PurposeTo compare the safety and efficacy of naftopidil and tamsulosin with prednisolone as medical expulsive therapy for distal ureteric stones.Materials and MethodsBetween July 2010 and March 2012, 120 adult patients presenting with distal ureteric stones of size 5 to 10 mm were randomized equally to tamsulosin (group A), naftopidil (group B) or watchful waiting (group C). Tamsulosin or naftopidil was given for a maximum of four weeks. In addition patients in group A and B were given 5 mg prednisolone once daily (maximum one week). Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment and adverse effects of drugs were noted. Statistical analyses were done using chi-square test, Mann-Whitney test and analysis of variance.ResultsThere was a statistically higher expulsion rate in groups A (70%) and B (87.5%) as compared to group C (32.5%) (p<0.001). The expulsion rates were not statistically different between groups A and B (p=0.056). The mean time to expulsion was comparable between groups A and B but longer in group C. Analgesic use was significantly lower in groups A and B. Average number of hospital visits for pain, follow-up and endoscopic treatment was similar in all groups. There was no serious adverse event.ConclusionsMedical expulsive therapy for the distal ureteric stones using either naftopidil or tamsulosin in combination with prednisolone is safe and efficacious.

Duodenal involvement in colonic malignancy is a rare event and poses challenge to surgeons as it may entail major resection in a malnourished patient. Nine patients with malignant colo-duodenal fistula were reviewed retrospectively. Depending on the pattern of duodenal involvement, it was classified as-type I involving lateral duodenal wall less than half circumference; type II involving more than half circumference away from papilla; type III involving more than half circumference close to papilla. Type I was managed with sleeve resection, type II with segmental and type III with pancreaticoduodenectomy. Median age was 47 years, with male to female ratio of 2:1. Eight patients had anemia and seven had hypoproteinemia. Tumor was located in right colon in eight patients and distal transverse colon in one. Diagnosis of fistula was established by CT abdomen in seven (78%), foregut endoscopy in three and intraoperatively in two patients. Two patients had metastatic disease. Elective resection was done in seven while two required emergence surgery. Five patients underwent sleeve resection of the duodenum, two underwent segmental resection and two required pancreaticoduodenectomy. All patients had negative resection margin. One patient died. Median survival was 14 months in eight survivors. Duodenal resection in malignant colo-duodenal fistula should be tailored based on the extent and pattern of duodenal involvement. Negative margin can be achieved even with sleeve resection. En bloc pancreaticoduodenectomy is sometimes required due to extensive involvement. Resection with negative margin can achieve good survival.

An isolated dilatation of the cystic duct (type VI choledochal cyst (CDC)) is extremely rare with only 21 cases reported in the world literature until now. There is only one case of in situ gall bladder cancer (GBC) reported in association with type VI CDC in the literature. Here we are reporting a case of type VI CDC with papillary GBC.

Esophagorespiratory fistula in adults as a result of corrosive ingestion is a rare occurrence and is a difficult problem to manage. Three young (15-19 years) patients (2F, 1M) out of 115 (incidence 2.6%) of corrosive ingestion who had tracheoesophageal fistula (TEF) were reviewed retrospectively. After initial management, enteral route of nutrition was established. Based on the extent of concomitant esophageal stricture, the fistulae were classified as: type I (short) and type II (long segment). Fistula was repaired through thoracotomy and formation of a neomembranous trachea. Esophageal stricture could be managed either short-segment resection (type I) or resection and replacement (type II). The etiology was aluminum phosphide in two and caustic soda in one. All the patients were operated beyond 9 weeks of ingestion. Tracheal defect was 5, 9 and 30 mm. Fistula could be repaired by neomembranous trachea in all the patients and defect reinforced with pleural flap in two and intercostal muscle flap in one patient. Two patients required colon interposition, while one could be managed with short-segment resection. All the patients are well at follow-up. TEF due to corrosive ingestion is a rare entity in adults. Formation of a neomembranous trachea is feasible in all patients. Management of esophageal stricture depends upon the pattern of involvement of the esophagus.

Background and Aim Severe acute pancreatitis (SAP) is commonly associated with intra‐abdominal hypertension (IAH). This acute increase of intra‐abdominal pressure (IAP) may be attributed to early organ dysfunction, leading to an increased morbidity and mortality. To assess the incidence of raised IAH and its correlation with other prognostic indicators and various outcomes in SAP. Methods and Results This was a prospective observational study in patients of SAP between July 2009 and December 2010. All patients of SAP who were admitted to the hospital within 2 weeks of onset of pain were included in the study. A total of 35 patients with SAP were included in the study. Among these, 25 (71.4%) were males. All our patients had raised IAP; however, IAH was present in 51.4% (18/35). Patients with IAH were found to have a higher APACHE II score (88.9 vs 5.9%; P < 0.001), infectious complications (72.2 vs 5.9%; P < 0.001), circulatory failure (88.9 vs 0%; P < 0.001), and respiratory failure (100 vs 41.2%; P < 0.001). All the eight (22.8%) patients who succumbed to sepsis had IAH. Patients with IAH were found to have a significantly longer intensive care unit (ICU) stay (17.72 vs 12.29 days) and in‐hospital stay (24.89 vs 12.29 days). Conclusion IAH is a good negative prognostic marker in SAP, seen in up to 51.4%. IAH was found to have a significant negative impact on the outcome in terms of increased mortality, morbidity, in‐hospital stay, and ICU stay among the patients of SAP.