Port-site metastasis (PSM) is often encountered during laparoscopic surgery in patients with malignancy. We report a 45-year-old woman who presented with a single PSM from papillary adenocarcinoma after undergoing laparoscopic cholecystectomy for calculus cholecystitis. Post cholecystectomy, a diagnosis of chronic cholecystitis was confirmed on histopathology. The patient presented with a mass at the site of epigastric port 28 months after surgery. PSM was suspected on clinical examination, which was supported by findings on computed tomography and further confirmed by fine-needle aspiration cytology of the lump. The patient underwent surgical clearance of the mass, and histopathological examination proved the lesion to be papillary adenocarcinoma. The site of the primary tumour was not detected even after thorough examination. Based on the histopathology report following local surgical clearance, the patient was started on chemotherapy. This case is unusualbecause of the long delay prior to the presentation of PSM and the unknown primary malignancy.

BACKGROUND:Hydatid cyst is a parasitic infection that is widely endemic in India. It is a zoonotic disease with man being an accidental dead end host. Despite its world-wide affection, its diagnosis still remains a matter of challenge due to lack of an authentic gold standard for its early detection. In such cases, clinical judgment and high index of suspicion, in an endemic area is a worthy tool. AIMS AND OBJECTIVES: The study was undertaken to highlight important clinical features of hydatid cyst to help early diagnosis and management, the rare presentations of hydatid cysts in an endemic belt of Maharashtra along with their management and the shift that had occurred from past to present in hydatid cyst management along with future implications. MATERIALS AND METHODS:The hydatid cyst pattern (etiology, symptomatology, diagnosis and treatment) was retrospectively analyzed in operated hospitalized patients at three hospitals, GMC, Nagpur, VNGMC, Veotmal and MGIMS, Sewagram from 1975 to 2010 at different cross-sections of time. RESULTS: A total of 560 patients, 289 males and 271 females, who were diagnosed and operated for hydatid cyst, were evaluated. The mean age of presentation was 39.8 years with 61.9% rural population. Abdominal pain was most common compliant among symptomatic group (88.5%). Liver was most commonly involved (56.9%) followed by lung (32.7%). The most common radiological method to diagnose the disease was ultrasonography, with 91.4% accuracy, followed by CT scan. Multiple organ involvement was seen in 11.1% cases. The recurrence rate was 3.7%. There was no mortality and no serious postoperative complication other than bile leak (8.4%) and pus discharge (4.1%) from drain. Preoperative Albendazole followed by surgery and postoperative albendazole had a definite role in preventing recurrence. The mean hospital stay was 10.8 + 2.67 (3-35) days. CONCLUSION: A sound knowledge of various modes of presentation of hydatid disease, combined with clinical judgment, high suspicion in endemic areas and confirmation by newer diagnostic modalities like USG and CT is required for early diagnosis and treatment and prevent complications.

BACKGROUND: Gall stones are the most common biliary pathology. Cholelithiasis, whether symptomatic or asymptomatic, needs cholecystectomy due to 70-98% association of gall bladder carcinoma with gall stones. Despite this, the prevalence of carcinoma gall bladder is 2-5% with 0.3-0.5% being incidentally diagnosed in patients undergoing cholecystectomy. In such cases, clinical judgment and high index of suspicion in a rural setup is a worthy tool. AIMS AND OBJECTIVES: The study was undertaken to determine incidence of cholelithiasis and gall bladder carcinoma in various age groups among patients undergoing cholecystectomy and to standardize stage wise treatment of gall bladder carcinoma, specifically in relation to incidentally diagnosed gall bladder carcinoma. MATERIALS AND METHODS: A total of 189 patients undergoing cholecystectomy over a period of two and a half years were analyzed in a rural hospital, attached to medical college. Patients with gall bladder carcinoma were followed 3 monthly until death or till 31 ST Oct 2013. RESULTS: Maximum number of patients were in age group of 51-60 years (22.2%) with female to male ratio of 1.9:1. Pain in right hypochondrium was the most common symptom (76.2%) patients. Cholelithiasis was present in 75% patients with gall bladder carcinoma. Incidental diagnosis of gall bladder carcinoma in patients undergoing cholecystectomy for benign disease was 1.5%. Overall incidence of gall bladder carcinoma in patients undergoing cholecystectomy was 4.2%. After confirming the final diagnosis by histopathology, ultrasound showed only 62.5% sensitivity, 97.79% specificity, 55.56% positive predictive value, 98.33% negative predictive value and 96.3% accuracy to diagnose gall bladder carcinoma. Among three incidentally diagnosed patients, operated by laparoscopic cholecystectomy, two were alive at 8 and 13 months of follow-up respectively. CONCLUSION: A sound knowledge of various modes of presentation of cholelithiasis and gall bladder carcinoma, combined with clinical judgment, high suspicion in high risk areas and confirmation by newer diagnostic modalities like USG and CT is required for early diagnosis and treatment and prevention of complications.

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The incidence of bronchiectasis has declined markedly in developed countries with improvement in health care, antibiotics, vaccines and control of tuberculosis (<0.6/1000 persons), but is still high in developing countries. Early complete resection of affected lung segment remains the mainstay of treatment as it causes maximum improvement in symptoms, minimum deterioration of lung function and prevents disease progression. Surgery is indicated in unsuccessful medical treatment and complications of bronchiectasis e.g. haemoptysis, lung abscess, lung masses and pneumothorax. Bronchiectasis with multiple broncholithiasis is a very rare presentation and very few cases have been reported in literature so far. This article presents here, the symptoms and signs, operative and perioperative management and literature review of a case of bronchiectasis with multiple bronchial stones.