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Fournier's gangrene is a rapidly spreading gangrene predominantly affecting the genital and perianal region. It has the highest mortality and is more common in immunocompromised and diabetic patients. Poorly controlled diabetes is one of the common risk factors for Fournier's gangrene. Delayed diagnosis and treatment increase mortality by nearly 100%. In our case, the patient was initially managed for a perianal abscess and later progressed to Fournier's gangrene. A 48-year-old male diabetic presented with erythematous swelling in the right-side scrotal region for one-week duration. He had a recent perianal abscess and underwent incision and drainage at another hospital He also reported fever with chills and rigors for the past two days. The patient is now in a state of septic shock. He has a history of irregular medication for type 2 diabetes mellitus. Clinical examination confirmed Fournier's gangrene resulting from a perianal abscess in the context of uncontrolled diabetes. The patient underwent an emergency wound debridement under spinal anesthesia. Extensive wound debridement was performed on the right hemiscrotum. Necrotic tissue was debrided on the right perianal region. The patient was initiated on empirical antibiotics, receiving a calculated dose of cefoperazone with sulbactam and metronidazole. Additionally, the patient underwent sitz baths and received regular wound dressing. Following wound debridement and glycemic control with insulin, the patient showed signs of improvement. Four weeks post-debridement, the patient underwent split-skin grafting for the raw area on the scrotum, while the fistula site was allowed to heal by secondary intention. The cornerstone in managing perianal abscess with Fournier's gangrene in diabetic patients is extensive wound debridement, antibiotic coverage, and proper management of diabetes. Early diagnosis and prompt surgery of perianal abscess can reduce the risk of developing Fournier's gangrene in diabetic patients. Post-surgical raw areas can be effectively managed with split-skin grafts. [ABSTRACT FROM AUTHOR]

A gastrointestinal stromal tumor (GIST) is a most common mesenchymal tumor of the gastrointestinal tract. GIST is more common on the stomach, followed by the small intestine and rarely occur in other locations. We present an unusual case of large jejunal GIST arises from the antimesenteric border. Most of the small intestinal GIST present as a mobile mass in the right iliac fossa. Hence, a patient with mobile right iliac fossa mass without signs of obstruction or minimal signs of obstruction should consider the small bowel GIST as one of the differential diagnosis and plan for prompt intervention. Good preoperative imaging will diagnose small intestine GIST. Proper preoperative diagnosis and timely intervention will reduce the complication such as tumor rupture, spillage, R1 resection, and local recurrence. Postsurgical chemotherapy with Imatinib will reduce the recurrence rate and increase the survival.

Introduction: Stoma could be a surgically created opening within the abdominal wall. The main purpose of the stoma is to divert the excreta off from the distal intestinal loops to relieve an obstruction or protect anastomosis. The indications for stoma creation are intestinal obstruction due to benign or malignant tumors, perforation peritonitis, inflammatory bowel disease, colorectal malignancies, and anorectal malformations. Aim of the study: The study aimed to identify the patterns, indications, and complications that occur following the creation of enteric stomas. Materials and Methods: It is a prospective observational study conducted from May 2012 to October 2015 on a hundred patients, who were admitted in the department of general surgery, surgical gastroenterology, and pediatric surgery, Government Stanley Medical College and Hospital. The sampling method followed here is the non-probability convenience sampling technique. The data is collected from all the patients who come under the inclusion criteria. Results: Of 100 patients, the majority of the patients belonged to 26–35 years and 46–55 years (n = 25). Based on the study, loop colostomy is more common with age less than one year and loop ileostomy is more common in 26–55 years. The foremost common indication of an enteric stoma is a gastrointestinal malignancy (25%) followed by abdominal trauma (22%). In our study, an ileostomy (80%) is the most common type of stoma created followed by colostomy. Within the ileostomy, loop ileostomy is the more common (60%) followed by end ileostomy (20%). Among the complications related to an enteric stoma, skin excoriation (54.4%) is most common followed by surgical site infections (8.5%). Conclusion: Our study shows stoma creation is higher in the adult and old age group, mostly done as an emergency procedure compared to an elective procedure. So, better preoperative planning in both emergency and elective settings can reduce the number of stoma and its related complications. The duration of hospital stay is higher in stoma patients. So, the reduction in stoma creation leads to a reduction in complication, duration of hospital stays and indirectly reduces expenditure related to it. In our study, most of the stoma is created for obstruction in malignancy and perforation in trauma patients. From our study, we can observe early diagnosis of intestinal malignancy with a well-planned elective procedure or bride procedure like colonic stenting in malignant obstruction can reduce the number of stoma creation. Skin excoriation is the most complication followed by surgical site infections. These complications can be reduced by better postoperative stoma care and early reversal of stoma.

Byline: Jayabal. Pandiaraja, Arumugam. Shalini A 75-year-old woman presented with complaint of the painful lump on her left arm for the past 3 years. The patient perceived numbness along the [...]

Ascaris lumbricoides is an intestinal parasite, more common habitant of the small intestine, particularly in the jejunum. It can produce a variety of presentations starting from anemia, gastrointestinal bleeding, intestinal obstruction, perforations, intussusception, and rarely obstructive jaundice. Obstructive jaundice is mainly due to proximal migration of the parasite into the biliary tree and causing an obstruction. It is the most common following biliary procedure. Here, we report the case of obstructive jaundice and cholangitis due to biliary ascariasis in a patient without any prior biliary procedure. Prompt intervention is needed in those cases of ascariasis with biliary sepsis. The patient has been managed by emergency cholecystectomy with common bile duct exploration and T-tube insertion.

Fat necrosis is an inflammatory process of fat folloing an insult to the adipose tissue. It is more common in the body region here there is high adipose tissue. It can present ith cellulitis, skin necrosis, discharging ounds, and mass. Carcinoma is one of the differential diagnoses of fat necrosis. Our case is presented ith a gluteal mass hich as diagnosed as a hydatid cyst, based on the imaging. Sometimes, imaging fails to identify traumatic fat necrosis, particularly if it is associated ith a capsule ith multiple fat lobules. Postoperative history confirms the encapsulated type of fat necrosis ith fat lobules. Encapsulated traumatic fat necrosis should be considered one of the differential diagnoses of hydatid cyst.

Testicular tuberculosis (TB) is commonly associated with genitourinary TB or as a part of miliary TB. In miliary type of testicular TB, there is often bilateral involvement of the adrenal gland. Our case presented with enlargement of the left adrenal gland only. This may be due to anomalous communication between the left gonadal vein and the left adrenal vein. He was started with antituberculous treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol. The patient failed to respond to anti-TB treatment; therefore, he underwent left low inguinal orchidectomy, and the histopathology confirmed the diagnosis. The adrenal lesion started disappearing following orchidectomy and antituberculous treatment.

Tuberculosis (TB) is one of the communicable diseases with high morbidity to the patient. TB is divided into pulmonary and extrapulmonary TB. In extrapulmonary TB, isolated axillary TB is rare and sometimes creates diagnostic difficulty, particularly in female patients. The axillary lymph nodes are affected in around 3% of tuberculous lymphadenitis. Our case presented with isolated axillary tuberculous lymphadenitis which is rare without evidence of TB elsewhere in the body. It is more common in females compared to males, and it commonly involves the left side. Most of the cases do not show systemic manifestations. Chest X-ray and ultrasound are useful primary investigations for the diagnosis. Histopathological examination of the lymph node is the confirmatory test for axillary tuberculous adenitis. Hence, tuberculous lymphadenopathy should be considered one of the differential diagnoses in a female patient with isolated axillary lymphadenopathy even without clinical manifestations of TB.

Intracystic papillary carcinoma breast is an uncommon breast cancer consisting of 0.5‑1.0% of all breast cancers. Papillary carcinoma is further subdivided into intraductal and intracystic papillary carcinoma. Intracystic papillary carcinoma is further divided into pure intracystic papillary carcinoma or associated with in situ carcinoma. The clinical and radiological features of intracystic papillary carcinoma are not specific, hence a high chance of misdiagnosis. Here we report a case of intracystic papillary carcinoma of both breasts which created a diagnostic dilemma. [ABSTRACT FROM AUTHOR]

Abstract: Intracystic papillary carcinoma breast is an uncommon breast cancer consisting of 0.5-1.0% of all breast cancers. Papillary carcinoma is further subdivided into intraductal and intracystic papillary carcinoma. Intracystic papillary carcinoma is further divided into pure intracystic papillary carcinoma or associated with in situ carcinoma. The clinical and radiological features of intracystic papillary carcinoma are not specific, hence a high chance of misdiagnosis. Here we report a case of intracystic papillary carcinoma of both breasts which created a diagnostic dilemma., (Copyright © 2024 Copyright: © 2024 Journal of Cancer Research and Therapeutics.)