A 69-year-old female patient presented with abdomen pain for nine months. She had a history of hysterectomy with bilateral salphingoopherectomy, 25 years back. Physical examination reve aled mass in right iliac fossa extending into right lumbar region measuring 20x18 cm. Swelling was firm in consistency, smooth surface with all borders well defined.The patient was subjected to ultrasonogram (USG) abdomen which showed 12x13x11 cm thick walled cystic lesion with calcified foci occupying right iliac fossa extending to lumbar region. CT scan of abdomen was suggestive of bilocular cystic lesion with possibility of mucinous cystadenoma with mucocele [Table/ Fig-1]. CA-125 ovarian tumour marker level was assayed and found to be within normal limit.She underwent laparotomy with midline incision. On abdominal cavity exploration a large mass was noted involving right iliac fossa, lumbar and hypochondrium with wrapped up omentum around the mass. Bowel and solid organs liver spleen kidneys were found to be healthy. Uterus and both the ovaries were absent. The cyst was excised in toto, on opening the cyst thick gelatinous mucinous material, unilocular cyst with calcified areas gritty to cut, may be teeth were noted [Table/ Fig-2].The specimen was subjected to histopathological examination and report showed cyst wall lined by flattened cuboidal epithelium, cyst contains derivative of ectoderm lined by squamous epithelium keratin material, mesoderm bone marrow elements fibro fatty tissue, cartilage and endoderm derivative like intestinal glands confirming the diagnosis of mature cystic teratoma arising from mesentery. DIsCUssIoNMesenteric cysts are rare pathologic entities, with a reported incidence of approximately 1 of 27 000 to 1 of 100 000 admissions. Florentine anatomist Benevieni first described a mesenteric cyst in 1507, while performing an autopsy on an eight-year-old boy [1]. Teratomas are germ cell tumours composed of multiple cell types derived from one or more of the three germ layers. Dermoid cysts rarely present as mesenteric cysts. Mesenteric cysts are rare pathologic entities, with a reported incidence of approximately 1 of 27 000 to 1 of 100 000 admissions. Mesenteric cyst was first described by Florentine anatomist Benevieni in 1507, while performing an autopsy on an eight-year-old boy. Most commonly, teratoma occurs in the early age group. Mature mesenteric teratoma in adulthood is extremely rare. Teratoma are germ cell tumours commonly composed of multiple cell types derived from one or more of the 3 germ layers. We present the case of a 69-year-old elderly female who presented with abdomen pain for nine months with right lumbar and right iliac fossa mass. Computed Tomography (CT) abdomen revealed bilocular cystic lesion with possibility of mucinous cystadenoma with no definitive organ of origin. She underwent explorative laparotomy and total excision of the cystic mass. Histopathologic examination confirmed diagnosis of mature cystic teratoma of mesentery. This case report highlights the need to maintain h...

Background: Acute pancreatitis (AP) is as an inflammation of the pancreas with varied range of complication like peri-pancreatic collection, pancreatic necrosis, renal failure, multi-organ dysfunction syndrome which increases mortality rate and morbidity. Majority of AP cases are mild but severe cases of AP are associated with increased complication and mortality. BISAP is simple bedside prognostic scoring system for predicting severity of AP. BISAP is a collection of simple routine investigation and scores are quantified at 24hours of onset of AP. This study aims to assess prognosis of AP cases at ESIC Medical college and Post Graduate Institute of Medical Science and Research, Bangalore, Karnataka, India.Methods: A prospective study of 60 Patients who were diagnosed as AP according to RAC. All patients were admitted in high dependency unit with close observation of vital parameters and investigations were done at 24 hours of onset of AP. BISAP score >3 was considered as Severe Acute Pancreatitis, its correlation with local complications, organ failure, ICU stay and Mortality was studied. Statistical analysis done using Chi-square test and Fisher Exact test for local complications and organ failure using xL Stat and SPSS v.21.0, a p-value <0.05 was considered to be significant.Results: Of the 60 patients, BISAP score was >3 and <3 in 15 and 45 patients respectively. Alcohol was the most common cause of acute pancreatitis, accounting for 53.33%. In current study 12 (20%) patients developed organ failure and among them 9 (75%) had transient organ failure and 3 (25%) had persistent organ failure. Total 8 (13%) patients had developed pancreatic necrosis and among them 6 had BISAP >3. Mortality rate in this study was 2%.Conclusions: The BISAP score is a simple and fairly accurate method for the early identification of patients at increased risk for in hospital mortality and to identify patients at risk of the development of intermediate markers of severity and organ failure within 24 hours of presentation.

Background: Haemorrhoids are the most common benign anorectal problems worldwide. Treatments of third and fourth degree hemorrhoids include surgical haemorrhoidectomy. Milligan Morgan haemorrhoidectomy (MMH) as described in 1937 has remained the most popular among many techniques proposed. In order to avoid the postoperative drawbacks of Milligan Morgan haemorrhoidectomy, a new surgical treatment for prolapsing haemorrhoids has been described by Longo in 1995, procedure called stapled haemorrhoidopexy which is associated with less postoperative pain and a quicker recovery. The objective of this study was to compare the short-term outcome between stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy.Methods: Prospective randomized study of 120 patients with grade 3 and grade 4 haemorrhoids requiring surgical treatment either MMH or SH, 60 in each group for the period of 18 months from June 2014 to November 2015. Post-operative pain, duration of surgery, duration of hospital stays, post-operative complications and time taken to return to work were compared with mean follow up period of 6 months.Results: Duration of surgery is significantly low in stapled group with P <0.001, duration of hospital stay is significantly low in stapled group with P <0.001, post-operative pain low in staple group with P <0.05, time taken to return to work is significantly early in stapled group with P <0.001. Post-operative complications incontinence not found in the present study but recurrence of two cases in each group noted.Conclusion: Stapled hemorrhoidopexy is associated with less postoperative pain, shorter duration of surgery and hospital stay, earlier return to work as compared with Milligan-Morgan open hemorrhoidectomy. The procedure is not associated with major post-operative complications.