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Echinococcal liver cysts are predominantly located in the right lobe of the liver and are mostly asymptomatic. A frank intra-biliary rupture (IBR) of hydatid cyst is uncommon, having variable clinical presentation and treatment options. We present a case of a 60-year-old male patient who presented with pain in the upper abdomen associated with vomiting but without jaundice. On investigations, he was diagnosed to have a left lobe hepatic hydatid cyst (HHC) with IBR for which left hepatectomy with bile duct exploration was performed. It highlights the benign nature of the disease for which seldom major hepatectomies have to be performed. [ABSTRACT FROM AUTHOR]

Mucinous adenocarcinoma of jejunum is a rare tumor of the gastrointestinal tract. Patients usually present after fifth decade of their life with non-specific symptoms. Delayed diagnosis is commonplace and often the reason for advanced disease and poor prognosis. These tumors may masquerade as other common malignancies, with a conclusive diagnosis only after the final histopathological examination. We present a case of jejunal mucinous adenocarcinoma, disguised as cecal malignancy, in an old female patient, managed with radical resection and adjuvant chemotherapy. The report reiterates that the mucinous variant of jejunal adenocarcinoma is a rare pathology with an unusual advanced presentation. [ABSTRACT FROM AUTHOR]

Introduction: Post-operative chylothorax is a dreaded complication after esophagectomy; hence real-time identification of the thoracic duct (TD) may aid in avoiding its injury or promptly tackling injury when it occurs. We utilized intra-nodal injection of Indocyanine green (ICG) dye to delineate TD anatomy while performing esophagectomy for esophageal carcinoma.Method: Two ml of 1 mg/ml solution of ICG was injected into the inguinal lymph nodes under ultrasound guidance. TD was checked with the laparoscopic Karl Storz IMAGE1 STM or Robotic da Vinci Xi system. The thoracic esophagus, periesophageal tissue, and lymph nodes were dissected. The TD was visualized throughout the dissection using OverlayTM technology & Firefly mode™ and checked at the end to rule out any dye leak. TD was clipped if any dye leakage or TD injury (TDI) was noted using Near Infra-Red Spectroscopy.Results: Twenty one patients with M:F 13:8 underwent minimally invasive esophagectomy (MIE) [thoracoscopic assisted (n = 15) and robotic-assisted (n = 6)]. TD was visualized in all the cases after a median (IQR) time of 35 (30, 35) min. The median (IQR) duration of the thoracic phase was 150 (120,165) min. TDI occurred in 1 case, identified intra-operatively, and TD was successfully clipped. There were no post-operative chylothorax or adverse reactions from the ICG injection.Conclusion: Intra-nodal ICG injection before MIE helps to identify the TD in real-time and is a valuable intra-operative aid to prevent or successfully manage a TD injury. It may help to prevent the dreaded complication of post-operative chylothorax after esophagectomy. [ABSTRACT FROM AUTHOR]

Background: Gastric conduit has emerged as the preferred treatment option for both esophageal bypass and replacement for corrosive stricture of the esophagus. There is a lack of consensus and a dearth of published literature regarding the short- and long-term complications of using a gastric conduit. This meta-analysis aims to evaluate the outcomes, morbidity, and complications associated with it. Methods: MEDLINE, Cochrane Library, and Google Scholar (January 1960 to May 2020) were systematically searched for all studies reporting short- and/or long-term outcomes and complications following the use of a gastric conduit for corrosive esophageal stricture. Results: Seven observational studies involving 489 patients (53.2% males, mean age ranging from 22.1 to 41 years) who had ingested a corrosive substance (acid in 74.8%, alkali in 20.7%, and unknown in the rest) were analyzed. Gastric pull-up was performed in 56.03% (274/489) of patients. Median blood loss in the procedure was 187.5 ml with a mean operative duration of 298.75 ± 55.73 min. The overall pooled prevalence rate of anastomotic leak was 14.4% [95% CI (6.2–24.0); p < 0.05, I2 = 67.38], and anastomotic stricture was 27.2% [95% CI (13–42.8); p < 0.001, I2 = 80.11]. Recurrent dysphagia according to pooled prevalence estimates occurred in 14.4% patients [95% CI (5.4–25.1); p < 0.05, I2 = 69.1] and 90-day mortality in 4.8% patients [95% CI (1.5–9.1%); I2 = 31.1, p = 0.202]. The dreaded complication of conduit necrosis had a pooled prevalence of 1.3% [95% CI (0.1–3.4%); I2 = 0, p = 0.734]. Conclusion: The stomach can be safely used as the conduit of choice in corrosive strictures with an acceptable rate of complications, postoperative morbidity, and mortality. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) and azygos vein anomaly is very rare. Available case studies report difficult esophagectomy in patients with esophageal carcinoma with IVC anomaly. Minimally invasive esophagectomy with preservation of the azygos vein in such patients is technically challenging. We report a case of a 44-year-old woman diagnosed with middle thoracic esophageal carcinoma with double IVC and dilated azygos vein. Thus minimally invasive surgery is feasible in such patients but requires high technical skills and ample experience to carry out this kind of surgery, and it should only be attempted by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

B Introduction: b Dilated common bile duct (CBD) [ 8-15 mm] with normal liver function test are seen frequently while evaluating upper abdominal pain. Patients were categorised as: Group A- Dilated CBD with post-cholecystectomy status; Group B- Dilated CBD with cholelithiasis; Group C- Dilated CBD without cholelithiasis. The outcome of patients managed without CBD excision is similar to those with excision. [Extracted from the article]

B Introduction: b Pancreatic schwannoma (PSN) is a rare, well-encapsulated tumor of the pancreas. Preoperative diagnosis of this tumor is uncommon due to marked degenerative changes, its rarity, overlapping clinical and imaging features with other pancreatic neoplasms, hence leading to major surgical resection in most cases. Based on these features, diagnosis of benign pancreatic mass lesion possibly neurogenic tumor was made. [Extracted from the article]

Enucleation was performed in all 4 patients with utilization of intra-operative continuous glucose monitoring (CGM) to ascertain removal of dominant lesion. B Conclusion: b Continuous glucose monitoring can predict the complete enucleation of dominant lesion in insulinoma of MEN-1 subjects accurately, avoided major resection and can be used as an alternative. [Extracted from the article]

B Summary b ERCP is the first line method of CBD stone clearance with high success rate. ERCP and stone retrieval with dormia basket was attempted but during the procedure, the wire snapped and the basket got retained in the CBD. Laparoscopic CBD exploration through supraduodenal choledochotomy was performed and the basket with calculus was found impacted in lower CBD. [Extracted from the article]