Surgical Techniques Development

663 KiB

Open AccessCase Report

Echinococcus in the Orbit: An Unusual Hideout

by Hetal Marfatia, Nilam U. Sathe, Subodh Hosagadde and Keya Shah

Surg. Tech. Dev. 2016, 6(1), 6539; https://doi.org/10.4081/std.2016.6539 - 20 Dec 2016

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Isolated involvement of the orbit by hydatidosis is extremely rare. It is a parasitic infestation due to a tapeworm called Echinococcus Granulosus. It is an uncommon disease in head and neck region as it commonly manifests in the lungs and liver. When seen in head and neck, it has been found in the orbit, paranasal sinuses and salivary glands. Orbital hydatidosis per se forms only 1% of all types of hydatid disease. It is endemic in Africa, Middle East and Southeast Asian countries including India. In orbital hydatid disease, patients usually present with unilateral proptosis and diminution of vision. Proptosis is classically painless. Total surgical removal remains the mainstay of treatment. A 30-year-old female belonging to lower socio-economic status, presented with left eye proptosis since 2 years. There was a gradual increase in proptosis associated with diminution of vision over the last 4 months. This finally led to complete loss of vision in a period of two months. Computed tomography scan showed two soft homogenous non-enhancing cystic structures present in the orbit abutting the optic nerve without any intracranial extension; most likely differentials are a developmental cyst, hydatid cyst, epidermoid cyst, rhabdomyosarcoma or a nerve sheath tumor. Magnetic resonance imaging showed two T1 hypointense non-enhancing, T2 hyperintense soft cystic capsulated space-occupying lesions present in the extraconal compartment of orbit abutting the optic nerve, likely to be lymphangioma or a hydatid cyst. Surgery was planned and endoscopic orbital decompression was done. Sago grain-like granules were seen pouring out of the cysts. Cyst walls were completely removed in piecemeal and the specimen was sent for histopathology. Immediate intra-operative reduction of proptosis was seen. The final histopathological report was suggestive of hydatid cyst. Full article

796 KiB

Open AccessCase Report

A Rare Case of Nasal Schwannoma of Middle Turbinate

by Nilam U. Sathe, Sheetal Shelke, Hetal Marfatia and Shampa Mishra

Surg. Tech. Dev. 2016, 6(1), 6467; https://doi.org/10.4081/std.2016.6467 - 20 Dec 2016

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Abstract

Schwannoma is a benign, slow-growing nerve sheath tumor derived from the Schwann cells. Cases with nasal schwannoma arising from nasal septum and inferior turbinate have been reported, though being rare. A 32-yearold male patient presented to our hospital with left side progressive nasal blockage since 4 months and multiple episodes of epistaxis. Anterior rhinoscopy revealed left side smooth spherical nasal mass, which was bleeding on touch. Computed tomography was done, which was suggestive of right side deviated nasal septum. Left nasal cavity soft tissue lesion extended into anterior ethemoid cells, causing widening of the osteomeatal complex. The patient underwent endoscopic excision of nasal mass. Histopathology of nasal mass suggested nasal schwannoma. Though nasal schwannoma is rare, it should be considered as a differential diagnosis in case of unilateral nasal mass with epistaxis. Definitive diagnosis of schwannoma can be considered only after final histopathological reporting of the surgical specimen. Full article

580 KiB

Open AccessCase Report

Broken Metallic Tracheostomy Tube Migrating into the Tracheobronchial Tree

by Nilam U. Sathe, Ratna Priya, Sheetal Shelke and Kartik Krishnan

Surg. Tech. Dev. 2016, 6(1), 6466; https://doi.org/10.4081/std.2016.6466 - 20 Dec 2016

Cited by 20 | Viewed by 789

Abstract

Foreign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson’s disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening. Full article

863 KiB

Open AccessArticle

Pancreatoduodenectomy for Trauma: Applying Novel Reconstruction Techniques

by Jake E.J. Krige and Sandie R. Thomson

Surg. Tech. Dev. 2016, 6(1), 6293; https://doi.org/10.4081/std.2016.6293 - 29 Jun 2016

Cited by 1 | Viewed by 739

Abstract

This single center study evaluated the technical modifications and outcome of reconstruction after pancreaticoduodenectomy for trauma. Prospectively recorded data including reconstructive techniques used in patients who underwent a pancreatoduodenectomy (PD) for trauma were analyzed. Twenty patients underwent a PD. Six had an initial damage control procedure. Thirteen had a pylorus-preserving PD and 7 a standard Whipple resection because injury to the pylorus precluded a pylorus-preserving resection. Twelve patients had a pancreatojejunostomy and 8 a pancreatogastrostomy, 3 of whom had a duodenojejunal hepaticojejunal sequence of anastomoses to allow endoscopic biliary stent retrieval. Three patients died postoperatively of multi-organ failure. All 17 survivors had postoperative complications: 5 patients developed pancreatic fistula, 2 had gastric outlet obstruction, 2 had bile leaks, 2 had duodenal anastomotic leaks, all of which resolved with conservative treatment. Pancreatic and biliary reconstructions performed under adverse conditions after a trauma PD required a variety of technical modifications. The pylorus does not have to be sacrificed and posterior gastric implantation is a safe option for an edematous pancreas. Full article

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Surg. Tech. Dev., Volume 6, Issue 1 (June 2016) – 4 articles

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