General Surgey

Giant Inguinoscrotal Hernias continue to pose a technical challenge to the general surgeon. Awareness of all the possible contents prior to surgery is pivotal in avoiding disastrous complications. A case of a giant inguinal hernia with transverse colon as its content is presented to highlight the diversity of contents. The natural history and surgical options for treating giant inguinoscrotal hernias is discussed. Giant inguinoscrotal hernias should be operated upon at the earliest after contrast enhanced CT evaluation for ascertaining the contents. Open surgical approach to such cases is the safest.

Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.

Blood transfusion is one of the commonest accompaniments of surgical practice. With a growing incidence of major polytrauma by vehicular accidents, bomb blasts and fires, awareness of the basic concepts underlying massive blood transfusion practice with special reference to the complications is essential. The paper outlines the pathophysiologic mechanisms underlying the various complications of massive blood transfusion.

Intussusception as a cause of intestinal obstruction in adults is rare. There is invariably an underlying pathology which leads to intussusception in adults. A case of intussusception in an adult due to a small intestinal lipoma is presented in view of this association. Ultrasound and CECT may help in a preoperative diagnosis. However early surgical intervention is the mainstay of treatment in order to confirm the diagnosis of the underlying pathology, thereby avoiding misdiagnosis of an underlying cancer.

Intrauterine contraceptive device (IUCD) is the commonest form of contraception used in view of less systemic side effects. However, there are a multitude of local complications caused by it. Of all the local complications described, migration of the device into adjacent organs is the most morbid of all complications. A patient presenting with history of loss or disappearance of the intrauterine contraceptive device accompanied by urinary symptoms should raise the doubt of a migrated device with the formation of a secondary calculus. This prompts further radiological investigations and merits surgical intervention either endourologically or by open surgery depending upon the merits of the case. A case report elucidating this fact is presented.

Introduction. Congenital lumbar hernia is one of the rare types of hernias. Anomalies of the ribs, spine, and muscles which constitute the lumbocostovertebral syndrome in association with congenital lumbar hernia make it the rarest of entities. In addition, a multitude of other organ systems may be involved. Case Report. A case of congenital lumbar hernia associated with lumbocostovertebral syndrome is presented in view of its rarity and diagnostic and therapeutic challenges. Discussion. Anatomical background of congenital lumbar hernia associated with various other anomalies especially of the musculoskeletal structures is discussed. All cases of congenital lumbar hernia should be investigated for other congenital anomalies. Both open and laparoscopic approaches have been described for surgical treatment. Conclusion. Open surgical intervention is the mainstay of treatment taking into consideration the technical challenges posed by distorted anatomy due to the associated congenital a...