Osseous metaplasia is a rare phenomenon in lipomas and dedifferentiated liposarcomas. Such an occurrence in a recurrent well-differentiated liposarcoma is a perplexing problem due to the potential confusion with dedifferentiation. This needs to be recognized to avoid overzealous chemotherapy and/or radiotherapy, which is required for dedifferentiated tumors.

Introduction: Portal hypertension in the presence of cirrhosis of liver carries poor prognosis. The medical management along with endoscopic therapy helps to reduce bleeding. Surgery is reserved for patients who fail medical therapy. Patients with portal hypertension with good functioning liver benefit from surgery. Study aimed to evaluate the results of surgical treatment for portal hypertension at our center Karnataka Institute of Medical Sciences Hubli. Karnataka. Material and methods. This was a prospective observational study. There were 34 patients undergoing surgical treatment for various presentations of portal hypertension during the period of 2015 to 2019.They were analyzed for demographics, etiology, presentation, various surgeries and outcome. The data was entered intoMicrosoft excel sheet and analyzed. Results: Of the 34 patients males were most common. Variceal bleeding was most common presentation followed by painful splenomegaly and anemia. 'Extrahepatic portal vein obstruction' was the leading cause of non-cirrhotic portal hypertension followed by 'non cirrhotic portal fibrosis' and 'left sided or sinistral portal hypertension'. Proximal linorenal shunt was the most common procedure followed by splenectomy with esophagogastric devascularization. The morbidity and mortality were very low and yielded durable satisfactory outcome. Conclusion: The surgery for non-cirrhotic portal hypertension has durable and satisfactory results and can be done with minimal morbidity and mortality at trained hands. For few selected cirrhotic patients surgery in the form of devascularization or shunt offers immediate relief from bleeding and gives time for future transplant if any.

Carcinoma of the gallbladder is considered a disease with grim prognosis owing to frequent locoregional recurrence despite surgery and poor disease specific and overall survival. It can spread directly, transperitoneally as well as via lymphatics, vessels and nerves. Distant spread to almost every organ is described and indicates a very late stage in the course of disease. Hence, evaluation for distant spread is not routinely considered if the disease is confined to locoregional area. We report a case of apparently locally confined Carcinoma gallbladder which manifested with osseous metastasis.

Intrahepatic pseudocyst of pancreas is a very rare entity and a significant diagnostic dilemma with less than 30 cases reported in the world literature. Demonstration of amylase rich fluid and a communication with pancreatic duct system establishes the diagnosis. There are no definite guidelines for the management. Here we describe a patient with alchohol related chronic pancreatitis with pseudocyst in head of pancreas developing intrahepatic dissection of pseudocyst resulting in a large intrahepatic multicystic lesion. The diagnosis was made by CT scan and Ultrasound guided aspiration of intrahepatic cyst contents showing amylase rich fluid. The patient had to be treated for both the pancreatic pain and intrahepatic pseudocyst. The patient underwent lateral pancreaticojejunostomy. The surgery resulted in resolution of intrahepatic pseudocyst by decompressing the main pancreatic duct and also resolved the pain of chronic pancreatitis.The lateral pancreato jejunostomy in this case is unique and not described before to treat intrahepatic pseudocyst.

Introduction: Pancreatic Ductal Disruption (PDD) may remain a localised collection to form pseudocyst or dissect into adjacent organs or rupture freely into the peritoneal cavity or pleural cavity resulting in massive or high-volume ascites or pleural effusions. The management of pseudocyst is well known among general and gastrosurgeons, but ascites and plural effusion remain difficult decisions. Depending on the availability of resources total parenteral nutrition, octreotide, pancreatic duct stenting are used with varying success. There are no guidelines as to which intervention is preferable in different clinical scenarios. Aim: To audit the clinical characters and management of patients with pancreatic ascites and pleural effusion. Materials and Methods: This study was done at the Department of Surgical Gastroenterology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. Fifty two patients with pancreatic ascites or pancreatico pleural fistula in the background of chronic pancreatitis satisfying both inclusion and exclusion criteria were identified and studied from the prospectively maintained database of patients with chronic pancreatitis in the period from September 2010 to September 2020. The patients were classified as conservatively managed, endoscopic main pancreatic duct stenting or surgery. Statistical analysis was done using windows excel. The results were expressed as percentage, mean and Standard Deviation (SD). Results: Five patients with ascites and two patients with pleural effusion responded completely to conservative measures (13.4%). In one of them ascites recurred at two months and one had left pleural effusion recurrence at one month. Fifteen patients died while on conservative management (68.2% mortality). Among eight patients undergoing endoscopic pancreatic duct stenting, ascites/pleural effusion resolved in six (75% success rate) and remained asymptomatic during mean follow-up of 12 months. Two patients who were not improving after stenting were lost to follow-up. Twenty-two patients underwent surgery namely lateral pancreatojejunostomy with resolution of symptoms. Two patients undergoing surgery died in postoperative period due to sepsis and chest infection (9.1% mortality). At a mean follow-up of 14 months they remained symptom free. Conclusion: Conservative management alone has high mortality. Early aggressive management can aim to stop leak either by pancreatic duct stenting or surgical lateral pancreatojejunostomy will help reduce mortality and morbidity.