Acute pancreatitis is one of the most common clinical emergencies encountered in our day-to-day practice. Although gallstones are the most common cause worldwide, alcohol consumption remains the leading cause of acute pancreatitis in the Indian population. We report a rare case of parathyroid adenoma, which presented with acute pancreatitis as its initial manifestation in an elderly patient. A 65-year-old gentleman with acute abdominal pain, distension, and obstipation, underwent emergency laparotomy in view of acute intestinal obstruction and was found to have acute pancreatitis intra-operatively. On post-operative evaluation, his serum calcium was >14 mg/dl and serum parathormone (PTH) was >2,000 pg/ml. Single-photon emission computed tomography (SPECT) and technetium (Tc-99m) sestamibi scintigraphy revealed a right inferior parathyroid adenoma, which was surgically excised, following which the patient made an uneventful recovery. Hypercalcemia induced by hyperparathyroidism causes auto-activation of pancreatic enzymes within the pancreatic parenchyma and is also believed to cause pancreatic duct obstruction by calcium deposition, thus causing pancreatitis. Radionucleotide scan, in addition to contrast-enhanced computed tomography, can help in localizing the lesion causing hyperparathyroidism. Appropriate resuscitation and stabilization with anti-hypercalcemic measures, including hydration and forced calciuresis, followed by surgery form the mainstay of treatment in patients with primary hyperparathyroidism. Patients with acute pancreatitis without a history of gallstone disease or alcohol intake should be evaluated for other rare causes. Early diagnosis and prompt treatment of the underlying condition can prevent the recurrence of pancreatitis.

Carcinoma of the accessory axillary breast is uncommon, with an incidence of 0.2 to 0.6%. We report a patient whose biopsy of a suspicious lesion in the axilla present for one year revealed invasive ductal carcinoma (IDC). There was presence of breast tissue and absence of lymphoid tissue in the biopsy, suggesting a breast malignancy. Magnetic resonance mammography was suggestive of the lesion well away from the normal breast, confirming an accessory axillary breast. She was offered wide local excision of the lesion with axillary lymph node dissection and modified radical mastectomy (MRM), and she chose the latter. Her post-operative biopsy showed the involvement of all the 25 lymph nodes harvested. Any suspicious lesion in the axilla should be promptly worked up for malignancy. Accessory axillary breast carcinoma, if confirmed, can be addressed with wide local excision along with axillary lymph node dissection. However, further studies should clarify this and the outcomes.

Background: The feasibility of ultrasound guided minimally invasive techniques in management of breast abscess has been a topic of concern from a long time thus, resulting in many studies. Objectives: To assess the feasibility and to compare ultrasound guided minimally invasive techniques with conventional incision and drainage in breast abscess management Materials and Methods: Patients admitted in Surgery Department / OPD with BREAST ABSCESS (total 60 patients) were divided into two random groups of 30 patients each using random number tables. Group 1 was treated by conventional incision and drainage, Group 2 was treated by ultrasound guided minimally invasive techniques. Chi-square test was used. Results: For group 2, the average pain(VAS) score was 4.7 with minimal bleeding during the procedure, no need of dressing, average duration of stay 0.47 days, average days required for complete recovery is 13 days and excellent cosmesis as compared to group 1 where average pain score was 7, mild bleeding occurred in all cases with requiring an average of 10 days of dressing, all healed leaving a scar, average days required for complete recovery is 28 days and thus only satisfactory cosmesis with average 3.1 days of hospital stay.

Background: The feasibility of ultrasound guided minimally invasive techniques in management of breast abscess has been a topic of concern from a long time thus, resulting in many studies. Objectives: To assess the feasibility and to compare ultrasound guided minimally invasive techniques with conventional incision and drainage in breast abscess management Materials and Methods: Patients admitted in Surgery Department / OPD with BREAST ABSCESS (total 60 patients) were divided into two random groups of 30 patients each using random number tables. Group 1 was treated by conventional incision and drainage, Group 2 was treated by ultrasound guided minimally invasive techniques. Chi-square test was used. Results: For group 2, the average pain(VAS) score was 4.7 with minimal bleeding during the procedure, no need of dressing, average duration of stay 0.47 days, average days required for complete recovery is 13 days and excellent cosmesis as compared to group 1 where average pain score was 7, mild bleeding occurred in all cases with requiring an average of 10 days of dressing, all healed leaving a scar, average days required for complete recovery is 28 days and thus only satisfactory cosmesis with average 3.1 days of hospital stay.