Gastroenterology International

The most common complications after thyroidectomy areinjury to the recurrent laryngeal nerve and parathyroid glands. Cervical esophagus perforation is an exceptionally rare complication after thyroidectomy; it can usually be resolved by conservative care. The most common cause of cervical esophagus is anterior spinal surgeries and there are reports of closure using muscle flaps esp. erector colli. In this report we are sharing our experience of cervical esophagus transection with tissue loss following thyroidectomy and presenting in the acute phase. Exploration was done and repair of esophagus by mobilization and reinforcing with sternocleidomastoid muscle from right side. The defect healed well with no stricture for a follow up period of 1 yr.

Keywords: Thyroidectomy Complications; Esophageal Perforation; Esophageal Transection; Sternocleidomastoid Muscle Flap.

Spontaneous dissection of celiac trunk is quiet an uncommon medical condition, with less than forty case reports in the medical literature. Due to rarity of this disease in clinical practice and non-specific nature of symptoms, a high degree of clinical suspicion is needed. Epigastric pain is most common presenting symptom. Symptomatic spontaneous celiac artery dissection is a rare condition that is being detected more often with the use of advanced imaging techniques. The ideal treatment has not yet been established but the available strategies are conservative medical management, endovascular intervention or surgical revascularization. We describe the case of 55 year old man who presented with severe upper abdominal pain , dynamic small bowel obstruction and diagnosed as spontaneous celiac artery dissection on imaging , confirmed on angiography. We provide a review of the current literature about imaging finding and management of this
rare entity.

Keywords: Celiac Artery; Bowel Obstruction; Angiography.  

Background: Mesenteric vein thrombosis due to Mesenteric fibromatosis presenting with ectopic variceal bleed is less common. Case Description: 38 year old male presented with history of large volume melena. He was resuscitated and Endoscopy was done, showed multiple ectopic varices-bleeder in Duodenal third portion, hemostasis achieved by injecting Cyanocrylate glue. On reviewing, he had evaluation for pain abdomen, a year back which suggested inoperable retroperitoneal neoplasm. He had taken alternative medicine, being given a poor prognosis. Endosonography guided aspiration from lesion was suggestive of atypical cells. After 1 year, he had re-bleeding. Glue injection was done to another bleeding varix in D3. Repeat CT scan showed similar sized retroperitoneal mass. Diagnostic laparoscopy showed Omental cake like mass, histologically - mesenteric fibromatosis. Clinical Relevance: GI Bleed is a rare manifestation of Mesenteric fibromatosis and here it was variceal bleed secondary to thrombosis of the mesenteric vein, managed endoscopically. Patient had spontaneous Mesenteric fibromatosis and is stable for few years now. Hence, all retroperitoneal lesions need complete evaluation before giving a poor prognosis. 

Keywords: Mesenteric Fibromatosis; Retroperitoneal Mass; Ectopic Variceal GI Bleeding; Glue Injection; CT abdomen; Endosonography; Diagnostic Laparoscopy; Histopathology.

Acute Pancreatitis is an acute inflammatory process of the pancreas with varying involvement of regional tissues or remote organ systems. Complex clinical criteria of Severe Acute Pancreatitis include Ranson’s criteria for non-gall stone pancreatitis. The Apache II & multiple organ system failure scale provides prognosis at the time of admission. D Dimer Is a fragment produced during the degradation of clot. FDP is Fibrin Degradation Product in blood which results from dissolution of clot. The Study was conducted at Chugh Multispeciality Hospital, Bhiwani in 103 patients fulfilling the inclusion and exclusion criteria for a period of 1 Year. The Result Concludes APACHE II FDP & D – Dimer values significantly correlate with each other in almost all aspects.

Keywords: APACHE–II; D-Dimer; FDP; Pancreatitis; MODS