General Surgery

Objectives: To report a case of salivary fistula in Goldenhar Syndrome and discuss its management. Methods: A 14 year old girl presented with salivary fistula since birth. A diagnosisof Goldenhar syndrome with salivary fistula was made using clinical findings and X-Ray sialography.. Results: Sialography revealed accessory parotid gland with fistulous tract draining on the left cheek. Intraoral transposition of the fistulous tract was done. Conclusion: Intraoral transposition of fistulous tract is an efficent way of management of congenital salivary fistula with accessory parotid gland n Goldenhar syndrome..

Abdominal lymphadenopathy (AL) - a common clinical scenario faced by clinicians - often poses a diagnostic challenge. In the absence of palpable peripheral nodes, tissue has to be obtained from the abdominal nodes by image-guided biopsy or surgery. In this context a laparoscopic biopsy avoids the morbidity of a laparotomy. This retrospective analysis of prospectively collected data represents our experience with laparoscopic biopsy of abdominal lymph nodes. Between October 2000 and November 2005, 28 patients with AL underwent laparoscopic biopsy. Pre-operative radiological imaging studies had identified a nodal mass in 20, a solitary node in 1, a cold abscess in 1 and a mesenteric cystic lesion in 1 patient. In five patients with chronic right lower abdominal pain and normal ultra-sonographic findings mesenteric nodes were identified and biopsied during diagnostic laparoscopy. The sites of biopsied lymph nodes included para-aortic (10), mesenteric (8), external iliac (3), left gastr...

The complications of choledochal cyst are avoidable if diagnosed early, and adequate resection undertaken. This case report describes the long history of right subcostal pain in a young man of 26 who had a squamous carcinoma in a choledochal cyst diagnosed after serial section of the excised cyst. Subsequent resection ofthe head ofthe pancreas showed histological residual tumour from which he died 4 months later. This case illustrates the need for complete early excision of a choledochal cyst to prevent this complication.

Objective: The aim of this study was to determine the feasibility of using the Prolene (polypropylene) Hernia System for open tension-free repair on inguinal hernias, and study the results in terms of operation time, patient comfort, hospital stay, return to normal activity and postoperative complications. Material and Methods: From February 2002 through April 2003, we performed 50 open tension-free hernia repairs on 47 patients (46 men, 1 woman) with a mean age of 55.8 years. There were 26 right and 18 left hernias, and 3 were bilateral. Of these, 39 were direct, 10 were indirect and 1 was femoral type. All were primary hernias. Results: The duration of surgery averaged 35 minutes (range 20 to 90 min). There was no perioperative mortality. Four patients developed mild self-limiting neuralgias. There were no subcutaneous wound infections, no haematomas, no seromas and no testicular atrophy. The average duration of postoperative hospitalisation was 3.5 days. The length of follow-up ranged from 1 month to 15 months (mean= 6.24 months). We have had no recurrences so far. Conclusion: The Prolene Hernia System is a novel approach in the management of inguinal hernias, with encouraging initial results. Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.

Intrauterine contraceptive devices (IUCD) have been used as an effective, safe and economic method of contraception for many years. Since its introduction, many complications have been reported, viz. dysmenorrhoea, hypermenorrhoea, pelvic infection, pregnancy, septic abortion, uterine perforation and migration into adjacent organs. Migration of IUCDs into the peritoneum, omentum, appendix, colon, wall of the iliac vein and bladder have been reported. We report a case of a 22-year-old lady with an IUCD migration into the tip of the appendix 14 months after its insertion.

Necrotizing enterocolitis is an acute disease that primarily affects premature neonates of low birth weight, and has a very high morbidity and mortality. The incidence in adults is significantly less, with lower mortality rates. Of those who survive, many are left with complications related to short gut syndrome. We report 4 cases of necrotizing enterocolitis all of whom underwent early surgical intervention and had good recovery, followed by a review of the literature on the subject.

Inflammatory pseudotumour (inflammatory myofibroblastoma, plasma cell granuloma) is a rare benign lesion in adults and children. It frequently simulates a true neoplasm both clinically and morphologically, presenting a diagnostic and therapeutic dilemma. We herein report a case of a 16 year old girl who presented with pyrexia of unknown origin for almost 4 months before developing a palpable lump in the right iliac fossa. The patient underwent a right hemicolectomy for a presumed ascending colonic neoplasm, and histology revealed that it was an inflammatory pseudotumour. Following resection of the mass there was resolution of constitutional symptoms and normalization of laboratory abnormalities. Since these tumors are self-limiting and have a favorable prognosis, our case review and review of literature suggests the importance of preoperative and intraoperative recognition of this entity, especially if laboratory parameters suggest an inflammatory process.