A 48-eight-year-old female patient came with prolapse of small intestines per rectum ( Fig. 1) due to impalement injury with iron rod at a construction site. As the patient was hemodynamically unstable, she was taken for emergency laparotomy. A large rent in the intraperitoneal rectum was found (Fig. 2), with prolapse of intestines. Luckily for the patient, there was no other intra-abdominal organ injury. As there was no fecal contamination at all, a decision against proximal colostomy was made. The rent was closed in two layers after re-placing the small bowel contents with thorough lavage. Patient made a swift recovery thereafter.Keywords Impalement injury . Small bowel prolapse . Rectal perforation A middle-aged female patient came with history of prolapse of small bowel contents due to impalement injury at a construction site (Fig. 1). The patient was taken for emergency surgery due to hemodynamic instability. A large perforation of size 4×4 cm in the intraperitoneal region (Fig. 2) was found. There were no other injuries. The bowel contents were re-placed in the abdomen after thorough lavage. The rent was closed by a two-layer technique. As there was no fecal spillage, colostomy was not done. The patient later made a swift recovery.

Amyloid goiter is described as an accumulation of amyloid, an amorphous proteinaceous material, in the thyroid gland. The deposition of amyloid is relatively common in the thyroid gland. However, a significant clinical enlargement due to amyloid accumulation and fat deposition in the thyroid stroma resulting in diffuse goiter leading to compressive symptoms is a rare phenomenon. In this report, we describe a rare case of amyloid goiter with adipose metaplasia in a 38-year-old woman with a history of pulmonary tuberculosis who presented to the outpatient department with complaints of heartburn, abdominal discomfort, and hoarseness of voice. Incidentally patient had diffused multinodular neck swelling. Preliminary blood investigations were normal. The contrast-enhanced computed tomography neck showed multiple non-enhancing lesions and a diffusely enlarged thyroid gland, causing a mass effect on the oropharynx posteriorly and minimally on the trachea. Fine needle aspiration cytology thyroid revealed thyroiditis. The patient underwent a total thyroidectomy, and histopathological examination of the specimen showed an extracellular eosinophilic amorphous substance that was positive for Congo red and showed apple-green birefringence under polarized light, and large areas of adipose metaplasia were noted, and a diagnosis was made. The amyloid involvement can result from localized primary deposition or secondary to chronic inflammatory disease. The prevalence of amyloid goiter in developed countries is due to primary amyloidosis, and in developing countries is due to secondary amyloidosis. Patients with a history of pulmonary tuberculosis commonly present with renal amyloidosis as its complication. Patients with an enlarged thyroid gland and a history of chronic inflammatory conditions or plasma cell dyscrasias should be evaluated with extreme suspicion. The correlation of tuberculosis with the subsequent development of amyloid goiter highlights the need for research in this area.

Background: Cancer is a biggest burden of modern society. Gastric cancer is the second leading cause of cancer death in the world. The objective of study was to study the clinico pathological features and management and outcome of gastric cancer patients admitted to hospital. Methodology: A prospective descriptive study was conducted in 50 diagnosed patients of gastric adenocarcinoma using pre-designed questionnaire collecting information on demographics, stage and site of tumor, clinical history, duration of stay etc. Results: There were 50 patients with male to female ratio 2.5: 1 with mean age of 62+/-7.89 SD. 88% patients had tumor at antrum region. 25 (50%) and 28 (56%) patients gave h/o smoking and alcohol consumption respectively with 23 (46%) had biopsy positive for H. pylori. Of the gastrectomies, 41 (82%) study subjects were managed by curative surgeries. The overall hospital stay in stage II gastric adenocarcinoma was 6-8 days and 7-8 days in stage III (p=0.16). Conclusion: systematic population screening program of upper gastrointestinal endoscopy should be established to detect early cases of gastric cancer show that treatment may be initiated early which has impact on survival for this dreaded diseases.

No abstract