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Coronavirus disease‐19 (COVID‐19) infection causing severe gastrointestinal complications is rare. A 9‐year‐old child after recovering from mild COVID‐19 infection developed small bowel gangrene due to superior mesenteric artery thrombosis. He required resection of entire necrotic small bowel along with caecum causing ultra‐short bowel syndrome. Reverse transcriptase‐polymerase chain reaction (RT‐PCR) done on the resected specimen was positive for COVID‐19. He was maintained on individualized parenteral nutrition for 3 months. A living donor intestinal transplant was performed using 200 cm of ileum donated by the patient's father. The graft function was satisfactory and was not complicated with thrombosis, infection, reactivation of latent COVID‐19 or rejection. He could be weaned off completely from parenteral nutrition by postoperative day 21. The donor had an uneventful recovery. Six month follow‐up was satisfactory with the child achieving complete enteral autonomy as well as target goal nutrition. Thrombotic phenomena associated with COVID‐19 infection can affect larger vessel‐like superior mesenteric artery leading to small bowel gangrene. Intestine transplant could be done safely after 3 months of recovery from COVID‐19 without any adverse outcomes. Further studies are required to establish optimal timing and safety of small bowel transplant in this situation.

To report first deceased donor isolated small intestine transplant (DDIT) from western India and discuss feasibility, procedure and outcome of this complex surgery. A 27-year-old male required massive small bowel resection for gangrene following small bowel volvulus. Patient developed ultrashort bowel syndrome with high output stoma. He was started on total parenteral nutrition. Inability to maintain nutrition along with deranged liver functions necessitated early listing for deceased donor small intestinal transplant. DDIT was performed using small intestine from size matched for a 42-year-old female. Inflow was taken from the infrarenal abdominal aorta. The superior mesenteric vein of the graft was drained into the inferior vena cava. Standard immunosuppression and antibiotic prophylaxis were followed. The graft functioned well, and patient was completely weaned off parenteral nutrition and discharged on day 14. However, he had sudden deterioration of health at home 1 month later and succumbed to death before reaching the hospital. Small intestine transplant is a viable option in patients with intestinal failure with complications of parenteral nutrition. Post-operative care and management remains a bigger challenge. There is a need to increase the awareness and develop expertise in successful execution of this complex procedure.

Background Living donor liver transplantation in small infants is a significant challenge. Liver allografts from adults may be large in size. This is accompanied by problems of graft perfusion, dysfunction, and the inability to achieve primary closure of the abdomen. Monosegment grafts are a way to address these issues. Methods Two recipients in our cohort weighed less then 6 kg. The prospective left lateral segments from their donors were large for size. Therefore, monosegment 2 liver grafts were harvested. Data regarding the preoperative, intraoperative, and postoperative events in the donor and the recipient were recorded. Results We were able to achieve significant reduction in the sizes of the grafts harvested. The donors underwent surgery and hospital stay uneventfully. The recipients had normal graft perfusion and no graft dysfunction, and we could achieve primary abdominal closure. One recipient had self-limiting bile leak postoperatively. Conclusions Monosegment 2 liver allografts are safe and effective for use in living donor liver transplantation in small infants weighing less than 6 kg.

Accidental or suicidal poisoning with yellow phosphorus or metal phosphides (YPMP) such as aluminum (AlP) zinc phosphide (Zn3P2) commonly cause acute liver failure (ALF) and cardiotoxicity. These are used as household, agricultural and industrial rodenticides and in production of ammunitions, firecrackers and fertilizers. In absence of a clinically available laboratory test for diagnosis or toxin measurement or an antidote, managing their poisoning is challenging even at a tertiary care center with a dedicated liver intensive care unit (LICU) and liver transplant facility. Patients and methods Patients with YPMP related ALF were monitored using standardized clinical, hemodynamic, biochemical, metabolic, neurological, electrocardiography (ECG) and SOFA score and managed using uniform intensive care, treatment and transplant protocols in LICU. Socio-demographic characteristics, clinical and biochemical parameters and scores were summarized and compared between 3 groups i.e. spontaneous survivors, transplanted patients and non-survivors. Predictors of spontaneous survival and the need for liver transplant are also evaluated. Results Nineteen patients with YPMP related ALF were about 32 years old (63.2% females) and presented to us at a median of 3 (0 – 10) days after poisoning. YPMP related cardiotoxicity was rapidly progressive and fatal whereas liver transplant was therapeutic for ALF. Spontaneous survivors had lower dose ingestion ( 6.5 had higher mortality risk. Patients undergoing liver transplant and with spontaneous recovery required longer ICU and hospital stay. At median follow-up of 3.4 (2.6 – 5.5) years, all spontaneous survivors and transplanted patients are well with normal liver function. Conclusions Early transfer to a specialized center, pre-emptive close monitoring, and intensive care and organ support with ventilation, CVVHDF, plasmapheresis and others may maximize their chances of spontaneous recovery, allow accurate prognostication and a timely liver transplant.

A number of formulae to estimate standard liver volume (SLV) exist. However, studies have shown that only certain formulae are applicable to a particular patient population, whereas the other formulae have not been accurate in estimating the SLV. Aim of this study was to assess which formula is most accurate in estimating SLV in the western Indian population. Data for donors of living donor liver transplantation from September 2014 to July 2015 was analyzed. Liver volumes were measured using computed tomography volumetry (CTV). SLV was calculated using formulae by the currently existing formulae. The mean SLV and CTV, percentage error in the SLV, and the correlation between SLV and CTV were calculated. Fifty-nine healthy subjects underwent donor hepatectomy [28 (47.5 %) males]. The mean age, mean body mass index (BMI), and mean body surface area (BSA) were 31.8 ± 8.8 years, 23.8 ± 3.7 kg/m2, and 1.6 ± 0.4, respectively. Mean CTV was 1178 ± 246.8 mL. Difference between mean SLV and mean CTV ranged from −133.5 (±189) mL to 632.2 (±190.2) mL. Mean SLV was significantly different from CTV by all the formulae except Urata. Percentage of population whose SLV was within 15 % of the mean CTV ranged from 1.7 % to 67.8 %, with the highest percentage obtained by using Fu-Gui’s formula. However, there was wide inter-individual variation on scatter plots between SLV and CTV by both these formulae. Currently existing formulae were not accurate in estimating SLV in our population.

Gastrointestinal bleeding following Roux-en- Y gastric bypass (RYGB) is rare. We report an unusual cause of upper gastrointestinal bleeding following RYGB that was complicated by porto- splenic vein thrombosis. A 35- year- old woman was successfully treated by mesocaval surgical shunt for recurrent variceal hemorrhage in the excluded stomach following RYGB.

Breast cancer is the most common cause of cancer death in women with the incidence rising in young women. GST gene polymorphisms are significant because of their role in the detoxification of both environmental carcinogens and also cytotoxic drugs used in therapy for breast cancer. The present study has been designed to identify the role of polymorphisms in GSTT1 and GSTM1 genes in the risk of development of breast cancer, in the prognostication of breast cancer, and in the prediction of response towards chemotherapy. Ninety-nine patients with breast cancer and 100 healthy controls with no history of cancer were taken from blood donors after informed consent. Epidemiological and clinical data was collected from participants and 5 ml of peripheral venous blood was collected for genotype analysis. Null genotype of GSTT1 was detected in 51.04 % of the controls in comparison to 20.2 % of patients with carcinoma breast, which was found to be statistically significant (OR 4.18; 95 % CI 2.01–8.75; P = 0.0001). GSTM1 gene deletion was also significantly more common among controls (60 %) than in patients with breast cancer (33 %) (OR 4.57; 95 % CI 2.20–9.51; P = 0.0001). Tumors more than 5 cm in size had greater tendency for GSTM1 gene expression (P value = 0.019), but other clinicopathological parameters did not show any correlation. GSTT1 and GSTM1 genes status did not show any association with response to chemotherapy. The results indicated the null genotype of both GSTT1 and GSTM1 to be protective for the development of carcinoma breast. None of the known etiological factors have any correlation with GSTT1 and GSTM1 gene deletion. Patients with small tumor size expressed GSTM1 gene deletion. Other tumor characteristics and clinicopathological parameters did not have any correlation with gene deletion.

Helicobacter species have been found to be associated with biliary tract diseases. This prospective study was done to determine the prevalence of H. pylori in the biliary tract of patients suffering from gallbladder disease. Forty-nine patients undergoing laparoscopic/open cholecystectomy for benign biliary tract diseases were investigated with urea breath test for H. pylori infection of gastric antrum. Bile and gallbladder tissues were studied for presence of H. pylori by rapid urease test, histopathological examination, culture and PCR analysis. Gallbladder specimens from two patients who underwent Whipple’s operation and from 10 cadavers were studied as controls. The mean (SD) age of patients was 42.4 (11.1) years. Urea breath test was positive in 17 (34.6%) cases. Rapid urease test was negative in all the cases. There was no evidence of H. pylori infection of gallbladder on histopathological examination using H&E, Giemsa and Warthin Starry stains. H. pylori DNA were detected in 16 patients (32.6%) and none of the 12 controls by PCR analysis (p = 0.025). The presence of H. pylori DNA in bile and/or gallbladder was associated with positive urea breath test, (p

The objective of this study was to ascertain the incidence and outcome of intrathoracic vascular injury during transhiatal resection of the esophagus. Resection of the esophagus is indicated for a variety of benign and malignant diseases and can be performed via the transhiatal or transthoracic route. As the esophagus is in close vicinity to the aorta, pulmonary vessels and the azygous vein, these blood vessels can be injured during its resection. We extracted data on the incidence, management, and outcome of intrathoracic vascular injuries that occurred during transhiatal esophagectomy between 1983 and 2010 from a prospectively maintained esophageal diseases database. During this period, 710 transhiatal esophagectomies were done for malignant (n = 617) and benign causes (n = 93). Intrathoracic vascular injury occurred in ten patients (1.4%). The indication for esophagectomy was malignancy (nine patients) and corrosive stricture (one patient). All nine patients with malignancy had squamous cell carcinoma, and the tumor was located in the midthoracic esophagus in seven and lower thoracic esophagus in two patients. Eight of nine patients with cancer had received preoperative radiotherapy. The site of injury was the aorta/its esophageal branch (six patients), azygous vein (three patients), and inferior pulmonary vein (one patient). The estimated median intraoperative blood loss was 4,450 ml (range, 2,000–6,000 ml), and the median duration of the surgery was 5 h (range, 4–7 h). On a multivariable analysis, location of tumor (in the midthoracic esophagus) was a significant risk factor for the occurrence of vascular injury. Seven patients required a thoracotomy to control the bleeding while in two patients, it could be identified and controlled transhiatally. Two patients died intraoperatively due to massive bleeding and another two died in the postoperative period. Of the patients who survived (n = 6), three patients had an uneventful recovery, one patient developed a cervical anastomotic leak, and two patients developed chest infection. Vascular injury during transhiatal esophagectomy is a rare but life-threatening complication. There may be a higher risk in tumors located in the mid esophagus. Management involves prompt identification and control via a dilated hiatus or a thoracotomy.