The management of Carcinoma of the Rectum is fairly standardized and protocolized, based on universally followed guidelines, including the NCCN, ESMO, and ASCO guidelines. However, there are certain advances and practices recommended which are contentiously requiring further debates and studies. The present study addresses these issues in its right perspective based on literature evidence.

Background: Pharyngoesophageal stricture with laryngeal involvement due to corrosive ingestion is rare, and limited literature is available regarding management. Outcome is unpredictable due to progressive scaring of anastomosis and associated respiratory complications. Here, we share our experience of managing this challenging entity. Materials and Methods: Of 57 corrosive ingestion patients, we reviewed 15 patients of isolated pharyngoesophageal stricture managed in our unit of a tertiary care center between 2008 and 2016. The medical records, initial management, operative data, postoperative course, and follow-up data of these 15 patients were reviewed. These 15 patients divided into Group A of endless string insertion and dilatation and Group B of five patients who underwent additional colonic interposition. Results: Of 15 patients, 10 patients belonged to Group A of endless string insertion and dilatation and five patients belonged to Group B with additional coloplasty. All the 10 patients were successfully dilated with endless string insertion, whereas in coloplasty group, four patients out of five are taking normal diet, and one patient succumbed due to nonoperative cause. All 15 patients had no respiratory complication postoperatively, and five patients who were on tracheostomy before surgery are weaned off completely. All 14 patients have no dysphagia, have no respiratory complications, and have gained weight. Conclusion: Severe upper aerodigestive injury is rare and its management is herculean task, but satisfactory functional reconstruction can be achieved in the majority of patients without the need for permanent tracheostomy or feeding jejunostomy by our technique giving good quality of life.