Spigelian hernia (SH) is rarely seen in the pediatric population and it is usually associated with undescended testis on the ipsilateral side. The condition has remained a question as to whether this is a cause, effect, or a new syndrome. Herein, we report the case of a 2-year-old child with right iliac region swelling that bulges out when he cries and the swelling disappears when he is sleeping. There was no vomiting or constipation. The parents also noticed the absence of the right testicle since birth. Examination revealed a reducible swelling in the right iliac region. The right hemiscrotum was hypoplastic and the testicle was not palpable. A diagnosis of right-sided Spigelian hernia with ipsilateral cryptorchidism was made. Contrast-enhanced computed tomography scan (CECT) did not reveal a hernia defect and the testicle was not localized. The hernia was repaired laparoscopically. The testes were found in the hernia sac and orchidopexy effected. The cryptorchid testis was a content of hernia sac which is a rare occurrence. Swelling in the iliac region in combination with ipsilateral undescended testes should be carefully evaluated. When the diagnosis of SH is established, it can be successfully repaired laparoscopically.

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Sinonasal phycomycosis or zygomycosis is an opportunistic infection caused by mold fungi belonging to the class Zygomycetes. These fungi are widely distributed in nature and mainly infect immunosuppressed patients. Herein, we present the rare case of sinonasal phycomycosis in an immunocompetent 37-year old man presented to an ENT surgeon with a history of rhinorrhea, nasal blockage, and progressive swelling of the cheek for 5 years, prior to presentation to hospital. A sinonasal soft tissue mass was observed with biopsy results yielding phycomycosis. Surgery was planned twice but was suspended by the patient himself. He finally absconded following a third appointment for surgery due to financial constraints. The purpose of this paper is to draw the attention of clinicians to strongly consider the inclusion of fungal infection as a differential diagnosis of orofacial or cheek swelling.

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Hydatid cyst is a common health-related entity in the developing world but is rarely seen as an isolated lesion in pancreas. It is mostly seen as a part of multisystem infection. It masquerades as cystic neoplasms clinically and radiologically, making its diagnosis a challenge. A high index of suspicion is required for timely diagnosis of such cases. We present one such rare case where a 50-year-old female patient was diagnosed as a case of serous cystadenoma on radiology. The patient underwent distal pancreatectomy with splenectomy for the same and on histopathology the lesion was diagnosed to be hydatid cyst of pancreas.

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Parasitic leiomyoma is a rare, benign smooth muscle tumor occurring in an extrauterine location. Their unusual growth pattern may mimic malignancy and, hence, could pose diagnostic and management challenges. Myxoid degeneration is further rarer finding in leiomyoma. There are few published cases of parasitic leiomyoma in our setting, hence, this report. A 52-year-old female presented with 4-year history of painless, progressive abdominal swelling with associated anorexia, weight loss, and body weakness. Abdominal examination revealed non-tender, nodular mass of 24 weeks size. Ultrasound scan showed a large well-defined heterogeneously hyperechoic right pelvic tumor crossing the midline. She had exploratory laparotomy; however, the histology confirmed parasitic leiomyoma with myxoid degeneration. Parasitic leiomyoma is an uncommon extrauterine benign tumor that mimics abdominopelvic malignancies. Meticulous clinical evaluation with radiologic and pathologic findings is the key to the otherwise challenging diagnosis.

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SAPHO syndrome is an association of specific bone, joint, and skin lesions. The acronym SAPHO refers to synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. However, not all these clinical manifestations need to be present to establish the diagnosis. It is a rare disease in which genetic predisposition or an autoimmune response to a microorganism in the skin mimicking a normal bone or joint molecular structure has been proposed. We present a 25-year-old man who presented with 2-year history of difficulty in opening the mouth with associated pain in the right jaw. He also developed progressive right hearing impairment and multiple acne-like rashes on his face 10 months prior to presentation. Examination of the right jaw revealed a tender firm immobile swelling in the region of the temporomandibular joint which was slightly warm to touch. CECT revealed cortical bone erosions of the right temporal squama and condyle with diffuse endosteal sclerosis and hyperostosis of the mandibular condyle and ramus. The temporal squama was partially resorbed with areas of bone remodeling. The right temporomandibular joint was also involved in the sclerotic changes with marked narrowing of its joint space. Based on the clinical and radiological features, a diagnosis of SAPHO syndrome was established. It is essential to make such diagnosis in order to avoid unnecessary and futile treatment.

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Penile tourniquet syndrome (PTS) is a condition in which a hair coil is wrapped around the penis causing damage to the urethra and penis. The spectrum of complications due to PTS may range from simple oedema of the penis to complete penile necrosis. We are reporting an 8-year-old boy who presented late to us with complete urethral transection having history of hair coil around penis 3 years back. Examination of the external genitalia revealed complete urethral transection at the coronal sulcus and deeply grooved cut mark at the dorsal part of the glans. The coronal sulcus was shallow and the glans overhanging. The urethral defect was about 0.5 cm. Following evaluation the patient underwent urethral repair by end to end anastamosis and was able to pass urine through the native urethral meatus postoperatively. Most of the cases reported in literature presented soon after the urethral injury unlike the index case which was discovered after 3 years.

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Background: Gallstone disease (GSD) is defined as the presence of one or more stones in the gallbladder. Prevalence of GSD in the adult population ranges from 6% to 9% in India. The present study was aimed to know the association of abdominal symptoms and GSD. Patients and Method: We conducted a case-control study from January 2013 to December 2013 among 120 cases and the same number of controls. Study subjects were selected from outpatient department (OPD) of general surgery. Data was collected by a self-designed pretested interview schedule, to assess sociodemographic profile, personal history, medical history, physical examination including anthropometry. Logistic regression was used for univariate and multivariate analysis to find out different symptoms and analyze the independent association of these symptoms with GSD. Results: We enrolled 120 cases and the same number of age and sex matched controls. 69.2% of the cases were females and 30.8% were males. Univariate as well as multivariate logistic regression analysis of presenting symptoms among study subjects showed only intolerance to fatty food (P = 0.000) and epigastric or hypochondric pain (P = 0.000) were found to be statistically significantly associated with gallstone disease. Conclusion: Biliary colic, consisting of sudden onset of pain in the epigastric or right hypochondric region lasting for more than 30 minutes is a good predictor of gallstone disease along with intolerance to fatty or spicy food.

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