Background/Aim:Mirizzi's syndrome (MS) is an unusual complication of gallstone disease and occurs in approximately 1% of patients with cholelithiasis. Majority of cases are not identified preoperatively, despite the availability of modern imaging techniques. A preoperative diagnosis can forewarn the operating surgeon and avoid bile duct injuries in cases of complicated cholecystitis. A preoperative scoring system helpful and hence, we aim to devise a scoring system based on clinical, biochemical, and imaging features to predict the diagnosis of MS in cases of complicated cholecystitis.Patients and Methods:From January 2000 to July 2013, 1,539 patients with cholelithiasis underwent cholecystectomy. Of these, 96 patients had complicated cholecystitis. Records of these patients were analyzed retrospectively. In these, 32 patients were found to be having MS that formed the study group. A scoring system was devised based on clinical, biochemical, and imaging parameters to predict the diagnosis of MS. Every positive parameter was given 1 point and patients rated on a scale of 0–10.Results:Score of 3 or more was found to have a 90% sensitivity of predicting MS among complicated cholecystitis. Similarly, a score of 6 or more had an 80% sensitivity of predicting Mirizzi's types II, III, and IV indicating fistulization. Jaundice, leucocytosis, associated choledocholithiasis/hepatolithiasis, intrahepatic biliary radical dilatation, meniscus sign and mass at confluence were found to be significant parameters.Conclusion:We propose a simple scoring system based on clinical, biochemical, and imaging parameters that can be useful for predicting MS in patients with complicated cholecystitis.

Mesh erosion and migration are considered the gravest of complications of mesh repairs. To the best of our knowledge, mesh erosion and migration into the stomach following a mesh repair of adult diaphragmatic hernia has yet to be reported in the literature. A case of mesh eroding into the stomach, after a prosthetic repair of an adult diaphragmatic hernia, is presented here because of its rarity.

BackgroundThe synchronous colorectal malignancy is well described in the literature but combination of pancreatic incidentaloma with sigmoid cancer has not been well described and the association has not been described in syndrome.Case presentationA 65-year-old man from the Indian subcontinent with a history of abdominal pain with loss of appetite, and with a history of bleeding per rectum and altered bowel habits presented to our hospital. An abdominal examination revealed a palpable mass in the region of his epigastrium and left hypochondrium, and a rectal examination was normal. A work-up included blood investigations, an abdominal contrast-enhanced computed tomography scan, a colonoscopy, and a positron emission tomography/computed tomography scan. He was managed by simultaneous distal pancreaticosplenectomy and radical sigmoidectomy. The final histopathology results were suggestive of moderately differentiated adenocarcinoma of the sigmoid colon with serous cystadenoma of the pancreas.ConclusionsThe synchronous sigmoid colon cancer and pancreatic cystic incidentaloma is a rare presentation, which, to the best of our knowledge, has not been reported in the literature. We report the surgical management of this case and present a review of the literature. Genetic studies may be conducted to find out whether there is common genetic mutation resulting in these two malignancies, and may be helpful in screening programs.

Few studies correlate anatomical parameters of the transected pancreatic neck to occurrence of the dangerous complication-post Whipple's pancreaticoduodenectomy pancreatic fistula. To evaluate the correlation between anatomical details of the transected neck of the pancreas and post-operative pancreatic fistula (POPF) following Whipple's pancreaticoduodenectomy. Observational study. The study included 66 patients undergoing Whipple's pancreaticoduodenectomy with pancreaticojejunostomy at tertiary care centre between December 2009 and December 2014. Student's t test, Fisher's exact test, Pearson's chi-squared test and forward stepwise. Clinically relevant POPF (grade B and C) was noted in 12 patients. Morbidity/mortality was 30.30% and 4.54% respectively. Among the fistula v/s no fistula groups, (a) mean thickness of the pancreatic stump was 12.17 ± 1.40 mm v/s 14.94 ± 1.87 mm (P = 0.000), (b) mean width of the pancreatic stump was 24.33 ± 4.14 mm v/s 25.87 ± 4.02 mm (P = 0.238) and (c) mean pancreatic duct (PD) diameter was 2.92 ± 0.79 mm v/s 4.27 ± 1.39 mm (P = 0.001). Mean distances of PD from anterior, posterior, superior and inferior pancreatic borders in the fistula group v/s no fistula group were 6.08 ± 1.62 mm, 3.17 ± 0.72 mm, 9.92 ± 2.15 mm, and 11.42 ± 3.45 mm v/s 5.93 ± 1.71 mm, 4.83 ± 1.26 mm, 11.83 ± 2.79 mm and 9.96 ± 3.25 mm respectively. Eleven of 38 patients (28.9%) with soft pancreas developed POPF. Pancreatic duct < 3 mm diameter, < 3 mm from posterior border, < 12 mm from superior border, pancreatic neck thickness < 12 mm and soft pancreas consistency were significantly associated with POPF.

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