Introduction: Gastrointestinal stromal tumors are mesenchymal tumors found in the stomach, jejunum and ileum and represent 9% of all small bowel tumors. Their intraluminal occurrence in the small bowel is a rare phenomenon as they predominantly grow extra-luminally, so rarely causing small bowel obstruction or intussusception. However, intraluminal presence can provide a lead point for intussusception as does the other benign and malignant diseases such as inflammatory bowel disease, post-op adhesions, crohn's disease, Meckle's diverticulum, Lipoma, lymphoma, adenocarcinoma, metastatic neoplasm or even presence of intestinal tubes. In adults only 8-20% cases of intussusceptions are idiopathic while the rest of cases are secondary to an underlying pathology. In elderly population most cases are of Ileo-colic type of intussusception secondary to malignant disease especially adenocarcinoma and lymphomas. However, there is no sufficient data available previously of intraluminal GIST causing ileo-ileal intussusception which makes our case worth presenting to literature. Presentation: An elderly male patient of 67 years age presented with signs and symptoms of small bowel obstruction, weight loss and mild anemia. These symptoms started 3 months back and were slowly progressive. On examination he had a diffuse lower abdominal mass with signs of obstruction. Systemic examination was unremarkable and the patient had no co-morbid conditions. Exploratory laparotomy was carried out after radiological and baseline investigation and a diagnosis of intraluminal growth causing ileo-ileal intussusception confirmed. Primary anastomosis after resection of the involved segment done Histopathology showed GIST of low malignant potential with resection margins free of tumors and no lymph node involvement.

Objective: To assess the safety, efficacy and cost effectiveness of ultrasound-guided foam sclerotherapy in superficial venous reflux in Clinical, Etiological, Anatomical and Pathological (CEAP) classification grade 2-6 disease. Study Design: Retrospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2018 to Feb 2020. Methodology: One thousand and sixty-seven patients (1312 legs) with varicose veins were treated by ultrasound-guided foam sclerotherapy using 3% sodium tetradecyl sulphate for truncal veins and 1% for smaller veins in 1:4 ratio with air. After 7 days, leg was assessed clinically and radiologically with Duplex ultrasound for occlusion of veins and complications. Second, third and fourth sclerotherapy sessions were performed for residual/recurrence/new varicosities. Compression bandage was used for at least 3 months after treatment. Results: The overall eradication of superficial venous reflux and healing of ulcers, was seen in 92.1% (1208 legs). It was 83.5% (1095 legs) after 1st session of UGFS. Second, 3rd and 4th session of UGFS further increases this percentage of benefitted patients Deep vein thrombosis developed post procedure in 2 (0.18%) patients and pulmonary embolus in one patient. Three (0.28%) patients had transient visual disturbances within half an hour of treatment. Retreatment was required due to formation of new superficial venous reflux in 39 (2.9%) legs and recurrence in 93 (7.1%) legs. Conclusion: Ultrasound guided foam sclerotherapy is a better option of treatment in varicose veins in terms of safety, efficacy and cost effectiveness.

Introduction: A rudimentary accessory or double nail of the middle finger of hand is extremely rare, although rudimentary accessory or double nail of the toes only described four times before in literature. Most cases are incidentally detected and only few patients seek help because they have discomfort and pain or cosmetic reasons. Some have a positive family history, but most patients cannot give any information concerning heredity or any previous trauma. Presentation: 28 years male presented with abnormal growth of the nail of middle finger of left hand which was hard. It was causing pain and discomfort to patient when touched. This growth was made of keratinized material and inseparable from nail bed which showed a longitudinal depression corresponding to a slight protuberance of the cuticle of primary nail. Discussion: being an extremely rare entity, this situation can lead to difficulty in diagnosis, so its symptoms and pattern of occurrence should be thoroughly noted. surgical excision is the only treatment of choice for patient's symptoms relief and cosmetic concern. Nail unit resection procedure can easily be performed under local anesthesia. Conclusion: Accessory nail of finger should be removed surgically due to pain and discomfort or cosmetic reasons and histopathology should be done afterwards. Highlights:

HighlightsThis article represents a unique case of accessory/double nail of middle finger of hand.The key purpose is to highlight this case as there is no such data in existing literature.This surgical pathology can cause pain, discomfort and cosmetic concern.Being a rare entity, this condition can cause diagnostic confusion.Treatment is surgical excision.