A three-year-old girl was referred to our surgery department from a rural hospital in West Bengal for a suspected incarcerated rightsided inguinal hernia in March '2014. Her mother had first noticed a peanut sized swelling in the right groin 6-months back; it gradually enlarged to reach the present size [Table/ Fig-1]. Her parents sought medical attention because of moderate pain in her right groin for last 4-days. There were no complaints of abdominal pain, distension of abdomen or vomiting. The patient did not have any history of trauma to the right inguinal region. There was no change in her bowel and bladder habit in last four days. Local examination revealed a pear shaped 5 × 2.5 cm irreducible, fluctuent swelling in the right inguino-labial region. There was no expansile impulse on straining (crying). The swelling was transilluminant but no thrill or bruit was noted over the swelling. Overlying skin was normal and free from the groin lump. Her complete blood count and urinalysis was normal. A differential diagnosis of an inguinal hernia or hydrocele was made from the aforesaid clinical picture. Then the patient was shifted to our emergency operation theatre where ultrasonography of the right inguino-labial region revealed hypoechoic swelling with fine internal septations.Then she underwent surgical exploration through right groin transverse skin crease incision, where after cutting the skin and The inguinal canal is traversed by the spermatic cord in men and the round ligament of uterus in women. The round ligament is attached to the uterine cornu near the origin of fallopian tube at one end and to the ipsilateral labia majora at the other. The round ligament accompanies a pouch of parietal peritoneum in the inguinal canal, which is known as 'canal of nuck'. It is analogous to the processus vaginalis in males. Incomplete obliteration of the peritoneal pouch causes indirect inguinal hernia or hydrocele of the canal of nuck; a very rare condition in women. As these types of cases are rarely seen in surgical practice we present a case of such little-known developmental disorder in a three-year-old girl. She presented with irreducible, tender right inguino-labial swelling with tachycardia simulating incarcerated inguinal hernia, which necessitates emergency surgical exploration. On exploration it was found to be an encysted hydrocele of canal of nuck; so although rare, this entity should be considered in differential diagnosis in a female child presented with inguino-labial swelling. Keywords: Encysted hydrocele, Processus vaginalis, Round ligamentsubcutaneous tissue we encountered a cystic lesion. Then we open the right inguinal canal after cutting the external oblique aponeurosis to delineate the extension of the lesion. Cyst was extended down to the right labia majora and it was clearly seen to be an encysted hydrocele of canal of the nuck [Table/ Fig-2], without any evidence of associated inguinal hernia. The cyst was carefully dissected from the round ligament and ligation of canal of nuck done near deep ...

A 58-year-old male patient was admitted in surgical ward with retention of urine for the last 16-hours. He had a history of difficulty in passing urine for last three years along with sense of incomplete bladder evacuation and increased frequency for the same duration. Abdominal examination revealed that suprapubic bloating was due to full bladder, which was tender on palpation and dull on percussion. On per rectal examination, a smooth cystic extraluminal mass was felt anteriorly in the rectovesical pouch without any rectal mass or prostatic enlargement. He was immediately catheterised to relieve his discomfort. There was no history of burning micturition, fever or significant weight loss in the recent past. He had no history of surgery, instrumentation or trauma to the lower urinary tract and there was no history of taking regular medicines (like NSAIDs) which can cause bladder outflow obstruction. General physical examination of the patient was unremarkable and examination of the other systems including neurological system was essentially normal. His complete blood count, serum urea, creatinine and electrolytes, liver function tests and urinalysis were essentially normal. Ultrasound examination (USG) revealed a large, encapsulated SOL with both solid and cystic components, measuring 7.8×7.4×7cm in the pelvis, posterior to urinary bladder. On colour flow study no vascularity was seen in the lesion. There was no lesion in the liver or any other abdominal organ, and also no abnormality detected in prostate and seminal vesicles. Contrast enhanced computed tomography (CECT)scan of the abdomen and pelvis revealed a 8.3×8×7.5 cm, well defined, multilocular, non-enhancing lesion having typical cartwheel appearance occupying the rectovesical pouch of Douglas pushing the rectum and anal canal backward and urinary bladder forward. Radiological examination of chest was normal. Flexible cystoscopy revealed an impression of the mass on posterior wall of urinary bladder. There were no duplications, ureterocoele or diverticule on intravenous urogram. Provisional diagnosis of primary pelvic hydatid disease was made based on aforesaid findings, but hydatid serology (serum anti-echinococcus granulosus IgG antibody on ELISA) was not suggestive. Albendazole (10mg/kg/day) was given to the patient Causes of urinary retention in old men include benign prostatic hyperplasia, prostatitis, prostate cancer, Scarring of the urethra or bladder neck as a result of injury or surgery, use of certain medicines particularly NSAIDs and opioid analgesics, constipation and neurogenic bladder. When the above common causes are not quite obvious by clinical examination and relevant investigations, then it is necessary to think of other rare diseases. It is with the above in our mind that a case of bladder outflow obstruction due to a large primary retrovesical hydatid cyst is herein reported in a 58-year-old man. Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) scan of the abdomen and pelvis of the patient revealed a large, mu...

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Penetrating injuries of the brain are quite uncommon, comprising approximately 0.4% of all head injuries. In our case, a four-year-old boy who fell forward on a house-key (lock) accidentally while playing with some other children sustained a left sided penetrating transorbital brain injury. After hospital admission, the patient had a Glasgow Coma Scale (GCS) score of 15/15, no visual loss but restriction of upward gaze (left eye) and profuse bleeding from the wound site. Firstly, the metallic key was removed in emergency operation theatre and haemostasis secured. Next day we did a combined surgical approach with neurosurgeons, Eye-surgeons and general surgeons after having CT scan report. We report this case because penetrating head injury is rare and transorbital penetrating head injury is even rarer and a predicament in emergency surgical practice with controversial management.

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