Euroasian Journal of Hepato-Gastroenterology

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2013 | January-June | Volume 3 | Issue 1

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Harbans Singh, Reeha Mahajan, Sajad Hamid

Histopathological Effects of Carbaryl on Liver in Albino Rats

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:7] [Pages No:1 - 7]

   DOI: 10.5005/jp-journals-10018-1051  |  Open Access |  How to cite  | 


Pesticides are one of the most alarming toxic substances that are deliberately added to our environment. Carbaryl, a synthetic 1-naphthyl-N-methylcarbamate insecticide, is being used extensively or its broad-spectrum activity in commercial agriculture, poultry, livestock, home and garden pest control. However, there is paucity of information about the role of carbaryl on the liver. Wistar rats were administered with carbaryl and the effects of this liver histology were analyzed. Profound damage of the liver of rats administered with carbaryl was noted. More studies would be required to assess the real implication of this pesticide on the liver.



Salimur Rahman, Mamun Al-Mahtab, Mohammad Jamshed Alam

Association of Fatty Liver and Hypothyroidism

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:2] [Pages No:8 - 9]

   DOI: 10.5005/jp-journals-10018-1052  |  Open Access |  How to cite  | 


Fatty liver is a common problem in the developed and developing countries. Both the patients of fatty liver and hypothyroidism are obese and hyperlipidemic. There may have association between fatty liver and hypothyroidism. This study was done to evaluate the association of fatty liver and hypothyroidism. This cross-sectional prospective study was carried out on 60 patients from July 2009 to June 2011. It was done in the Department of Medicine of Sher-E-Bangla Medical College Hospital, Barisal. There is no association of fatty liver and hypothyroidism.



Nooruddin Ahmad, Mohammad Faiz Ahmad Khondaker, Sharmin A Sumi

Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:10 - 14]

   DOI: 10.5005/jp-journals-10018-1053  |  Open Access |  How to cite  | 


Portal hypertension leads to the formation of portosystemic collateral veins in cirrhosis of liver. Rupture of esophageal varices is common and can be fatal. Although ammonia plays a certain role in determining portosystemic encephalopathy, the venous ammonia level has not been found to correlate with the presence or severity of this entity. So, this concept has become partially obsolete. Realizing the need for noninvasive markers mirroring the presence of esophageal varices in order to reduce the number of endoscopy screening, this study is aimed to determine whether there is a correlation between blood ammonia concentrations and the size of esophageal varices. This was a cross-sectional study conducted upon 40 consecutive cirrhosis patients and 40 age-matched noncirrhotic control subjects. Fasting blood ammonia was measured in both groups and upper gastrointestinal endoscopy was done in cirrhotic patients to note different sizes of esophageal varices. Cirrhosis patients group had mean ammonia level of 84.88 mol/l compared to 28.47 mol/l in control group (p < 0.05). The mean (± SD) blood ammonia concentration in small esophageal varices group was 72.00 (± 39.13) mol/l and that in medium or large esophageal varices group was 97.75 (± 31.34) mol/l. The difference was significant at p-value <0.05 level. Among blood ammonia, platelet count and spleen longitudinal diameter (SLD) on ultrasonography (USG), only ammonia level positively correlated with size of varices (p = 0.004). There was a moderate but significant correlation between blood ammonia level and size of esophageal varices. So, this could be a good tool for identifying individuals with large esophageal varices who will need to undergo endoscopy more frequently.



Javed Akhtar Ansari, Abdul Mateen Sayyed, R Manavalan, Balamurgan

Hepatoprotective Effect of Tribulus terrestris L against Acetaminophen-Induced Liver Damage in Wistar Rats

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:4] [Pages No:15 - 18]

   DOI: 10.5005/jp-journals-10018-1054  |  Open Access |  How to cite  | 


Background: Nowaday’s liver diseases due to exposure of different drug molecules are very common. The aim of the present study was to investigate the effect of methanolic extract of Tribulus terrestris L (TT) against acetaminophen (AA)-induced liver damage in Wistar rats. Materials and methods: Animals were divided into five groups of six rats each. Results and discussion: Oral administration of TT (500 mg/kg) along with AA (2.5 gm/kg) showed a significant decrease in serum enzyme aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, direct bilirubin and alkaline phosphatase (ALP) levels with a decrease in total protein levels (p < 0.01). The results were comparable with silymarin (SL), a standard hepatoprotective drug. The present study reveals that the administration of TT can be beneficial for the suppression of liver damage. Based on present findings, it can be concluded that methanolic extract of TT protects the liver from AA-induced liver damage. The present study for the first time reports the hepatoprotective potential of TT in AA-induced liver damage in Wistar rats.



Arunkumar Krishnan, Rajesh Prabhu Ponnusamy, Vimala Ramakrishnan

Long-term Acid Suppression Therapy: Its Influence on Gastric Mucosa

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:4] [Pages No:19 - 22]

   DOI: 10.5005/jp-journals-10018-1055  |  Open Access |  How to cite  | 


Background/Aim: Long-term acid suppressants are known to have adverse effects. Its effect on gastric mucosa is not known. A cross-sectional study was undertaken to study the effect of Helicobacter pylori on gastric mucosa among patients on longterm acid suppressants. Materials and methods: One hundred and twenty-six patients with symptoms of ulcer type dyspepsia and reflux type dyspepsia for more than a year and on acid suppressants for at least a year were included in the study. Biopsy was obtained from the stomach for demonstration of H. pylori and the histological changes. The duration of treatment and presence of H. pylori was correlated with the histological changes. Results: Sixty-six patients were on omeprazole at a dose of 20 mg a day (group I) and the rest were on ranitidine 150 mg twice a day (group II). Demography and the duration of treatment was comparable in both groups. Gastric mucosa was normal in 18 (27.3%) and 30 (60%) patients in groups I and II respectively, which was statistically significant (p = 0.01). Intestinal metaplasia was significantly more common among those on proton pump inhibitor (PPI) (p = 0.05). None had dysplasia or carcinoma. The colonization of H. pylori correlated with the duration of therapy in each of the two groups but was not statistically significant (p > 0.05). Conclusion: Long-term acid suppressants are generally safe. Gastric mucosal changes especially intestinal metaplasia is more common with PPI with fewer mucosal changes when on H2RA and is not influenced by the presence of H. pylori.



Ajulo Matthew Olugbenga, Ajulo Hephzibah Oluwatoyin, Etuk Ifiok Okon

Risk of Hepatitis among Undergraduates attending Primary Health Care Facility in Uyo

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:23 - 27]

   DOI: 10.5005/jp-journals-10018-1056  |  Open Access |  How to cite  | 


Sexuality encompasses sexual intercourse and sexual contact in all its forms, as well as medical concerns about the physiological or even psychological aspects of sexual behavior. Aim of the study was to observe the relationship between sexuality, drug use and hepatitis infection among university students. The study involved distribution of questionnaires and informed consent forms to 200 volunteer undergraduates after ethical approval was obtained from Primary Health Care Center, Uyo. The filled questionnaires were returned and blood samples were collected from the volunteers for hepatitis A and B screening tests. The result showed that the majority (69.3%) of the volunteer undergraduates were in their penultimate and final year of study. More than half (58.2%) of the volunteer students have had sexual intercourse with one (69.39%) or more than one (7.14%) sex partners with the use of barrier method in most (91.23%) of the study population that had sexual activity while few (8.77%) failed to use barrier method. Rate of sexual activity varies among the volunteer undergraduates as once daily (4.08%), once weekly (17.35%), twice weekly (5.10%) and abstinence (22.45%). Among the volunteer undergraduates, few (19.4%) had viral hepatitis screening while majority (80.6%) had no awareness until the research study commenced. One unaware volunteer participant (1.28%) was detected to be positive to viral hepatitis B infection. The study population which has 21 to 25 years, female (57.1%) and single (86.8%) were most actively involved in sexual activity. They lack substantial knowledge of the risk of being infected with viral hepatitis. The study population also reflected the indiscriminate use of drugs among students. In conclusion, students are involved in risky sexual activity and indiscriminate use of nonprescription drugs that can lead to hepatitis infection and also its spread. Most of the students lack knowledge of hepatitis infection.



Salimur Rahman, ABM Shakil Gani

Characteristics Features of Hepatocellular Carcinoma in Bangladesh and their Public Health Implications

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:3] [Pages No:28 - 30]

   DOI: 10.5005/jp-journals-10018-1057  |  Open Access |  How to cite  | 


Background/Objectives: In spite of being a common cancer, little is known about clinical presentation, etiological factors and prognosis of hepatocellular carcinoma (HCC) in Bangladesh. Accordingly, early detection and efficient management of HCC is not available at this country. Materials and methods: Demographical data, etiological factors and clinical presentations of 57 consecutive patients with HCC were analyzed prospectively at the only medical university of Bangladesh. Results: Ninety-one percent patients with HCC were male. The mean age of HCC patients was 45.8 years (standard deviation: 15.3 years; range: 18-75 years). All patients were symptomatic when they first appeared to the physicians, and many of them were unaware that they had been suffering from liver diseases. Hepatitis B surface antigen was detected in 62% and antibody to hepatitis C virus was found in 6% patients with HCC. Most of the patients with HCC had liver cirrhosis (77%). Single HCC nodule was detected in 61% patients. Sixty-four percent patients had intermediate stage of liver cancer. Conclusion: Containment of HCC-related morbidity and mortality and better prognosis of HCC in Bangladesh depends on early diagnosis of hepatitis viruses.



Sanjay Kumar, Rajeev Sen, Sumiti Gupta, Sonia Chhabbra, Monika Sangwan, Sunil Lamba

Profile of Liver Fine Needle Aspiration in Tertiary Care Hospital

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:31 - 35]

   DOI: 10.5005/jp-journals-10018-1058  |  Open Access |  How to cite  | 


Objective: This retrospective study was planned to evaluate role of fine needle aspiration cytology (FNAC) in space occupying lesions of liver as first line investigation to differentiate benign from malignant pathologies, primary vs secondary malignancies and establishing exact diagnosis. Materials and methods: A total number of 81 ultrasonography (USG)-guided FNA liver were performed in Postgraduate Institute of Medical Sciences (PGIMS), Rohtak from June 2010 to May 2011. Wet fixed and air dried smears were stained with Papanicolaou and May-Grunwald-Giemsa respectively. Results: Age ranged from 19 to 86 years. Sixty-seven out of 81 cases were conclusive. Four out of 67 were benign. Out of remaining 63 malignant, six were primary lesions including four cases of hepatocellular carcinoma, one of Burkitt’s lymphoma and one of cholangiocarcinoma. Secondary metastatic lesions were 44 including metastasis from malignant melanoma, squamous cell carcinoma and leiomyosarcoma. Conclusion: USG-guided FNAC is very useful tool in establishing diagnosis of hepatic lesions as the procedure is simple, safe and minimally invasive.



Salimur Rahman, Mamun Al-Mahtab, Md Fazal Karim, Ayub Al-Mamun, Golam Mashud, Arun Jyoti Tarafdar, Mir Fowaz Hossain

Serum Creatinine Levels Unrelated to Child-Pugh Status in Uncomplicated Cirrhosis of Liver with Ascites

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:3] [Pages No:36 - 38]

   DOI: 10.5005/jp-journals-10018-1059  |  Open Access |  How to cite  | 


Introduction: Liver cirrhosis and renal failure are two diseases that may occur in conjunction due to mutually related pathological processes. Liver cirrhosis causes portal hypertension that ultimately causes splanchnic vasodilatation leading to hepatorenal syndrome. Hypovolemia is another cause of renal failure in liver cirrhosis. The study presented here was done to assess the renal functions in patients with liver cirrhosis with ascites. Materials and methods: Sixty patients with uncomplicated cirrhosis of liver with ascites with normal renal function were included in this study. All patients were examined physically and biochemical. Main biochemical variables were serum bilirubin, serum albumin, serum creatinine and prothrombin time. Enrolled patients were categorized according to Child-Pugh class B and C. Serum creatinine levels were measured in all cases. Results: Mean level of serum albumin, serum creatinine and prothrombin time among Child B and C classes of liver cirrhosis patients were 27.36 vs 26.84 gm/dl, 0.79 vs 0.93 mg/dl, 15.97 vs 19.26 seconds respectively. No statistically significant change in the serum creatinine level among Child B and C were noticed. Conclusion: This study showed that the effect of liver cirrhosis on renal dysfunction would be minimal, if any.



Salimur Rahman, Mamun Al-Mahtab, Faroque Ahmed, Md Fazal Karim, Md Dalil Uddin

Ribavirin as a Therapeutic Modality in Patients with Severe Acute Hepatitis E

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:3] [Pages No:39 - 41]

   DOI: 10.5005/jp-journals-10018-1060  |  Open Access |  How to cite  | 


Background: With the postulation that ribavirin, an antiviral agent, can modulate the clinical course of severe acute hepatitis due to hepatitis E virus (HEV), a clinical trial was conducted in patients with acute hepatitis E. Materials and methods: A total of 24 patients with severe acute hepatitis E were enrolled in this study. Ribavirin was given at a dose of 400 mg, twice a day for 28 days. The clinical course of the disease was assessed on a regular basis. Results: Out of 24 patients in this cohort, three patients were lost during follow-up and their prognosis remains unknown. A total of six patients died during follow-up. The rest 15 patients showed improvement of their pathological conditions during observation period. Conclusion: Although preliminary, this study indicates that more information is required about beneficial and detrimental effects of ribavirin in patients with severe acute hepatitis E. This study inspired optimism that a randomized-controlled trial of ribavirin should be adopted in severe acute hepatitis E to develop proper in sights in this regard.



Madhusudan Saha, Shasanka Kumar Saha, Ranjit Kumar Banik, Khondoker Asaduzzaman

Cirrhotic Cardiomyopathy in Bangladeshi Patients: A Pilot Study

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:4] [Pages No:42 - 45]

   DOI: 10.5005/jp-journals-10018-1061  |  Open Access |  How to cite  | 


Background: Cirrhotic cardiomyopathy is reported to be a major cause of mortality and morbidity in liver transplant recipient. It might be an emerging issue as liver transplantation has been started in Bangladesh. Materials and methods: Forty-four cirrhotic patients of varying etiology and 44 healthy volunteers were enrolled as cases and controls, respectively. Hepatic functional status was assessed by clinical examination and biochemical tests. Transthoracic echocardiography was done in both the groups. Results: Deceleration time of cirrhotic patients was significantly prolonged irrespective of etiology in comparison to controls indicating diastolic dysfunction. Left ventricular systolic diameter was also larger (significant statistically) in cirrhotic patients. Other echocardiographic parameters like E/A ratio, EF, left ventricle (LV) wall thickness, interventricular septal thickness and LV diastolic diameter showed no significant difference. Cardiac dysfunction does not depend on severity of hepatic dysfunction. Conclusion: Cirrhotic patients irrespective of cause show diastolic dysfunction. Cardiac dysfunction did not correlate the severity of hepatic dysfunction.



Sibel Ozkan Gurdal, Tayfun Yucel, Mustafa Oran, Gursel Remzi Soybir, Ferda Nihat Koksoy, Rafet Mete

Our Experiences on Injuries due to Corrosive Intake

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:3] [Pages No:46 - 48]

   DOI: 10.5005/jp-journals-10018-1062  |  Open Access |  How to cite  | 


Background: The aim is to present our experiences on the treatment and follow-up in the injuries of corrosive intake. Materials and methods: Twelve patients who were admitted to clinics because of swallowed corrosive substance between year 2005 and 2010 were evaluated retrospectively. Results: According to the findings of esophagogastroduodenoscopies performed in the first in 12 to 24 hours, none of the patients had grade III esophageal injuries but only one patient who had grade III stomach injury was operated urgently and total gastrectomy + Roux-en-Y esophagojejunostomy was performed. The others that were grades I and II were managed conservatively. During the follow-up period, all patients were controlled with clinic and endoscopic examinations in 1st and 3rd months. Conclusion: These patients were managed by the teams of general surgeon, and head and neck surgeons urgently. Early esofagogastroscopy was so important for the treatment strategy of these patients.



Arif Hakan Demirel, Seyfettin Köklü

Silver Nitrate Cauterization for Anal Fistulas with High Blind Tract Chemical Therapy in Complicated Anal Fistulas

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:49 - 53]

   DOI: 10.5005/jp-journals-10018-1063  |  Open Access |  How to cite  | 


Aim: The efficiency of a chemical cauterization technique in the treatment of high blind tracts, which are important causes of recurrence in anorectal fistula, were investigated. Materials and methods: Fifteen patients underwent surgery for low perianal fistula with high blind tracts. Partial fistulectomy and cutting seton technique was performed on all patients. The high blind tracts were cauterized by silver nitrate particles and the surgical area was left for secondary healing. The follow-up duration was 6 months to 1 year. The anal continence was evaluated according to the Wexner score. Results: Four of the 15 patients were female, whereas 11 were male. Ages ranged between 17 and 67 years. While 11 participants were primary cases, four were recurrent. Nine of the fistula tracts were intersphincteric and five were transsphincteric and one case had horseshoe fistula. The mean wound healing duration was 5.5 weeks. Mild anal incontinence (Wexner score = 3) was recorded in one case and recurrence was observed in another. Conclusion: Cauterization with silver nitrate is a new treatment method for high blind tract in anal fistulas. It is a safe and noninvasive method that reduces recurrences and surgical complications.



Hitoshi Maruyama, Osamu Yokosuka

B-RTO for Gastric Varices

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:54 - 58]

   DOI: 10.5005/jp-journals-10018-1064  |  Open Access |  How to cite  | 


Gastric varices (GV) are considerable hemodynamic abnormality in patients with portal hypertension. Recent developments in both imaging technology and medical devices have made it possible to perform various radiological techniques. Balloonoccluded retrograde transvenous obliteration (B-RTO) is an interventional technique which provides high success rate of GV embolization with less recurrence. This review article aimed to introduce the concept and technique of B-RTO, and overview the effect and outcome of the treatment.



Shimaa Attia Atta

Hepatocyte Transplantation

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:59 - 63]

   DOI: 10.5005/jp-journals-10018-1065  |  Open Access |  How to cite  | 


Orthotopic liver transplantation is an established treatment for patients with severe acute and end-stage chronic liver disease. The shortage of donor organs continues to be the rate-limiting factor for liver transplantation throughout the world. Hepatocyte transplantation is a promising treatment for several liver diseases and can, also, be used as a ‘bridge’ to liver transplantation in cases of liver failure.



Basil George Verghese, Sanjana Kalvehalli Kashinath, R Ravi Kanth

Lymphangioma of the Spleen—A Rare Tumor Rarely seen in an Adult: A Case Report and a Comprehensive Literature Review

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:6] [Pages No:64 - 69]

   DOI: 10.5005/jp-journals-10018-1066  |  Open Access |  How to cite  | 


Lymphangioma of the spleen, a cystic, benign and slow growing tumor, is rarely seen in children and in adults and usually found only incidentally. We would like to report a case of a splenic lymphangioma in a 33-year-old female that presented to our hospital. To our knowledge this is the first case of its kind being reported from the Indian subcontinent in over 35 years. The previous case was reported in 1974 by Devi et al. In addition to this, our case is also unique because of the age of the patient and the size of the lymphangioma being one of the largest reported so far. This case report will be followed with a detailed literature review of splenic lymphangioma and its management. Abbreviations: Hb: Hemoglobin; ESR: Erythrocyte sedimentation rate; APTT: Activated partial thromboplastin time; GI: Gastrointestinal; CT: Computerized tomography; MRI: Magnetic resonance imaging.



Grace Lai-Hung Wong

Transient Elastography (Fibroscan®): A New Look of Liver Fibrosis and Beyond

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:8] [Pages No:70 - 77]

   DOI: 10.5005/jp-journals-10018-1067  |  Open Access |  How to cite  | 


It is now indispensable to assess the severity of liver fibrosis in essentially all chronic liver diseases in order to determine the prognosis, the need of treatment, as well as monitor disease progression and response to treatment. Liver biopsy is limited by its invasiveness and patient acceptability. Transient elastography (TE, Fibroscan®) is a noninvasive tool with satisfactory accuracy and reproducibility to estimate liver fibrosis. TE has been well validated in all major liver diseases namely chronic hepatitis B (CHB) and C, nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease, primary biliary cirrhosis and primary sclerosing cholangitis. As alanine aminotransferase (ALT) is one of the major confounding factors of liver stiffness in CHB, an ALT-based algorithm has been developed and higher liver stiffness measurements (LSM) cutoff values for different stages of liver fibrosis should be used in patients with elevated ALT levels. Falsely high LSM results well within cirrhotic range may occur during ALT flare, such that TE should not be used in patients with serum ALT level above five times of the upper limit of normal. TE is also useful in predicting patient prognosis such as development of hepatocellular carcinoma (HCC), portal hypertension, postoperative complications in HCC patients, and also survival. Unfortunately, failed acquisition of TE is common in obese patients. The new XL probe, a larger probe with lower ultrasound frequency and deeper penetration, increases the success rate of TE in obese patients. The median LSM value with XL probe was found to be lower than that by the conventional M probe, hence lower LSM cutoff values may be warranted. On the other hand, a novel ultrasonic controlled attenuation parameter (CAP) of the machine is currently under the evaluation and it is a potentially useful parameter as a noninvasive and objective method to detect and quantify hepatic steatosis.



Ashwin Rammohan, Sathyanesan Jeswanth, Perumal Senthil Kumar, Palaniappan Ravichandran

Endoscopic Banding for Duodenal Carcinoid Tumors

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:3] [Pages No:78 - 80]

   DOI: 10.5005/jp-journals-10018-1068  |  Open Access |  How to cite  | 


Introduction: Carcinoids of the duodenum are rare and have an indolent course. Most of these patients have been conventionally subjected to extensive surgery based on the site of the tumor. In this report, we have explored the safety and feasibility of endoscopic banding for such tumors. This to our best knowledge is only the second such report in English medical literature. Case report: In a 50-year-old woman with history of abdominal pain and vomiting, upper gastrointestinal endoscopy revealed a 0.5 cm umbilicated nodular lesion along the medial wall of the first part of duodenum. Biopsy of the lesion confirmed it to be a carcinoid, and endoscopic ultrasonography (EUS) showed the carcinoid was confined to the submucosa. Endoscopic banding with resection of the lesion was done. Patient tolerated the procedure well and is asymptomatic on follow-up. Conclusion: Small duodenal carcinoids confined to the submucosa can be safely and effectively managed by endoscopic banding and preoperative. Larger studies in patients with duodenal carcinoids tumors are needed to confirm these promising results.



Pankaj Tyagi, Anil Arora, Vinit Shah, Vikas Singla, Rinkesh Kumar Bansal, Vijendra Kirnake

Dual (Mixed and Bland) Thrombus in Inferior Vena Cava: A Rare Presentation of Hepatocellular Carcinoma

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:2] [Pages No:81 - 82]

   DOI: 10.5005/jp-journals-10018-1069  |  Open Access |  How to cite  | 


Budd-Chiari syndrome (BCS) is defined as hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava (IVC) and the right atrium. Hepatocellular carcinoma (HCC) is the complication of chronic liver disease and it usually presents as decompensation of the known chronic liver disease. HCC rarely present as BCS. Here, we present a rare case of HCC presenting first time with BCS with involvement of hepatic veins and dual thrombus in the IVC.



Basil George Verghese, Sanjana Kalvehalli Kashinath, R Ravikanth

Retroperitoneal Appendicitis: A Surgical Dilemma

[Year:2013] [Month:January-June] [Volume:3] [Number:1] [Pages:2] [Pages No:83 - 84]

   DOI: 10.5005/jp-journals-10018-1070  |  Open Access |  How to cite  | 


Introduction: Acute appendicitis is frequently encountered in both the surgical OPD and emergency room setting. But, a retroperitoneal appendicitis is very rarely seen and the literature available on it is scarce. Case report: We wish to present a case of a 26 years old female who presented to the emergency room with features of appendicitis and on whom an appendectomy was done. But during the surgery, the appendix was found situated retroperitoneally and had to be removed via a retrograde approach. We followed it with a short discussion of retroperitoneal appendix, the presentation of retroperitoneal appendicitis and its surgical management. Conclusion: Documented cases of retroperitoneal appendix are rare to the best of our knowledge and should be kept as a differential when a patient presents with atypical features of appendicitis.


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