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Bansal VK, Misra MC, Agarwal AK, Agrawal JB, Agarwal PN, Aggarwal S, Aslam M, Krishna A, Baksi A, Behari A, Bhattacharjee HK, Bhojwani R, Chander J, Chattopadhyay TK, Chintamani, Chowbey P, Dalvi A, Dash NR, Dhawan IK, Gamangatti S, Garg PK, Gupta NM, Gupta R, Gupta SK, Gupta V, Kaman L, Kapur BML, Kataria K, Khan M, Khanna AK, Khullar R, Kumar A, Kumar A, Kumar S, Kumar S, Lal P, Maurya SD, Moirangthem GS, Pal S, Panwar R, Parshad R, Pottakkat B, Prajapati OP, Puntambekar S, Ranjan P, Rathore YS, Sahni P, Sarangi R, Seenu V, Sharma R, Shukla VK, Singh DP, Singh J, Singh R, Sinha R, Sikora SS, Srivastava A, Srivastava A, Srivastava KN, Thomas S, Verma GR, Wig JD, Kapoor VK. SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B. Indian J Surg 2021. [DOI: 10.1007/s12262-019-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kochhar R, Malik S, Reddy YR, Mallick B, Dhaka N, Gupta P, Sinha SK, Manrai M, Kochhar S, Wig JD, Gupta V. Endoscopic balloon dilatation is an effective management strategy for caustic-induced gastric outlet obstruction: a 15-year single center experience. Endosc Int Open 2019; 7:E53-E61. [PMID: 30648140 PMCID: PMC6327726 DOI: 10.1055/a-0655-2057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/30/2018] [Indexed: 01/10/2023] Open
Abstract
Background and study aims There is sparse data on the endoscopic management of caustic-induced gastric outlet obstruction (GOO). The present retrospective study aimed to define the response to endoscopic balloon dilatation (EBD) in such patients and their long-term outcome. Patients and methods The data from symptomatic patients of caustic-induced GOO who underwent EBD at our tertiary care center between January 1999 and June 2014 were retrieved. EBD was performed using wire-guided balloons in an incremental manner. Procedural success and clinical success of EBD were evaluated, including complications and long-term outcome. Results A total of 138 patients were evaluated of whom 111 underwent EBD (mean age: 30.79 ± 11.95 years; 65 male patients; 78 patients with isolated gastric stricture; 33 patients with both esophagus plus gastric stricture). The initial balloon diameter at the start of dilatation, and the last balloon diameter were 9.6 ± 2.06 mm (6 - 15 mm) and 14.5 ± 1.6 mm (6 - 15 mm), respectively. Procedural and clinical success was achieved in 95 (85.6 %) and 108 (97.3 %) patients, respectively, requiring a mean (SD) of 5.3 (2.6) and 7.21 (3.86) sessions, respectively. Patients with isolated gastric obstruction had a better response than those with combined esophagus and gastric stricture. Minor complications such as self-limited pain or bleeding were seen in 18 (16.2 %) and 16 (14.4 %), respectively. Perforation occurred in two patients. Over a follow-up period of 98 months, there were no recurrences. Conclusion Caustic-induced GOO can be successfully managed using EBD with 97.3 % clinical success.
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Affiliation(s)
- Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India,Corresponding author Dr. Rakesh Kochhar, MD DM Department of GastroenterologyPGIMERChandigarh – 160012India+91-172-2744401
| | - Sarthak Malik
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India
| | - Yalaka Rami Reddy
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India
| | - Bipadabhanjan Mallick
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India
| | - Narendra Dhaka
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India
| | - Manish Manrai
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, Punjab, India
| | - Suman Kochhar
- Department of Radiodiagnosis, Government Medical College and Hospital, Sector 32, Chandigarh, Punjab, India
| | - Jai D. Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, Punjab, India
| | - Vikas Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, Punjab, India
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Kochhar R, Jain K, Gupta V, Singhal M, Kochhar S, Poornachandra KS, Kochhar R, Dutta U, Nagi B, Singh K, Wig JD. Fistulization in the GI tract in acute pancreatitis. Gastrointest Endosc 2012; 75:436-40. [PMID: 22154413 DOI: 10.1016/j.gie.2011.09.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/19/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
One of the major signaling pathways that determine the tumor aggression and patient outcome in pancreatic cancer is the transforming growth factor-beta (TGF-ß) pathway. It is inactivated at various levels in pancreatic cancer and plays a dual role in tumor initiation and progression. The Smad family of proteins transduce signals from the TGF-ß superfamily ligands that regulate cell proliferation, differentiation and death through activation of receptor serine/threonine kinases. This review discusses the structure, function and regulation of various participating Smad family members, and their individual roles in determining the progression and outcome of pancreatic cancer patients, with a special emphasis on Smad4.
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Affiliation(s)
- P Singh
- Kolling Institute of Medical Research, NSW, 2006, Australia.
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Singh P, Wig JD, Srinivasan R, Radotra BD. A comprehensive examination of Smad4, Smad6 and Smad7 mRNA expression in pancreatic ductal adenocarcinoma. Indian J Cancer 2011; 48:170-4. [PMID: 21768661 DOI: 10.4103/0019-509x.82876] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Smad4, Smad6 and Smad7 are important molecules in TGF-beta pathway, which plays an important role in pancreatic ductal adenocarcinoma (PDAC) biology. Aims : This study examined the expression profiles of Smad4, Smad6 and Smad7 mRNA in patient samples of PDAC and their relationship to Smad protein expression, SMAD4 gene mutations, clinicopathological parameters and patient survival. SETTINGS AND DESIGN Surgically resected, paired normal and tumor tissues of 25 patients of PDAC were studied. MATERIALS AND METHODS Protein and mRNA levels were assessed by immunohistochemistry and RT-PCR, respectively. STATISTICAL METHODS Statistical analysis was done using Student's t-test, Pearson's chi-square test, Spearman's Rank Correlation, Pearson's Correlation test and Kaplan-Meier Logrank test. RESULTS While there was a highly significant difference in the protein levels of all three Smads in tumor as compared to normal samples, mRNA levels were significantly different only for Smad4. Protein levels did not correlate significantly with mRNA levels for any of the three Smads. The mRNA levels of Smad4 and Smad6, Smad4 and Smad7, and Smad6 and Smad7 in tumor samples showed a significant positive correlation. The relationship of Smad4 mRNA expression to SMAD4 gene status and Smad4 protein expression was discordant and there was no significant correlation between mRNA expression and clinicopathological parameters and patient survival. CONCLUSION The absence of concordance between SMAD4 gene status, mRNA expression and Smad4 protein expression suggests the presence of other regulatory mechanisms in Smad4 transcription and translation in PDAC.
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Affiliation(s)
- P Singh
- School of Molecular and Microbial Biosciences, The University of Sydney, NSW, 2006, Australia.
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Kochhar R, Poornachandra KS, Puri P, Dutta U, Sinha SK, Sethy PK, Wig JD, Nagi B, Singh K. Comparative evaluation of nasoenteral feeding and jejunostomy feeding in acute corrosive injury: a retrospective analysis. Gastrointest Endosc 2009; 70:874-80. [PMID: 19573868 DOI: 10.1016/j.gie.2009.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 03/05/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nutritional support in corrosive injury patients is traditionally achieved through total parenteral nutrition (TPN) or jejunostomy feeding (JF). There are no reports of nasoenteral tube feeding in patients with corrosive ingestion. OBJECTIVE We report our experience with nasoenteral tube feeding (NETF) and compare the outcome of these patients with those undergoing JF. SETTING Tertiary medical center in North India. DESIGN AND INTERVENTION The records of 53 and 43 patients with severe acute corrosive injury who underwent NETF and JF, respectively, were reviewed. All had received a 50-kcal/kg, 2-g/kg protein homogenized liquid diet for 8 weeks. A contrast study was performed at 8 weeks, and body weight and serum albumin levels were recorded at hospitalization and at 8 weeks. MAIN OUTCOME MEASUREMENTS Change in weight and serum albumin at 8 weeks and stricture development rate. RESULTS Strictures developed in 41 (80.39%) and 36 (83.72%) patients in the NETF and JF groups, respectively. Development of esophageal stricture (P = .71) and gastric stenosis (P = .89) was comparable in the 2 groups. No significant changes in serum albumin and weight were noted at 8 weeks in either group. The complication rate was lower in the NETF group compared with the JF group. Although all of the patients in the NETF group had a patent lumen, 5 in the JF group had total obstruction precluding endoscopic intervention. LIMITATIONS Retrospective study design. CONCLUSION NETF is as effective as JF in maintaining nutrition in patients with severe corrosive injury. The stricture development rate is similar, but nasoenteral tube placement provides a lumen for dilatation should a tight stricture develop.
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Affiliation(s)
- Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Kochhar R, Dutta U, Shukla R, Nagi B, Singh K, Wig JD. Sequential endoscopic papillary balloon dilatation following limited sphincterotomy for common bile duct stones. Dig Dis Sci 2009; 54:1578-81. [PMID: 19005760 DOI: 10.1007/s10620-008-0534-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 09/11/2008] [Indexed: 12/11/2022]
Abstract
Endoscopic papillary balloon dilatation (EPBD) has been recently used in conjunction with endoscopic sphincterotomy (EST) for the removal of common bile duct (CBD) stones. The present study was aimed at assessing the safety and outcome of sequential EPBD following EST for CBD stones. A total of 74 patients (43 females, mean age 41 years) with > or = 10-mm stone(s) in the CBD were selected for the procedure, which included limited EST followed by EPBD with balloon dilators of 10-18 mm in size. Eleven patients had undergone EST and unsuccessful stone removal earlier. Forty-nine patients had symptoms of CBD stones, while 25 were detected on imaging. Eleven patients had previous CBD stent in situ and four had T-tube in situ. The stone size was 10-12 mm in 34, 13-14 mm in 26, and > or = 15 mm in 14 patients. Thirty-one patients had a single stone, while 43 had > or = 2 stones. The successful removal of stones was achieved in 68 (91.9%) patients; 62 in the first attempt, five in the second, and one in the third. Six patients were deemed to be "failures." In two of them, the stones could be removed after mechanical lithotripsy. Complications were seen in 16 patients, with self-limiting pain in 13, self-limiting ooze in five, melaena in one, and mild pancreatitis in two. One patient had impaction of the dormia basket. We conclude that EPBD following EST is safe and effective in removing stones > or = 10 mm in size in over 90% of patients.
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Affiliation(s)
- Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Gupta V, Wig JD, Kochhar R, Sinha SK, Nagi B, Doley RP, Gupta R, Yadav TD. Surgical management of gastric cicatrisation resulting from corrosive ingestion. Int J Surg 2009; 7:257-61. [PMID: 19401241 DOI: 10.1016/j.ijsu.2009.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/12/2009] [Accepted: 04/18/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Caustic injury to the stomach can be complicated by gastric stenosis. We review our experience with surgical management of symptomatic gastric stenosis. METHODS This is a retrospective chart review of patients who underwent surgery for gastric stenosis within 6 weeks to 26 months following corrosive ingestion. The data analyzed included the extent of cicatrisation, surgical procedure performed and outcome. Preoperative evaluation in these patients included a barium contrast study and upper gastrointestinal endoscopy. RESULTS Main presenting symptoms were nonbilious vomiting, early satiety, dysphagia and significant weight loss. Antropyloric strictures were present in 28 (64%) patients, total gastric involvement was seen in 16 (36%) patients, associated esophageal stenosis was present in 18 (40.91%) patients. Surgical procedures performed included distal gastrectomy with Billroth1 reconstruction in 31.82%, distal gastrectomy with Roux-en-Y reconstruction in 20.45%, stricturoplasty in 11.36%, subtotal gastrectomy in 18.18% and total gastrectomy with pouch reconstruction in another 18.18% patients. Complications encountered were pneumonitis in 18.18%, wound infection in 11.36%, intra-abdominal infection, anastomotic breakdown, reactivation of pulmonary tuberculosis and dumping syndrome, each in 2.27% patients. One patient (2.27%) died. CONCLUSION Surgical procedure should be tailored according to the extent of gastric involvement. Surgical resection is feasible and safe. Our results suggest that satisfactory outcome could be expected with different therapeutic modalities based on degree of cicatrisation.
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Affiliation(s)
- Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kochhar R, Masoodi I, Singhal M, Dutta U, Nagi B, Wig JD, Singh K. Pancreatogastric fistula after severe acute pancreatitis: a case report. Gastrointest Endosc 2009; 69:969-71. [PMID: 18926528 DOI: 10.1016/j.gie.2008.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Accepted: 05/16/2008] [Indexed: 12/10/2022]
Affiliation(s)
- Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Arora SK, Gupta S, Joshi K, Wig JD. High frequency of loss of allelic integrity at Wilms′ tumor suppressor gene-1 locus in advanced breast tumors associated with aggressiveness of the tumor. Indian J Cancer 2009; 46:303-10. [DOI: 10.4103/0019-509x.55550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wig JD, Nayak NC, Kumar S, Buxi TBS, Nundy S, Mittal KC, Gupta PS. A 20-year-old man with recurrent abdominal pain and vomiting since the age of 5 years. Familial chronic pancreatitis with nesidioblastosis and hyperinsulinaemic hypoglycaemia. Natl Med J India 2008; 21:307-312. [PMID: 19691221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- J D Wig
- Sir Ganga Ram Hospital, New Delhi
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Gupta S, Joshi K, Wig JD, Arora SK. Intratumoral FOXP3 expression in infiltrating breast carcinoma: Its association with clinicopathologic parameters and angiogenesis. Acta Oncol 2007; 46:792-7. [PMID: 17653902 DOI: 10.1080/02841860701233443] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The activity of T regulatory cells (Tregs) is known to be closely associated with the expression of forkhead/winged helix transcription factor, FOXP3. To determine, whether accumulation and activation of intratumoral Tregs help in the progression of breast carcinoma, we have analyzed the intratumoral expression of FOXP3 in invasive breast carcinoma and compared it with its level in ductal carcinoma in situ (DCIS) and adjacent normal tissue with the main aim of using this factor as marker of tumor progression. Intratumoral FOXP3 levels were correlated with the levels of transforming growth factor beta1 (TGF-beta1), vascular endothelial growth factor (VEGF, an invasogenic and angiogenic growth factor) and intratumoral microvessel density (IMD, a prognostic marker for angiogenesis). We also analyzed whether FOXP3 gene expression correlated with other clinicopathological variables like age, tumor stage, histological grade and lymph node metastasis. Infiltrating cancers had higher FOXP3 transcription (7.43+/-3.44) than did ductal carcinoma in situ (4.27+/-1.97, p<0.05) and normal tissues (3.51+/-1.22, p<0.001). Intratumoral FOXP3 expression was significantly higher in patients with stage III disease (TNM classification) compared to patients who had stage II disease (p=0.037). In infiltrating carcinoma, a significant positive correlation between FOXP3 expression and TGF-beta1 expression was noted (p<0.001). Furthermore, a positive correlation between FOXP3 expression with VEGF expression and IMD values was also detected, however, statistically that was non-significant. A linear association of intratumoral FOXP3 expression with invasion, size and vascularity suggests a utility of FOXP3, an indicator of Treg activity as a marker of tumor progression and metastasis in breast carcinoma.
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Affiliation(s)
- Sachin Gupta
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Singh L, Bakshi DK, Majumdar S, Vasishta RK, Arora SK, Wig JD. Expression of interferon-gamma- inducible protein-10 and its receptor CXCR3 in chronic pancreatitis. Pancreatology 2007; 7:479-90. [PMID: 17912012 DOI: 10.1159/000108965] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 04/23/2007] [Indexed: 12/11/2022]
Abstract
AIM The role of CXC chemokine, interferon-gamma-inducible protein-10 and its receptor CXCR3 in pathophysiology of chronic pancreatitis (CP) is not very clear. Hence, this study was carried out to analyze the expression of CXCL10 and CXCR3 in CP tissues. METHODS Pancreatic tissues from 25 histopathologically graded CP cases (11 alcohol associated CP, 5 confirmed idiopathic and 9 of undefined nature) and 10 normal cases were studied. Tissues were subjected to real-time PCR, immunohistochemistry, and Western blot analysis for CXCL10 and CXCR3 expression. RESULTS Real-time (RT)-PCR revealed increased expression of CXCL10 (13-fold) and CXCR3 (7-fold) in CP tissue. The immunohistochemistry and Western blot analysis of the same showed significant increased protein expression and correlated well with the histopathological grades. The CXCL10 was localized mainly in the cytoplasm of pancreatic acinar cells and expression increased from grade I to grade II and declined in grade III while no expression was recorded in normal. The CXCR3 was expressed strongly at the acinar cell membrane in CP as compared to normal. Further, comparative analysis by semiquantitative RT-PCR analysis was performed for other CXC/CC chemokines (CXCL9, CXCL11, CCL3, CCL4, CCL5) and receptor (CCR5) which revealed their upregulation in the diseased state. CONCLUSION The existence of CXCL10 and CXCR3 with other CXC/CC chemokine signature in CP is suggestive of their vital role in the progression of chronic inflammation.
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Affiliation(s)
- L Singh
- Department of General Surgery, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
AIM: To analyze the clinico-pathological spectrum of primary duodenal neoplasms.
METHODS: A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were included in the study. Clinical details were noted and routine hematoxylin and eosin stained paraffin sections were studied for histological subtyping of the tumors.
RESULTS: On histopathological examination primary duodenal neoplasms were categorized as: epithelial tumor in 27 cases (49.0%) including 10 cases of adenoma, 15 cases of adenocarcinoma, and 2 cases of Brunner gland adenoma; mesenchymal tumor in 9 cases (16.3%) consisting of 4 cases of gastrointestinal stromal tumor, 4 cases of smooth muscle tumor and I case of neurofibroma; lymphoproliferative tumor in 12 cases (21.8%), and neuroendocrine tumor in 7 cases (12.7%).
CONCLUSION: Although non-ampullary/periampullary duodenal adenocarcinomas are rare, they constitute the largest group. Histopathological examination of primary duodenal tumors is important for correct histological subtyping.
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Affiliation(s)
- Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Sciences and Research, Chandigarh 160012, India.
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Kalra N, Suri S, Bhasin DK, Sinha SK, Saravanan N, Kour T, Vaiphei K, Wig JD. Comparison of multidetector computed tomographic colonography and conventional colonoscopy for detection of colorectal polyps and cancer. Indian J Gastroenterol 2006; 25:229-32. [PMID: 17090838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Computed tomographic colonography (CTC) is a new technique for detecting colonic neoplasms. Data on the utility of this method in the Indian population are limited. METHODS Forty-two patients with symptoms of colonic disease underwent CTC and conventional colonoscopy (CC) within one week of each other and the findings at these two investigations were compared. RESULTS The entire colon could be evaluated in 38 patients on CTC and in 23 patients on CC. Of the 19 patients who had incomplete CC, 14 had occlusive colonic lesions. Of the 86 lesions detected on CC, 76 (88.4%) were correctly identified on CTC with regard to location and size. CTC was false negative for 10 lesions and false positive for 5 lesions in 3 patients. The sensitivity and specificity of CTC were 65% and 77%, respectively, for lesions 1-5 mm; 97% and 83% for 6-9 mm-sized lesions; and 100% and 100% for lesions 10 mm or larger. Extracolonic findings were seen in 24 of 42 patients (57%). CONCLUSIONS CTC is reliable for detecting lesions 6 mm or larger in size. It permits evaluation of the region proximal to an occlusive growth, which is often not possible with CC.
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Affiliation(s)
- Naveen Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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Kaza RK, Gulati M, Wig JD, Chawla YK. Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography. ACTA ACUST UNITED AC 2006; 50:212-7. [PMID: 16732816 DOI: 10.1111/j.1440-1673.2006.01564.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study is to evaluate the efficacy of dynamic MRI with magnetic resonance cholangiopancreatography (MRCP) in the preoperative assessment of gall bladder carcinoma. Magnetic resonance imaging and MRCP were carried out in 15 patients with gall bladder carcinoma before surgery and the imaging findings correlated with surgical and pathological findings. Gall bladder carcinoma manifested as focal or diffuse wall thickening in 73% (11/15) and as a mass replacing the gall bladder in 27% (4/15). All tumours showed enhancement in the early phase, which persisted into the delayed phase. The sensitivity and specificity of MRI with MRCP in detecting hepatic invasion, lymph node metastasis and bile duct invasion was 87.5 and 86%, 60 and 90%, and 80 and 100%, respectively. Magnetic resonance imaging correctly diagnosed duodenal invasion in only 50% and in none of the two patients with peritoneal metastasis. In conclusion, dynamic MRI with MRCP is an accurate and a reliable method of showing gall bladder carcinoma and in assessing its local and regional extent as part of preoperative assessment.
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Affiliation(s)
- R K Kaza
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
OBJECTIVE The purpose of our study was to determine the utility of dual-phase MDCT with 3D reconstruction in the staging and resectability of gallbladder carcinoma. SUBJECTS AND METHODS Twenty-seven consecutive patients with suspected gallbladder carcinoma on clinical examination and routine sonography were prospectively analyzed with dual-phase MDCT. Of these patients, only 20 who underwent a laparotomy for extended cholecystectomy or a palliative surgery were included in the study. Three-dimensional volume-rendered reconstruction was used for evaluation of the vascular invasion and anatomy. The staging and resectability as determined on CT were compared with preoperative findings. RESULTS On the basis of the CT findings, eight tumors were resectable and 12 were unresectable. On surgery, 11 tumors were found to be resectable and the remaining were unresectable. Overstaging by CT occurred in three patients due to overassessment of duodenal infiltration. CT had a sensitivity of 72.7%, a specificity of 100%, and an accuracy of 85% for determining resectability of gallbladder carcinoma. For the diagnosis of hepatic and vascular invasion by the tumor, there was 100% correlation between CT and surgery. Vascular variations were found in six of the 11 patients who underwent radical cholecystectomy. CONCLUSION Dual-phase MDCT with 3D reconstruction is a comprehensive imaging technique for staging gallbladder carcinoma and determining the vascular road map before surgery.
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Affiliation(s)
- Naveen Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, PGIMER, Sector 12, Chandigarh, India 160012.
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Budhiraja S, Wig JD, Gupta NM, Khanna SK. Xanthogranulomatous cholecystitis. J Indian Med Assoc 2003; 101:586-7, 596. [PMID: 15168974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Twelve cases of xanthogranulomatous cholecystitis are reported. The clinical presentation was similar to chronic cholecystitis. All patients had associated gallstones. The diagnosis was achieved at histopathological examination of the resected gall bladders and none had any focus of malignancy. Cholecystectomy was curative.
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Affiliation(s)
- Sushil Budhiraja
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012
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20
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Bidarkundi GK, Wig JD, Bhatnagar A, Majumdar S. Clinical relevance of intracellular cytokines IL-6 and IL-12 in acute pancreatitis, and correlation with APACHE III score. Br J Biomed Sci 2002; 59:85-9. [PMID: 12113409 DOI: 10.1080/09674845.2002.11783640] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pro-inflammatory cytokines are involved in the pathogenesis of acute pancreatitis (AP). Here, we measure and correlate clinically the percentages of peripheral blood mononuclear cells (PBMC) that contain interleukin (IL)-6 and IL-12 and compare these with acute physiology and chronic health evaluation (APACHE III) scores in 30 patients with AP. Severity of AP is determined according to the Atlanta criteria. Patients with severe AP (n = 15) had significantly higher IL-6 values compared to those with mild AP (n = 15). IL-12 levels correlated well with aetiological factors (alcohol and biliary pathology) in patients with AP. Correlation was seen between IL-6 value and APACHE score in severe AP. A score of 30 points was used as the cut off between mild (<30) and severe (>30) cases, with a sensitivity of 80% and specificity of 100%. Cut off percentages for IL-6- and IL-12-positive PBMCs were >25% (positive predictive value [PPV]: 100%) and >9% (PPV: 70%), respectively. Based on these results, it would seem logical to use both APACHE III score and IL-6 percentage to assess severity in patients with AP.
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Affiliation(s)
- G K Bidarkundi
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Dutta U, Nagi B, Kumar A, Vaiphei K, Wig JD, Singh K. Pneumobilia--clue to an unusual cause of diarrhea. Trop Gastroenterol 2002; 23:138-40. [PMID: 12693157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
A 65-year lady presented with diarrhea and weight loss of six months duration. Initial evaluation suggested that malabsorption was the possible underlying mechanism for the diarrhea. Work up for the common etiologies of malabsorption was non-contributory. Presence of pneumobilia raised the suspicion of a bilio-enteric fistula, which was subsequently confirmed on barium enema and endoscopic cholangio-pancreaticography to be a cholecystocolic fistula. At surgery, a fistulous tract from the fundus of the gallbladder was found to be communicating with the hepatic flexure. Fistulectomy with cholecystectomy resulted in prompt relief of symptoms. Cholecystocolic fistula (CCF) is a rare biliary fistula with diverse presentation.
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Affiliation(s)
- U Dutta
- Department of Gastroenterology and Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India-160 012.
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22
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Verma GR, Bose SM, Wig JD. Pericholecystic adhesions in single v multiple gallstones and their consequences for laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2001; 11:275-9. [PMID: 11642662 DOI: 10.1089/109264201317054555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adhesions are amongst the common reasons for open conversion of laparoscopic cholecystectomy. It is not clear whether this problem is more common with single or multiple gallstones. PATIENTS AND METHODS The clinical records of 110 patients with chronic cholelithiasis harboring multiple stones in the gallbladder (multiple stone group; MSG) and 45 patients with single stones in the gallbladder (SSG) undergoing laparoscopic cholecystectomy were analyzed for differences in the clinical presentation and outcome with special reference to the incidence of pericholecystic adhesions, size of the stones, and their implications for conversion and complications. RESULTS Patients in the SSG had a significantly higher incidence of dense pericholecystic adhesions in the region of the porta hepatis (P = 0.003). Eleven patients in the SSG (24.4%) were converted to open cholecystectomy. Dense pericholecystic adhesions around the porta hepatis alone contributed to nine of these conversions (81.8%). The size of the stones was significantly greater (P < 0.001) in those patients of the SSG who required conversion to open cholecystectomy. Thirteen patients of the MSG (11.8%) required conversion to open cholecystectomy. Dense pericholecystic adhesions alone contributed to conversion in four cases (30.7%), and the size of the gallstones was not significantly different (P = 0.981) in patients with or without conversion to open cholecystectomy. There was no difference in the clinical presentation or complications in the two groups of patients. CONCLUSION Dense adhesions in the porta hepatis are significantly more common in patients with single stones and are the most common reason for open conversion.
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Affiliation(s)
- G R Verma
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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23
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Nada R, Vaiphei K, Singh R, Wig JD, Gupta NM, Banerjee AK. Gastrointestinal stromal tumors the assessment of malignant potential. INDIAN J PATHOL MICR 2001; 44:393-7. [PMID: 12035347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
GISTS are the largest category of non-epithelial neoplasms of stomach and small bowel. Numerous immunohistochemical, ultrastructural and flow cytometry studies have been carried out for evaluation of prognostic factors which could predict malignant behaviour of these neoplasms. Tumor size of 5 cm and mitosis of 2/10 hpf were suggested as two important parameters which could predict the chances of recurrence and clinically aggressive course. The aim of this study is to examine predictive value of these two important parameters in assigning the tumors as high, intermediate and low risk groups. Using these two parameters we categorized 30 cases of GIST over a period of 6 years (1990-95) into low, intermediate and high risk groups and examined other features of these cases. Based on these two parameters alone we found that 4 cases each in low and intermediate group could be assigned to a higher risk group clinically as there were presence of adjacent organ infiltration, lymphatic emboli, serosal nodules, lymph node metastasis and transmural infiltration. Hence, other features like hemorrhage, necrosis and anaplasia should also be included in risk assessment. Metaplastic tissues like bone, cartilage and adipose tissues were seen only in high-risk categories.
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Affiliation(s)
- R Nada
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh
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24
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Abstract
Adhesion and activation molecules as well as cytokines play an important role in an immune scenario. In acute pancreatitis, we have studied some of these in order to evaluate dysregulation. For this we took peripheral blood mononuclear cells and pancreatitis tissue cells. We analysed activation markers like CD69, CD25 and HLA-DR and found a marked elevation of CD69 as well as CD25 in both peripheral blood cells and tissue mononuclear cells when compared to controls. In PBMC-CD69: P<0.01 and CD25: P<0.01; in tissue-CD69: P<0.001 and CD25: P<0.001. The HLA-DR levels, however, were reduced in the disease state (in acute pancreatitis patient blood (P<0.01) and tissue cells (P<0.001)). The adhesion molecules showed unanimous rise in the blood and the tissue samples. In blood samples, CD11a: P<0.05 and CD11b: P<0.05 and tissue samples CD11a: P<0.01 and CD11b: P<0.01and CD54 in peripheral blood (P<0.05) and tissue (P<0.01) of AP was high as compared to controls. By simultaneous flowcytometric analysis, we determined the co-expression of a surface marker (CD4/CD8/CD14) and intracellular cytokine (TNF-alpha and IFN-gamma) in individual cells. The IFN-gamma producing CD8+T cells were elevated in pancreatic tissue (P<0.01). TNF-alpha producing cell numbers were significantly higher in tissue cells than in blood and also in CD8+ T cells (P<0.001). We conclude that monocyte function is affected in AP as shown by reduced HLA-DR numbers and lowered TNF-alpha producing cells. Moreover, the CD8+T cells appear to play an important role in cytokine synthesis at the effector site.
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Affiliation(s)
- A Bhatnagar
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, 160 012, Chandigarh, India
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25
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Abstract
Tuberculous involvement of the stomach is rare. We report herein the unusual case of a 25-year-old man in whom a benign gastric ulcer was found along the lesser curvature after he presented with massive upper gastrointestinal bleeding. Histopathological examination helped to confirm a diagnosis of tuberculosis. The granulomas typical of tuberculosis were caseation with epithelioid and giant cells. The patient was successfully treated by a combination of appropriate surgical therapy and prompt institution of antituberculosis medication.
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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26
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Abstract
The objective of the study was to evaluate the usefulness of two-phase incremental contrast-enhanced computed tomography (CT) with water-filling method in the preoperative assessment of stomach carcinoma. Dynamic CT was done in 20 patients with biopsy-proven gastric cancers and the findings were compared with surgery. A 150-ml ionic contrast medium was administered intravenously at a flow rate of 3.5 ml/s. CT scanning was done at 45 s (early phase) and 3 min (equilibrium phase) after the start of intravenous injection. Primary tumors were detected in all the cases. The overall accuracies of dynamic CT in determining depth of tumor invasion, pancreatic invasion, adjacent liver infiltration, and lymph node metastasis were 85% (17/20), 90% (18/20), 85% (17/20), and 69% (13/19), respectively. The early phase of dynamic CT is highly accurate in determining the depth of tumor invasion of advanced gastric cancers but has low sensitivity in the detection of nodal metastasis. The delayed phase scans do not add any additional information and hence, should not be routinely used for staging.
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Affiliation(s)
- N B Mani
- Department of Radiodiagnosis and Imaging, Postgraduate, Institute of Medical Education and Research, 160 012, Chandigarh, India
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27
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Bhasin DK, Poddar U, Wig JD. Knot formation in a floppy-tipped guidewire in the common bile duct: an unusual complication of ERCP. Endoscopy 2000; 32:S17. [PMID: 10774982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D K Bhasin
- Dept. of Gastroenterology and Surgery, PGIMER, Chandigarh, India.
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28
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Kumar S, Wig JD, Kochhar R, Vaiphei K. Concurrent renal transitional cell carcinoma and right colon cancer. Indian J Gastroenterol 2000; 19:35-6. [PMID: 10659489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 45-year-old man who had undergone right radical nephrectomy for transitional cell carcinoma 3 months earlier was admitted with right colonic tumor. Review of CT done for right kidney tumor was suggestive of right colon pathology. Right hemicolectomy was performed, followed by a course of chemotherapy for mucinous adenocarcinoma, and he is well a year later.
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Affiliation(s)
- S Kumar
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
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29
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Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol 1999; 40:422-8. [PMID: 10394872 DOI: 10.3109/02841859909177758] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are limited studies in the literature comparing plain radiography, US and CT in the evaluation of intestinal obstruction. We carried out this prospective study to compare the relative efficacies of these three imaging techniques in patients with intestinal obstruction. MATERIAL AND METHODS Thirty-two patients presenting with clinical suspicion of intestinal obstruction were subjected to plain radiography, US and CT and the findings were compared with reference to the presence or absence of obstruction, the level of obstruction and the cause of obstruction. The final diagnosis was obtained by surgery (n=25), or by contrast studies and/or clinical follow-up in those who were treated conservatively (n=7). RESULTS Out of 32 patients, 30 had mechanical intestinal obstruction (22 had small bowel obstruction and 8 had large bowel obstruction). Of the remaining 2 patients, 1 had adynamic ileus and the other had a mesenteric cyst. CT had high sensitivity (93%), specificity (100%) and accuracy (94%) in diagnosing the presence of obstruction. The comparable sensitivity, specificity and accuracy were, respectively. 83%, 100% and 84% for US and 77%, 50% and 75% for plain radiography. The level of obstruction was correctly predicted in 93% on CT, in 70% on US and in 60% on plain films. CT was superior (87%) to both US (23%) and plain radiography (7%) in determining the aetiology of obstruction. CONCLUSION CT is a highly accurate method in the evaluation of intestinal obstruction especially for determining the level and cause of obstruction and should be the technique of choice when clinical or plain radiographic findings are equivocal.
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Affiliation(s)
- S Suri
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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30
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Wig JD. Pancreatic necrosis: an overview. Trop Gastroenterol 1999; 20:61-3. [PMID: 10484888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh.
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31
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Wig JD, Kumar H, Suri S, Gupta NM. Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice--a prospective randomised study. J Assoc Physicians India 1999; 47:271-4. [PMID: 10999118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Patients with obstructive jaundice undergoing surgical procedures have a significant risk of morbidity and mortality. The role of preoperative percutaneous transhepatic biliary drainage (PTBD) was evaluated in a randomized trial. METHODS A total of 40 patients were assigned to either preoperative PTBD (n = 20), or surgery alone (n = 20). PTBD was performed under ultrasound guidance. There were no major complications related to the procedure. RESULTS Ultrasound guided drainage was a successful and safe method of preoperative biliary decompression. There was a marked relief from pruritus and significant reduction of hyperbilirubinaemia from a mean of 386.48 mumol/L to 116.10 mumol/L (p < 0.001). Mean duration of drainage was 42.5 days. Postoperative complications occurred in five patients in PTBD group (25%) compared to 11 patients (55%) in the control group. One death (5%) occurred in PTBD group compared to four deaths (20%) in the control group (significant at 5% level with probability 0.2). CONCLUSIONS Ultrasound guided drainage is a useful preoperative supportive measure in preparing deeply jaundiced patients for surgery and permits hepatic function to return to a near normal state preoperatively. The improved results in our study were due to longer duration of drainage.
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Affiliation(s)
- J D Wig
- Dept. of Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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32
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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33
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Abstract
A case of isolated candidal fungal balls in the common bile duct causing obstructive jaundice and cholangitis is described. There were no predisposing factors. The fungal balls were removed from the common bile duct and a transduodenal sphincteroplasty was performed. Microscopic analysis yielded colonies of candida. Postoperative period was uneventful. At follow-up no evidence of candida infection was evident. He is now 3 years post-surgery and is well.
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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34
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Abstract
The incidence of complications of acute pancreatitis is high in patients with endotoxemia, and so we determined the endotoxin levels in the blood and peritoneal fluid of patients with acute severe pancreatitis to correlate the levels with any sequelae. Fourteen patients with acute severe pancreatitis were examined with regard to clinical features, biochemical tests, and laparotomy (n = 9). In all coagulation profiles, blood gas analysis, chest and abdominal x-rays, ultrasound, and abdominal computed tomography scan (n = 10) were performed. Qualitative estimation of endotoxin levels was done in peripheral blood and peritoneal and peripancreatic fluid. Ten (71.42%) of 14 patients had endotoxin in the blood, and 9 (64.28%) had it in the peritoneal fluid. Twelve (85.7%) had pulmonary involvement, with hypoxia being the most common (85.7%); among them endotoxin was found in the blood of 10 (83.32%) and in the peritoneal fluid of 8 (66.66%) patients. Renal dysfunction was found in 4 (28.57%) patients; endotoxin was present in the blood of all 4 patients and in the peritoneal fluid of 3 (75%) patients. Cardiovascular abnormality was detected in 8 (57.14%) patients, and endotoxin was present in the blood and peritoneal fluid of all patients. Metabolic abnormality was present in 8 (57.14%) patients; endotoxin was present in the blood of all 8 patients and in the peritoneal fluid of 7 (87.6%) patients. Eight (88.88%) of the 9 patients who required surgery had endotoxemia. Three (30%) patients with endotoxemia survived, whereas all 4 patients without endotoxemia survived. Mean hospital stay was 61.2 days and 46.7 days for endotoxin-positive and endotoxin-negative patients, respectively. We conclude that the presence of endotoxin in blood and peritoneal fluid correlates with the severity, systemic complications, and mortality rates of acute pancreatitis. Endotoxin estimation can identify patients at risk in the early stages of acute pancreatitis.
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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35
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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36
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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37
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Singh DP, Sharma SC, Sandhu AP, Goenka MK, Kochhar R, Nagi B, Sur RK, Patel FD, Ayyagari S, Bhatia SS, Mukhopadhyay P, Xavier S, Bhasin D, Singh K, Wig JD, Gupta NM, Das A, Gupta BD. Primary gastrointestinal lymphoma--disease spectrum and management: a 15-year review from north India. Indian J Gastroenterol 1997; 16:88-90. [PMID: 9248177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze retrospectively the disease spectrum and outcome of primary gastrointestinal lymphoma (PGIL) in a tertiary referral center in north India. MATERIAL Seventy five patients presenting with PGIL between January 1971 and December 1985 were evaluated. RESULTS The 49 males and 26 females were aged 3.5-69 years (mean 34) at presentation. Abdominal pain, weight loss and vomiting were cardinal symptoms at presentation; the stomach was the most common site of involvement. Histologically, a majority of patients were classified as having diffuse poorly-differentiated lymphocytic lymphoma (46.7%) and diffuse histiocytic type (30.7%). Twenty seven (36%) patients had stage I disease, 31 (40%) stage II, 11 (14.7%) stage III, and 6 (8%) stage IV. At laparotomy, primary resection and anastomosis was carried out in 66 patients, while only biopsies were taken in nine. Forty eight patients received adjuvant radiation with or without chemotherapy. The mean follow-up was 3.9 years (range 1-14). The 5-year actuarial survival was 34%, 25% and 16% for stages I, II, and higher-stage disease, respectively. The survival was significantly better (p < 0.01) for gastric location (44%) compared to other sites (24%). CONCLUSION PGIL was more common in the 3rd and 4th decades of life, with the stomach being the predominant site of involvement. Survival was better among patients with stages I and II disease, and gastric location of lesion.
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Affiliation(s)
- D P Singh
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh
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38
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Chakrabarti A, Kumar P, Padhye AA, Chatha L, Singh SK, Das A, Wig JD, Kataria RN. Primary cutaneous zygomycosis due to Saksenaea vasiformis and Apophysomyces elegans. Clin Infect Dis 1997; 24:580-3. [PMID: 9145731 DOI: 10.1093/clind/24.4.580] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We report three cases of primary cutaneous zygomycosis due to either Saksenaea vasiformis (two patients) or Apophysomyces elegans (one patient). Extensive surgical debridement helped two patients recover from their infections. The underlying disease in the one patient who died was diabetes mellitus. We reviewed the literature on primary cutaneous zygomycosis and found that S. vasiformis and A. elegans were the etiologic agents in 16 and 13 earlier cases, respectively.
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Affiliation(s)
- A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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39
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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40
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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41
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Verma GR, Wig JD. Pancreatoduodenectomy in abdominal trauma: a viable alternative. Indian J Gastroenterol 1997; 16:26-7. [PMID: 9167377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pancreatoduodenectomy was performed in five patients with severe pancreatoduodenal trauma following vehicular accidents. Three of them presented within five hours of injury and two patients, four and ten days later. Surgery was performed within 6-12 hours of hospitalization. All patients underwent pancreatoduodenectomy; in one the pancreatic stump was closed completely owing to its friability. Three patients survived; two succumbed to ongoing preoperative septicemia due to late presentation. The results of pancreato-duodenectomy are good when patients are operated on early, before the development of sepsis.
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Affiliation(s)
- G R Verma
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
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42
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Takhtani D, Gupta S, Suman K, Kakkar N, Challa S, Wig JD, Suri S. Radiology of pancreatic tuberculosis: a report of three cases. Am J Gastroenterol 1996; 91:1832-4. [PMID: 8792708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report three cases of biopsy proven pancreatic tuberculosis. The patients presented with abdominal pain and intermittent fever. Ultrasound and computed tomography revealed a diffusely enlarged pancreas with focal hypoechoic/hypodense lesions in all three patients. In addition, one patient had a large pancreatic cyst with internal echoes. Associated findings included peripancreatic and mesenteric lymph nodes, bowel wall thickening of ileocecal junction, focal hepatic or splenic lesions, splenic vein thrombosis, and ascites. Pancreatic tuberculosis should be considered in the differential diagnosis of focal pancreatic lesions, especially if associated with ancillary findings such as enlarged hypodense nodes in the peripancreatic region or in the mesentery in patients presenting with longstanding fever and abdominal pain.
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Affiliation(s)
- D Takhtani
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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43
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Das K, Goenka MK, Wig JD, Nagi B, Bhasin D. Pancreatic carcinoma complicating tropical pancreatitis in north India. Indian J Gastroenterol 1996; 15:103. [PMID: 8840639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- K Das
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
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44
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Wig JD, Goenka MK, Nagi B, Vaiphei K. Abdominal cocoon in a male: rare cause of intestinal obstruction. Trop Gastroenterol 1995; 16:31-3. [PMID: 8854953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abdominal cocoon, which is characterised by encasement of bowel by a fibrous membrane, is a rare cause of intestinal obstruction. It occurs primarily in females with only three cases reported earlier in males. We report a male patient presenting with small bowel obstruction and detected to have abdominal cocoon at surgery. Incision of thick membrane and lysis of adhesions led to relief of obstruction without any recurrence.
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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45
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Wig JD, Goenka MK, Bhasin DK, Vaiphei K. Eosinophilic gastroenteritis presenting as acute intestinal obstruction. Indian J Gastroenterol 1995; 14:104-5. [PMID: 7657362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Eosinophilic gastroenteritis is a rare disorder of the gastrointestinal tract. Three cases of eosinophilic gastroenteritis presenting as intestinal obstruction are reported. Two patients had stenotic lesions in the jejunum whereas the ileum was involved in the third. None had peripheral eosinophilia. All underwent resection-anastomosis of the bowel and are symptom-free at follow-up ranging from 8 months to 6 years.
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
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46
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Wig JD, Kochhar R, Goenka MK, Singh SK, Nagi B, Suri S, Vaiphei K. Colovesical fistula complicating colonic diverticulosis. Indian J Gastroenterol 1995; 14:73-4. [PMID: 7797284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Two cases of colovesical fistulae secondary to colonic diverticulosis are reported. Urinary symptoms were the prominent presenting features. Barium enema was helpful in documenting the fistulae, which cystoscopically was not localised. Definitive treatment included resection of the fistula and the diseased segment of the intestine. Both patients are well on follow-up. Diverticulosis coli should be considered in the differential diagnosis of colovesical fistulae even in tropical countries.
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
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Kumar A, Wig JD, Kochhar R, Gupta NM, Nagi B. An audit of pneumatic dilatation and oesophagomyotomy in patients with achalasia cardia. Trop Gastroenterol 1994; 15:152-6. [PMID: 7863551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The role of pneumatic dilatation and oesophagomyotomy in the management of achalasia cardia was evaluated. Twenty patients with achalasia cardia managed either by pneumatic dilatation (n = 10) and oesophagomyotomy (n = 10) were studied. Patients undergoing dilatation were followed up for a mean of 20 months (12-30 months) and those undergoing myotomy for 17 months (6-48 months). The patients were evaluated clinically, radiologically and endoscopically. Relief of dysphagia was excellent in 20%, good in 50% and fair in 30% of those who underwent dilatation. In the myotomy group, 60% had an excellent result, 30% had a good result and fair results was observed in 10%. Oesophagitis on endoscopic evaluation, was found in two patients in myotomy group. The diameter of the gastro-oesophageal junction increased from a mean of 2 mm (range 1 to 4 mm) to a mean of 11 mm (range 4 to 15 mm) in dilatation group while in myotomy group it changed from a mean of 2 mm (range 0.5 to 8 mm) to a mean of 9 mm (range 5 to 15 mm). Symptomatic improvement was better after myotomy than after pneumatic dilatation and correlated poorly with radiological features.
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Affiliation(s)
- A Kumar
- Department of surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Verma GR, Wig JD, Khanna SK, Bose SM. Management of duodenal trauma. Trop Gastroenterol 1994; 15:23-8. [PMID: 7974753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The surgical management of fifteen cases of duodenal trauma is reported. Blunt injury of the abdomen was the commonest mode of injury. Thirteen patients (86.6%) had associated intra-abdominal and/or extra-abdominal injuries. Diagnosis of duodenal injury was made at laparotomy in all patients. In the majority of patients (n = 11), either duodenal repair, or anastomosis with the pylorus or jejunum was done. Duodenal diverticulization or pancreaticoduodenectomy were undertaken in 2 patients each. Feeding jejunostomy was an important adjunct for nutritional support. Septicemia with multisystem organ failure and duodenal fistula were lethal complications. Mortality in the present series was 46.6%.
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Affiliation(s)
- G R Verma
- Department of Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Abstract
Bile duct or choledochal cysts are rare congenital anomalies and presentation in adult is infrequent. Seven cases of type I/IV bile duct cysts presenting in adult life have been treated by the authors during the past 2 years. The diagnosis was made using a combination of ultrasound and cholangiography (endoscopic retrograde cholangiopancreatography/percutaneous transhepatic cholangiography). All cases underwent total cyst excision and Roux-en-Y hepaticojejunostomy. There were no operative complications and all patients were asymptomatic in the follow-up period, which ranged from 3 to 23 months.
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Affiliation(s)
- S M Bose
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh K, Nagarjuna YR, Nagi B, Bhasin DK, Wig JD. Long common channel syndrome as etiology of choledochal cysts and pancreatitis--two instructive cases. Trop Gastroenterol 1993; 14:33-6. [PMID: 8342248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aetiology of choledochal cysts is controversial. The authors report two cases of Type I C and Type IV B choledochal cysts; both showing axial dilatation of the common bile duct and common hepatic ducts, single fusiform (Type IC) and multiple cysts of extrahepatic ducts only (Type IVB). Both had anomalous junction of the pancreaticobiliary ductal system as delineated on ERCP leading to the formation of a long common channel. Both these female patients presented in the third decade of life with 7-8 years history of repeated episodes of right upper abdominal and epigastric pain suggestive of pancreatitis. Similar pain was precipitated in both patients following ERCP with raised serum amylase. Hepatico-enterostomy gave lasting relief in both these patients.
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Affiliation(s)
- K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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