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A case of angiomyoma as an unusual cause of knee pain is presented and the usefulness of magnetic resonance imaging in such a situation is discussed.

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Background: To assess the outcomes of Laser Four Quadrant stricturoplasty surgery in patients with staple line anal stricture post MIPH and STARR surgery.Methods: A prospective observational study was planned with purposive sampling. Cases with staple line stricture during the period February 2014 to July 2015 were included. There were 30 patients included in the study after informed consent and ethical clearance from hospital ethical committee. The data collected was background data, history of previous surgery, duration of Laser Four Quadrant stricturoplasty and Hospital stay, post-operative relief of symptoms and any complications, assessment of pain on VAS up to one year follow up period, overall patients’ satisfaction.Results: Out of 30 patients, 22 anal stricture patients were post STARR surgery and 8 were post MIPH surgery.  The mean surgery and hospitalization duration were 24.48±6.31 minutes and 13.72±4.30 hours respectively. Symptoms reported were Obstructed defecation (n=30), painful evacuation (n=30) and episodes of minor rectal bleeding (n=9). There was significant (p<0.0001) reduction in pain from preoperative 7.13±1.04 to 1.13±0.54, 0.27±0.45, 0.16±0.38 and 0.06±0.25 at baseline (post-operative), day 7, month 1 and month 3 respectively. At the end of one year, 86.67% patient were highly satisfied, 13.33 % were not satisfied. Recurrence was reported by 3 patients within 6 to 10 weeks post-surgery.Conclusions: Laser Four Quadrant Stricturoplasty is an easy and effective surgery for the treatment of staple line stricture with a low recurrence rate.

Cecal volvulus is a rare cause of large bowel obstruction. It is responsible for 1% of all adult intestinal Obstructions. It develops due to an abnormal mobility of the ileocecal loop because lacking attachment to ascending colon. We present the case of a 70-yearold female who presented to our surgical department with symptoms of intestinal obstruction. Various radiological investigations supported the diagnosis of sub-acute intestinal obstruction. She was subsequently managed by an exploratory laparotomy. During laparotomy, findings revealed a hugely dilated bowel loop with serosal tears. There was a twist of dilated cecum and ascending colon on its mesentery. The twist in the mesentery was released and serosal tears repaired. Cecopexy with extraction of faecolith performed. The postoperative course was uncomplicated so patient was discharged after 7 days. A physician should be aware of presence of this and subsequent management options so that clinical outcomes are improved.