Conventional hemorrhoidectomy for grade III

Blue dye lymphatic mapping by peritumoral injection of methylene blue was found to be accurate and cost effective for SLN identification. It avoids the expenses of lymphoscintiscanning, which requires special infrastructure and expertise with a significant learning curve. The identified SLN can, with reasonable accuracy, be assessed for metastasis by TIC. The frequently used method of frozen section requires a cryostat and a pathologist trained in the technique. Additionally scanty SLN tissue can be wasted in the cryostat and freezing artifacts can be introduced in the imprint, both of which are avoided by TIC.

Bilothorax is a rare complication of biliary peritonitis and, if not treated promptly, can be lifethreatening. We report a case of a middle-aged woman who had undergone a bilio-enteric bypass and subsequently a biliary leak developed, which finally led to intra-abdominal biliary collection and spontaneous bilothorax. The clinical course was rapid and mimicked venous thromboembolism, myocardial infarction and pulmonary oedema, which led to a delay in diagnosis and management and finally death. We high-light the fact that bilothorax, although a rare complication of biliary surgery, should always be considered as a probable cause of massive effusion and sudden-onset respiratory and cardiovascular collapse in the postoperative period. A chest X-ray and a diagnostic pleural tap can confirm the diagnosis. Once detected, an aggressive management should be instituted to prevent organ failure and death.