Hiatal hernia (HH) is the herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm. A giant HH with pancreatic prolapse is very rare and its causing pancreatitis is an even more extraordinary condition. We describe a case of a 65-year-old man diagnosed with acute pancreatitis secondary to pancreatic herniation. In these cases, acute pancreatitis may be caused by the diaphragmatic crura impinging upon the pancreas and leading to repetitive trauma as it crosses the hernia; intermittent folding of the main pancreatic duct; ischemia associated with stretching at its vascular pedicle; or total pancreatic incarceration. Asymptomatic hernia may not require any treatment, while multiple studies have supported the recommendation of early elective repair as a safer route in symptomatic patients. In summary, though rare, pancreatic herniation should be considered as a cause of acute pancreatitis. A high index of suspicion for complications is warranted in cases like these.

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Summary:Tuberculosis of the thyroid gland is rare. A case of tuberculosis of the thyroid gland associated with thyrotoxicosis is reported. Case reportA 38 year old woman presented with weakness, heat intolerance and progressive loss of weight despite increased appetite for one and a half years. She also complained of insomnia, episodic diarrhoea, exertional dyspnoea and oligomenorrhoea of the same duration.She was thinly built young female with a pulse rate of 100 beats/min and blood pressure of 170/90 mm Hg. She had fine tremors of the fingers, brisk knee and ankle jerks and hypopigmented patches over both legs.Proptosis, lid lag and lid retraction were present. The thyroid gland was diffusely enlarged and soft in consistency, with a bruit and thrill. There was no cervical lymphadenopathy.Haemoglobin was 11.2 g/dl, total leucocyte count 9.8 x 109/l and erythrocyte sedimentation rate 16 mm in the 1st hour. X-rays of the chest and the neck were normal. Protein bound iodine (PBI) was 11.4tLg/dl and I131 uptake 55.5% at 24 h. Thyroid scan with 1131 revealed diffuse enlargement of the gland with uniform uptake.

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To compare the time course of clinical recurrences and reoperations following primary resections for fistulization versus fibrostenotic obstruction in ileal Crohn's disease, we performed a retrospective cohort study of 71 patients undergoing their first resection at The Mount Sinai Hospital between 1961 and 1984. Among these 71 patients, 35 were classified as fistulizing and 36 as fibrostenotic. Follow-up was 93% complete through 1990, with a median follow-up of 73 months to reoperation and 105 months to last contact. The fistulizing and fibrostenotic patients experienced virtually identical numbers of clinical recurrences: 25 from the former group and 24 from the latter. The recurrences appeared very slightly earlier among the fistulizing than among the fibrostenotic group, but the difference did not approach statistical significance. Only 18 patients came to reoperation during follow-up: 12 from the fistulizing and 6 from the fibrostenotic group. The earliest reoperation in the fistulizing group occurred at 14 months and in the fibrostenotic group at 44 months. There was a trend for earlier reoperation in the fistulizing group, but the difference was not statistically significant. Different clinical patterns of Crohn's disease have yet to be correlated with distinctive subclinical biologic markers.