Persistent müllerian duct syndrome (PMDS) is usually a surprise finding either during orchidopexy or during routine inguinal hernia repair in male patients. Often, the surgeon would face a dilemma about what is to be done with the remnants of müllerian duct, i.e. the fallopian tubes, uterus and proximal vagina. Till recently, it was advised to retain these structures whenever it was felt that the complete excision of these structures may jeopardise the blood supply and integrity of the vas deferens. Recent reports of malignancy in these retained structures would justify more aggressive approach. In our patients with PMDS, we have removed the mucosa of the retained müllerian structures, without compromising the integrity and vascularity of the vas deferens, thus reducing the chances of malignancy.

A 69-year-old female patient presented with abdomen pain for nine months. She had a history of hysterectomy with bilateral salphingoopherectomy, 25 years back. Physical examination reve aled mass in right iliac fossa extending into right lumbar region measuring 20x18 cm. Swelling was firm in consistency, smooth surface with all borders well defined.The patient was subjected to ultrasonogram (USG) abdomen which showed 12x13x11 cm thick walled cystic lesion with calcified foci occupying right iliac fossa extending to lumbar region. CT scan of abdomen was suggestive of bilocular cystic lesion with possibility of mucinous cystadenoma with mucocele [Table/ Fig-1]. CA-125 ovarian tumour marker level was assayed and found to be within normal limit.She underwent laparotomy with midline incision. On abdominal cavity exploration a large mass was noted involving right iliac fossa, lumbar and hypochondrium with wrapped up omentum around the mass. Bowel and solid organs liver spleen kidneys were found to be healthy. Uterus and both the ovaries were absent. The cyst was excised in toto, on opening the cyst thick gelatinous mucinous material, unilocular cyst with calcified areas gritty to cut, may be teeth were noted [Table/ Fig-2].The specimen was subjected to histopathological examination and report showed cyst wall lined by flattened cuboidal epithelium, cyst contains derivative of ectoderm lined by squamous epithelium keratin material, mesoderm bone marrow elements fibro fatty tissue, cartilage and endoderm derivative like intestinal glands confirming the diagnosis of mature cystic teratoma arising from mesentery. DIsCUssIoNMesenteric cysts are rare pathologic entities, with a reported incidence of approximately 1 of 27 000 to 1 of 100 000 admissions. Florentine anatomist Benevieni first described a mesenteric cyst in 1507, while performing an autopsy on an eight-year-old boy [1]. Teratomas are germ cell tumours composed of multiple cell types derived from one or more of the three germ layers. Dermoid cysts rarely present as mesenteric cysts. Mesenteric cysts are rare pathologic entities, with a reported incidence of approximately 1 of 27 000 to 1 of 100 000 admissions. Mesenteric cyst was first described by Florentine anatomist Benevieni in 1507, while performing an autopsy on an eight-year-old boy. Most commonly, teratoma occurs in the early age group. Mature mesenteric teratoma in adulthood is extremely rare. Teratoma are germ cell tumours commonly composed of multiple cell types derived from one or more of the 3 germ layers. We present the case of a 69-year-old elderly female who presented with abdomen pain for nine months with right lumbar and right iliac fossa mass. Computed Tomography (CT) abdomen revealed bilocular cystic lesion with possibility of mucinous cystadenoma with no definitive organ of origin. She underwent explorative laparotomy and total excision of the cystic mass. Histopathologic examination confirmed diagnosis of mature cystic teratoma of mesentery. This case report highlights the need to maintain h...

AIMS AND OBJECTIVESTo determine the prognostic factor for mortality and to review our experience on the various surgical methods in the management of typhoid ileal perforation.

No abstract

Necrotizing fasciitis (NF) is often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The present study was aimed to validate the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score as a tool to predict/diagnose NF and to differentiate it from other soft tissue infections depending on the score. A Prospective Observational study was conducted in ESICMC PGI MSR, Medical College Hospital, Rajajinagar, Bengaluru, from Jan 2019 to June 2020. Patients ≥18 years of age with severe soft tissue infections were included in the study. Based on the LRINEC score, the patients were categorised as low (≤5), moderate (6-7) and high risk (≥8) for the prediction of onset or diagnosis of NF. Data analysis was performed using SPSS version 21.0. A total of 55 patients were included in the study. A significant 3 association was observed Dweitpharatgmee(npt=o0f.0X4X2)X, ,LURnINivEerCsitsycorfeX(pX=X0,.0X0X01X),TCraRineiancgtiavnedPRroetseianrc(hCRHPo;spi=ta0l.,0C00it1y),,Choauenmtroyglobin (p=0.008), serum 4 sodium levels (p=0.004), serum creatinine (0.D00e1p)a,ratmndenatmopfuXtaXtiXon, F(pac=u0l.t0y0o4f).XAXmXp,uCtaityio,nCwouanstdryone in 5 cases. Only 1 mortality was observed in LRINEC high risk group with NSSTI. To conclude, LRINEC scoring system showed a better positive predictive value in identifying the onset of NF and risk strategizing of the patients with severe soft tissue infections.