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Involvement of esophagus with tuberculous infection is a rare form of extrapulmonary tuberculosis. Secondary esophageal tuberculosis is much more common than primary TB. The most common source of secondary esophageal involvement is tuberculous mediastinal lymphadenitis. Esophageal tuberculosis mimics carcinoma esophagus. Clinical features are same and it is difficult on imaging studies also to differentiate the two pathologies. Misdiagnosis is common. The disease is medically curable; therefore, it is essential to make all efforts to diagnose the pathology with non-surgical diagnostic modalities in suspected cases so as to save patients from the trauma of major surgical resection. Surgical intervention is indicated for failed medical therapy and complications. A total of 133 cases of esophageal TB have been reported till date. The authors encountered 4 cases of esophageal TB between April 2011 and March 2019. The aim of this article is to present our data and to provide comprehensive review of the available literature on this pathology in order to gain a better understanding of diagnostic methods and provide guidelines for the diagnosis and management of esophageal TB.

Rectal tuberculosis is an uncommon entity. It has unique epidemiological features, specific medical treatment and surgery is rarely indicated. The first case of rectal tuberculosis was reported in 1957. Delayed diagnosis is common. Patients who develop rectal tuberculosis have been reported to have some risk factors or associated comorbid conditions or pathologies with some form of abnormal host-defence mechanism such as acquired immunodeficiency syndrome, complement deficiency. Rectal tuberculosis has been reported to be more common in females as compared to males. Haematochezia is the most common presenting symptom. The definite diagnosis requires demonstration of Mycobacterium tuberculosis bacillus on histopathologic examination. Once a correct diagnosis has been made, rectal tuberculosis is curable with antituberculous treatment. Surgery is indicated for diagnostic dilemmas, non-responsive disease and complications. The authors encountered 3 cases in the last 10 years. The aim of this study is to provide our data on this rare disease and to review the reported literature comprehensively so as to provide guidelines for diagnosis and management.

Coexistence of carcinoma colon and tuberculosis is rare. The aim of this study is to present our 12-year experience on colonic carcinoma with coexisting colonic TB. Histopathology and imaging records of 189 patients of colonic carcinoma patients who underwent treatment in surgical unit 6 in our institute between January 2006 and December 2017 were reviewed. In 7 patients, histopathology and/or imaging studies were suggestive of coexistence of colonic carcinoma and tuberculosis. Fifteen cases of colonic tuberculosis were also reviewed. Descriptive statistics were used to summarize the data. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The duration of symptoms spanned between 2 and 7 weeks. Anorexia and weight loss were the predominant symptoms. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The morbidity was low and there was no surgery associated mortality. Clinical awareness and advancement in diagnostic studies and improvement in management strategies may guide and lead to early diagnosis, optimum therapeutic guidelines and thus improved outcome.

The tuberculous infection of major salivary glands is rare because they are relatively resistant to tubercle bacilli. The aim of this study is to present our 13 year experience on major salivary gland tuberculosis. The clinical, histopathological, microbiological and imaging records of 9 cases of major salivary gland tuberculosis were reviewed retrospectively. The cases diagnosed with either microbiological culture and/or polymerase chain reaction assay and/or Histopathological examination were included in the study. Descriptive statistics were used to summarize the data. There were 9 cases with tuberculous involvement of major salivary glands; parotid (n = 5), submandibular (n = 3), sublingual (n = 1). The most common local symptom was painless swelling present in 8 cases and constitutional symptoms were present in all the cases. The previous history of TB was present in 5 out of 9 cases. Surgical intervention was done in 2 cases of parotid TB for diagnostic purpose and therapeutic intervention was required in 1 patient. Patients responded well to medical therapy. Two patients with disseminated disease died. The major salivary gland is rare in both immunocompetent and immunocompromised patients. Diagnosis is difficult and requires high degree of suspicion especially in isolated cases. Medical management yields satisfactory results.

Submandibular salivary gland is an uncommon and unusual site for tuberculosis. It is a rare extrapulmonary manifestation of a common infection caused by Mycobacterium tubercle bacillus. Submandibular gland TB can be due to primary or secondary infection. The clinical features are non-specific and depend on its manifestations. A delay in diagnosis is common because of the rarity of disease. Direct histological examination is the best method of diagnosis. As the disease is curable with antituberculous drugs; treatment should not be withheld in suspected cases until the diagnosis is confirmed. Surgery is indicated for non-responsive disease and complications. Till date, only 15 cases have been reported in the literature. First case was reported in the year 1990. The authors encountered three cases in last 10 years. The aims of this study are to review clinical presentation, epidemiological features, diagnostic methods and to provide our data and guidelines for optimum management of this rare pathology.

Short bowel syndrome (SBS), one of the commonest types of intestinal failure, usually secondary to extensive bowel resection, traditionally has been associated with a high mortality rate and hence a big challenge for the treating surgeons. It requires comprehensive clinical care to minimise the morbidities and mortality associated with the condition. We report a retrospective review of a series of seven patients with SBS, who presented at our surgical emergency within a period of 1 year and their outcome so as to encourage others in managing such a challenge with more positive mindsets. A retrospective analysis of seven patients with SBS admitted from January 2014 to January 2015 with a follow-up of 1 year has been done in terms of their demographic characteristics, underlying pathology and clinical outcome. A rising incidence of SBS in the younger age group (71.4%) has been observed in this analysis. Majority of patients (57.1%) had mesenteric ischemia as the underlying cause followed by each case of small bowel volvulus, internal herniation and blunt trauma abdomen. A discharge rate of 71.4% and mortality rate of 28.5% were observed. With this analysis, we believe that SBS is no more an uncommon condition. A structured clinical approach, timely surgical intervention and multidisciplinary postoperative management are essential for managing such frail patients to achieve best possible results. This will encourage others in managing such a critically challenged condition with a more positive approach and thus beneficial for both the patients and the treating surgeon.

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 is a highly infectious disease and is causing enormous morbidity and mortality all over the world. Initially it was thought to cause only respiratory complications. But subsequent reports started appearing implicating the gastrointestinal system, nervous system. Thromboembolic complications like myocardial infarction, pulmonary embolism, stroke and mesenteric ischemia were reported to be the main causative factors. Hereby we are reporting one such case of a patient who presented to surgery emergency with predominant abdominal symptoms.

Pseudo-recurrence after laparoscopic hernia repair, though known, is poorly understood. Common causes of pseudo-recurrence are pneumoscrotum, haematoma, seroma, cord thickening and persistent cough impulse. To analyze the incidence of pseudo-recurrence and its impact on morbidity after laparoscopic inguinal hernia repair. All laparoscopic inguinal hernia repair cases performed by a single surgical unit over a period of five years from April 2007 till March 2012 were retrospectively analyzed. Among 243 operated laparoscopic inguinal hernia repairs (TEP and TAPP) included in the study, twenty (8.26%) cases displayed a pneumoscrotum, eighteen (7.43%) a haematoma, twenty-four (9.98%) a seroma, eight (3.29%) cord thickening, and six (2.46%) persistent cough impulse. All patients were managed conservatively with the exception of one case of seroma which had to be aspirated. Pseudo-recurrence following laparoscopic inguinal hernia repair, though common, has no significant impact on morbidity. Recognition of the problem is important to continue conservative management and avoid intervention.

Background Diagnosis of skin and soft tissue infections (SSTIs) is difficult as they commonly masquerade as other clinical syndromes. So, the prospective cohort study was carried out to study the clinical profile, evaluate the existing method of severity stratification of SSTIs and identify factors responsible for prolonged stay and poor outcome in patients with SSTIs. Methods The prospective study was carried out based on clinical profile to evaluate the role of severity stratification of SSTIs in 105 patients attending the surgical outpatient department and surgical emergency. The patients were managed conservatively on oral or intravenous antibiotics and dressing or combined with surgical intervention based on severity stratification. Sometimes radiological investigation helped to know the deep seated abscess and thereby need of early intervention by surgical drainage, fasciotomy and rarely amputation. The data collected, summarised and evaluated using chi-square method. Result SSTIs has been categorized into mild, moderate and severe form based on clinical and demographic profile of the patient. The study revealed risk factors that were statistically significant to be male patients of lower socioeconomic groups, temperature above 38 °C, hypotension, TLC > 15000, presence of gangrene, bullae, crepitus, trauma, animal/insect bite, BSA > 9% except when involving hand, head & scrotum, loss of sensation, loss of movement/function of affected part and restriction of joint movement ( P Conclusion Based on above findings, an algorithm for severity stratification is formulated for reducing the morbidity and mortality of the patients with SSTIs.

Treatment of metastatic liver disease is at the crossroads of an evolutionary transformation with more and more reports reiterating the benefits of resectional therapy in various cancers. A quest for application of laparoscopic approaches to the management of liver metastasis has arisen due to the projected benefits of less morbidity, early recovery, and equivalent oncological outcome in selected malignancies. However, the diverse and heterogenous data on indications, operative technique, and outcome evaluation make a comparative analysis of these studies difficult. This review is an appraisal of technique and outcome of minimally invasive liver resection as reported in the current literature with special reference to treatment of metastatic colorectal cancers.

A laparoscopic approach may be feasible in the management of very large pseudocysts of the pancreas., Laparoscopic cystogastrostomy is an established procedure for the drainage of pancreatic pseudocysts. Cysts are mainly present in the lesser sac (retro-gastric), which is completely amenable to cystogastrostomy. We discuss the problems faced and simple solutions to the problems in managing a huge pancreatic pseudocyst of 22 cm×18 cm in a young boy 18 y of age.