Introduction Osteoid osteoma (OO) is a rare primary (10% incidence) bone-producing benign neoplasm, most common during first two decades of life (87%) with male predominance. We present the sixth reported case in literature of thoracic OO. Materials and Methods A 69-year-old male presented with chronic back pain, sphincter dysfunction, and lower-limb weakness, with nocturnal pain relieved by NSAIDs. MRI revealed a bilateral Th10 OO causing myelopathy. Discussion OO typically presents with nocturnal pain, stiffness, and muscular spasms solved with NSAIDs use; OO also presents with scoliosis and radiculopathy, spinal cord or nerve root compression. OO rarely exceed 10 mm, so it might easily be overlooked. Conclusion OO is often self-limited over 2 to 6 years. When conservative treatment fails or adolescents develop structural scoliotic spinal curve, surgery is indicated.
Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare, making up less than 0.5% of all NETs. The liver is a common site for metastatic NET, leading to challenges in determining if a neuroendocrine neoplasm located in the liver is primary or metastatic. We report two cases of patients diagnosed with PHNETs. They were first misdiagnosed, the first case as liver hamartoma and the treatment was delayed for 4 years and the second case was first diagnosed as hepatocellular carcinoma. Although rare, the possibility of primary hepatic neuroendocrine neoplasms should be considered for a solid-cystic mass in a young patient with no known chronic liver disease and without any known primary malignancy elsewhere. Surgical resection is the most effective and reliable treatment method for patients with PHNET.
Although gastrointestinal stromal tumours (GISTs) mostly present as solid tumours, they may rarely manifest as cystic lesions. A 52-year-old man presented with a large globular lump in the supraumbilical region for 5 months. Triphasic CECT showed a large, lobulated, heterogeneously enhancing solid cystic mass suggestive of exophytic GIST arising from antropyloric angle. USG-guided FNAC revealed bland spindle cells consistent with GIST. Preoperative treatment with imatinib showed no response. Intraoperatively, there was approximately 20 & times; 15 & times; 10 cm lobulated cystic lesion seen attached to pyloroduodenal junction containing brownish-coloured serous fluid. Histopathology report came as duodenal GIST with DOG-1, CD-117, CD-34, desmin, and SMA positivity. Follow-up of 1.5 years revealed no evidence of recurrence. GISTs should be considered as one of the possibilities while dealing with any cystic lesions in the gastrointestinal tract. Prompt surgical intervention in view of non-responsiveness to neoadjuvant chemotherapy was pivotal for proper management of our patient.
Perforation peritonitis due to duodenal ulcer is the most common surgical emergency and is frequently associated with postoperative wound complications such as seroma, surgical site infection (SSI) and wound dehiscence. Although several preventive measures exist the optimal strategy for minimizing these complications remains unclear. This study aimed to evaluate whether placing a subcutaneous closed-suction drain during laparotomy reduces early wound complications following primary repair of duodenal ulcer perforation. This prospective comparative observational study was conducted in the Sylhet MAG Osmani Medical College Hospital from December 2022 to December 2023. A total of 100 consecutive patients undergoing emergency laparotomy for duodenal ulcer perforation were enrolled and allocated into two groups based on intraoperative wound-closure technique: Group A (primary closure without subcutaneous drain) and Group B (primary closure with subcutaneous closed-suction drain), with 50 patients in each group. Demographic data, operative findings, and postoperative outcomes were recorded. Seroma formation, wound dehiscence, SSI and duration of hospital stay were compared employing chi-square test, t-test, and logistic regression. The mean age of patients was 34.92 +/- 6.09 years and 33.58 +/- 5.87 years in Group A and Group B respectively. Seroma development was significantly lower with subcutaneous closed-suction drain placement compared with no drain (odds ratio [OR] = 0.317 [95% confidence interval, CI: 0.114-0.894]; p = 0.02713). SSI was also reduced in Group B (OR = 0.255319 [95% CI: 0.065-0.992]; p = 0.037). Wound dehiscence occurred less frequently with drains (OR = 0.107 [95% CI: 0.012-0.892]; p = 0.0144) than without. Hospital stay was significantly shorter in Group B than Group A (8.39 +/- 3.53 vs. 12.42 +/- 2.95 days). Subcutaneous suction drain is effective in preventing early wound complications after laparotomy for repair of duodenal ulcer perforation.
Background In the era of enhanced recovery after surgery (ERAS), accurate estimation of postoperative length of stay (p-LOS) after gastrectomy is significant for patient discharge planning and hospital bed management. However, a precise and straightforward prediction tool is lacking. Materials and Methods In this study, the clinical data of 924 patients who underwent gastrectomy between December 2018 and December 2023 were included from five tertiary care medical centers. There were 647 cases in the training set and 277 cases in the verification set. The linear regression analyses were used to determine the independent factors affecting p-LOS. The model's accuracy was assessed by the C-index, calibration curve, and decision curve analysis (DCA). Results The final model included age, American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), tumor size, and location, all of which had a significant effect on p-LOS. The nomogram comprising these five predictors exhibited sufficient predictive accuracy, with a C-index of 0.662 in the training group and of 0.664 in the verification group. The calibration curves and DCA of both groups had excellent calibration and clinical usefulness. In the high-risk group, the use of robot-assisted surgery (RAS) could effectively shorten p-LOS. Conclusion The developed nomogram could provide personalized risk prediction for p-LOS, and help clinicians better manage patients within ERAS.
