Lipomas are benign mesenchymal tumors of mature adipocytes and commonly occur in the upper trunk. Mesenteric lipomas are relatively rare tumors of the gastrointestinal system. They are usually asymptomatic, detected incidentally on abdominal imaging, or can present with variable symptoms depending on the location, size, and rapidity of tumor growth. The ileal mesentery is the most common site, occurring in adults ranging from 40 to 60 years. We present the case of an unusually large mesenteric lipoma in an adult male patient who presented with vague abdominal pain.

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BACKGROUND Twisting of the spermatic cord resulting in ischemia of the testicles known as testicular torsion is a surgical emergency. Delay in diagnosis or surgery results in loss of testicles. Doppler ultrasound of scrotum is used in evaluating acute scrotum to support or rule out a diagnosis of torsion testis. Our study compares Doppler results with findings at exploration to finding out the accuracy of Doppler diagnosis in this scenario. METHODS This was a record based observational cross-sectional study. Out of all cases of acute scrotum presented to a tertiary care hospital over 14 months time, those patients with Doppler evaluation done were identified (n = 52) and their surgical findings were compared to the Doppler findings. Diagnostic accuracy of Doppler in diagnosing torsion testis was measured using sensitivity, specificity, accuracy, and predictive values. RESULTS Out of these 52 cases, 44 (84.6 %) were testicular torsion on exploration while remaining cases were epididymo-orchitis four (7.7 %) and testicular appendage torsion four (7.7 %). Among 44 cases of torsion testis, 31 (70.5 %) patients underwent orchiectomy (70.45 %) and in remaining 13 (29.5 %) orchiopexy was done. Sensitivity of Doppler to diagnose testicular torsion was 86.4 %, specificity was 87.5 % and accuracy was 86.54 %. Positive predictive value (PPV) was 97.4 % and negative predictive value (NPV) was 53.8 %. CONCLUSIONS Doppler ultrasound can be used as an adjunct to clinical findings in acute scrotum. High positive predictive value suggest that all Doppler diagnosed torsion should undergo emergency exploration as it will be correct in 97.5 % cases. If performing a Doppler study delays the definitive management, and if clinical findings are highly suggestive of testicular torsion, treating doctor can proceed to surgery without Doppler evaluation. KEY WORDS Doppler, Torsion Testis, Scrotum

Ortner’s syndrome refers to the compression of the recurrent laryngeal nerve by cardiovascular disorders of various etiologies. We describe a rare case of Ortner’s syndrome caused by thoracic aorta aneurysm and a brief review of literature on this unusual cause of Ortner’s syndrome. Hoarseness of voice due to the compression of recurrent laryngeal nerve by thoracic aorta aneurysm could be a harbinger of aneurysmal rupture.

Background: Fetus in fetu (FIF) is a rare congenital anomaly in which a parasitic fetus is trapped inside the body of its twin. The incidence is 1 in 500,000 births. Initially, considered as a mature teratoma, it was later identified as a separate entity due to the presence of an axial skeleton and organized limbs. Clinical Description: A 48-day-old girl presented with an antenatally detected calcified intra-abdominal mass. She had a palpable retroperitoneal mass measuring 6 cm × 4 cm at the left lumbar area. Sonology showed a heteroechoic cystic mass in the left lumbar region. Serum markers were normal except for a slightly elevated serum lactate dehydrogenase. Contrast-enhanced computerized tomography of the abdomen showed a well-defined cystic lesion measuring 7.6 cm × 6.5 cm × 5.9 cm with enhancing septae, multiple calcific foci, teeth, and bones in the left suprarenal region displacing the left kidney. Management: Laparotomy showed a cystic appearing mass with solid components within. Cystic structure was the amniotic covering and solid component turned out to be the FIF with a face, limbs, and umbilical cord. No adjacent infiltration was seen. Pathology confirmed the finding of FIF with an identifiable vertebral column, umbilical cord, pelvis and lower limb bones, skin, and retinal and brain tissue. The infant has been under follow-up for a year and is thriving. Conclusion: FIF is a rare condition of infancy which can be diagnosed preoperatively by radiological examination, treated by complete excision, and confirmed by gross and histopathology. Differentiation of FIF from teratoma is mandatory as the latter can be malignant.