Abdomen is a Pandora's Box. During our routine patient evaluation we come across different types of abdominal lumps out of which some are straight forward and diagnosed after routine clinical examinations and available investigations. At times these abdominal lumps present differently from their usual presentations and create confusions despite undergoing necessary investigations. The truth is explored only after opening the Pandora's Box. We present a case of 21 years old male who presented with history of gradually increasing right sided upper abdominal lump of three years duration. He was thoroughly investigated with USG and CT scan abdomen along with other supportive investigations and was diagnosed to have Hydatid cyst of liver. Accordingly patient was prepared for surgery and it was only at the time of laparotomy that he was found to have right sided giant hydronephrosis with a nonviable renal parenchymal tissue. He underwent right sided nephrectomy and had a good postoperative recovery. So at times the abdominal lumps keep on creating diagnostic dilemmas.Key words: abdominal lump, giant hydronephrosis

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential. Inflammatory myofibroblastic tumor (IMT) of the alimentary tract often occurs in children or young adults, but may occur at any age. The lung is the most commonly affected location. However, it may appear in small bowel mesentery especially the distal ileum, mesotransverse colon, or greater omentum. A 35 years old female presented to out-patient department with complaint of mass in right abdomen since 1 month associated with loss of weight. Computed tomography of abdomen revealed a solid intraperitoneal mass arising from bowel mesentery. Laparoscopic excision of the tumor was performed and the histopathological examination of the mass revealed it to be an inflammatory myofibroblastic tumor arising from the omentum and large bowel mesentery. The post- operative period was uneventful with no evidence of tumor recurrence at follow up at 2 years. Inflammatory myofibroblastic tumor is a rare soft tissue tumor usually arising from lungs but tumor arising from the omental-mesenteric origin has also been documented. The precise diagnosis is made only by the histopathological evidence. Surgical resection is the treatment of choice.

Introduction: Laparoscopic hernia surgery is performed by almost every general and laparoscopic surgeon worldwide, Trans-abdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) being the most frequently performed. Seroma formation leading to deep seated mesh infection with abscess is rare but once it occurs it can be very difficult to treat. The rate of mesh infection after open mesh repair is reported to be between 0.5% - 3%, whereas in laparoscopic repair is less than 0.16%. Seroma formation following TAPP is 3%-8% and following TEP is 0.5-12.2%. Case Report: A 19 years old male presented with groin swelling, fever and weight loss three months after the laparoscopic TAPP surgery for right inguinal hernia. Workup showed he had developed mesh infection with pre-peritoneal abscess which was managed with open drainage of the abscess with removal of the infected mesh. Conclusion: Seroma formation may result in abscess formation. If occurred removal of the mesh with drainage of abscess is often required. The chance of recurrence of hernia following management of infected mesh should always be considered

Introduction: Laparoscopic cholecystectomy is the gold-standard operation for the treatment of cholelithiasis. Various factors affect the conversion of laparoscopic to open cholecystectomy. Methods: In this prospective analytical study one hundred and sixty consecutive patients who underwent laparoscopic cholecystectomy were studied to see the factors that affect the conversion to open cholecystectomy. Factors contributing to conversion of laparoscopic to open cholecystectomy were analyzed. Result: In this study the conversion rate of laparoscopic to open cholecystectomy was 6.25%. The most common cause for conversion was unclear anatomy and adhesion at the Calot’s triangle and abnormal course of the cystic artery. Conclusion: Proper knowledge about the anatomical variations of cystic duct and artery and timely conversion in cases of confusion can help prevent bile duct injuries during cholecystectomy.

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