Thyroglossal duct cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. Apart from being a quiescent embryological remnant, it presents itself clinically at any age and often requires surgical excision. Twenty four patients were encountered at Sri Ramachandra Medical College and Research Institute between June 2004 and June 2009 with thyroglossal duct cyst. The purpose of the study was to analyse their presentation, associated complications including malignancy and the approach to their management. Operative notes, histopathology files and medical records were used for the retrospective analysis of the patients with thyroglossal duct cyst. Thyroid profile and Radioisotope scan were performed on all the patients to document the position of the thyroid gland. Further, these patients were subjected to Ultrasonography and Computerised Tomography neck to conclusively map the location of the cyst. Fine Needle Aspiration of the tissue was done to diagnose malignancy. It was noted that there was maximum clustering of about 62.5% in males. About 45% of them belonged to the paediatric age group. The total number of symptomatic patients was about 59%. Unlike the various studies in literature, most of the thyroglossal duct cyst patients at our hospital were symptomatic. The symptoms were pain, dyspnoea, dysphagia, discharge and recurrence. Malignancy was diagnosed in two patients who were ironically asymptomatic. Other complications were looked into and treated. Thyroglossal duct cyst is a cervical anomaly that is usually found as an asymptomatic painless cystic swelling. However, most of our patients had a symptomatic presentation. Association with malignancy was noted. Surgical intervention was the cure for all the patients.

Aim:Hyperparathyroidism (HPT) is a condition that occurs due to exacerbated activity of the parathyroid glands. According to the etiology it may be primary, secondary or tertiary hyperparathyroidism (pHPT, sHPT, tHPT). This is a study done to document and evaluate the presentations of primary and secondary HPT, with the associated complications and the approach to management in these patients, at our hospital.Materials and Methods:Twenty-one patients with HPT were encountered at Sri Ramachandra Medical College and Research Institute between January 2000 and January 2010. Operative notes, histopathology files, and medical records were used for the retrospective analysis of the patients with HPT. Parathormone, calcium, and phosphate levels were estimated on all the patients, to determine the primary or secondary etiology of this endocrine abnormality. Furthermore, these patients were subjected to ultrasonography (USG) of the neck and Technetium (99 mTc) scan of the neck to identify the parathyroid gland.Results:This study revealed that about 76, 19, and 5% of the patients suffered from pHPT, sHPT, and tHPT, respectively, with a female preponderance (62%).The neoplasm in all patients with pHPT was parathyroid adenoma. The patients presented with renal, bony, and menstrual abnormalities. Cases with sHPT had a 15 – 20 year history of chronic kidney disease and they subsequently developed bony abnormalities. Even as all the patients with pHPT were managed with parathyroidectomy, individuals with sHPT were treated conservatively. Postoperative features of hypocalcemia were noted in only one patient.Conclusion:This study re-emphasizes that pHPT is more common and is often due to an adenoma. Recent advances in parathormone sampling operatively and minimal access surgery, along with accurate and prompt clinical diagnosis, is necessary for the cure of these patients presenting with obscure abdominal, bony, and renal ailments.

SUMMARY:The ileal diverticulum (Meckel's diverticulum) is a congenital outpouching located in the distal ileum which occurs due to the failure of obliteration of the yolk stalk. The peak age in which this anomaly is mostly found is the pediatric age especially below the age of two. Hence it is noted as an uncommon cause of intestinal obstruction and fatality in adult life. We present a case of a 26 year old man with abdominal pain and vomiting for 6 days associated fever for 3 days. Emergency laparotomy revealed ileal diverticulitis with small bowel obstruction. Ileal diverculectomy with ileal resection and ileoileal anastamosis was performed. However, the patient developed renal dysfunction leading to Multiorgan Dysfunction Syndrome and died on the fourth post operative day. This anatomic anomaly is rare in adult patients and is difficult to diagnose early due to its bizarre presentation resulting in high mortality in them. Hence we find this case of interest.

El divertículo de Meckel es un remanente congénito localizado en el ileum distal, el cual resulta de un defecto en el cierre del saco de Yolk. Esta anomalía es comunmente detectada en la poblacion pediátrica antes de los 2 años de edad. Por lo tanto, es una causa extraña de obstrucción intestinal y de mortalidad en adultos. Este es el reporte de un individuo de 26 años con 3 dias de fiebre y seis dias de dolor abdominal y vómito continuo. La laparotomía exploratoria demostró la presencia de una diverticulitis de Merkel y signos de obstrucción intestinal. Se realizó la resección del divertículo y parte del ileum afectado, seguido por anastomosis ileo-ileal. Sin embargo, el curso clinico del paciente se deterioró rápidamente debido al desarrollo de falla renal aguda y multiorgánica. Estas complicaciones llevaron al fallecimiento del paciente en su cuarto dia postoperatorio. En conclusión, la baja frecuencia de esta anomalía en adultos dificulta su diagnostico oportuno, teniendo como consecuencia un aumento en la mortalidad de estos casos clínicos. Meckel’s diverticulum is a congenital outpouching located in the distal ileum which occurs due to the failure of obliteration of the yolk stalk. The peak age in which this anomaly is mostly found is the paediatric age especially below the age of 2.  Hence it is noted as an uncommon cause of intestinal obstruction and fatality in adult life. This is a case report of a 26 year old man with abdominal pain and vomiting for 6 days associated with fever for 3 days. Emergency laparotomy revealed Meckel’s diverticulitis with small bowel obstruction. Meckel’s diverculectomy with ileal resection and ileoileal anastamosis was performed. However, the patient developed renal dysfunction leading to Multiorgan Dysfunction Syndrome and died on the 4th post operative day. This anatomical anomaly is rare in adult patients and is difficult to diagnose early due to its bizarre presentation resulting in high mortality. Hence we find this case of interest.