Background: A congenital mesenteric defect is very rare, but can potentially cause internal hernia with consequent incarceration or strangulation of the small intestine. The incidence of mesenteric hernia, as reported by Shaffner and Tennel [1] in a series of autopsies, was found to be 0.2 to 0.9% [2]. Patient's medical examination revealed the presence of internal hernias. Difficulty in reaching a definitive diagnosis due to non-specific clinical and imaging findings often cause life-threatening bowel ischemia.  Case Presentation: A 14-year-old girl, without any remarkable antecedent history, presented to the hospital with progressive abdominal pain in epigastric region, nauseous, and bilious vomiting occurring three days before admission. Clinical examination abdominal findings were distension with decreased bowel sounds and pain in deep palpation in epigastrium region. Discussion: The mesenteric defect is located 22 cm from the ligament of Treitz. Her intestinal obstruction and strangulation were so complex that resection required incision of the mesenterium. Her intestinal obstruction and strangulation were so complex that resection required incision of the mesenterium. Thus we proceeded with reduction of the bowel, small bowel untwisting, and closure of the mesenteric defect followed by primary anastomosis. Conclusion: Internal hernia is one of the rare causes of small bowel obstruction. Treatment involves repositioning of the intestinal loops at all times and prudent closure of the peritoneal orifice in question. Early intervention and surgical correction goes a long way in preventing high morbidity and mortality associated with cases of internal hernia.

Background: Nipple-sparing mastectomies (NSMs) are a relatively new method of conservatism in the treatment of breast cancer. Most of the breast skin is left intact during NSM, creating a pocket that can be filled with an implant or an autologous graft for a rapid reconstruction that yields an excellent cosmetic outcome. Combining prosthetic-based breast restoration with autologous flaps, such the latissimus dorsi (LD) flap, may be necessary to achieve symmetry. Case Description : A 45 year old woman who developed a breast deformity following a mastectomy for breast cancer. The Latissimus dorsi (LD) flap was chosen because it is a thin layer flap with good vascularization. The Latissimus dorsi (LD) flap, on the other hand, necessitates a different skin incision than the mastectomy. An inframammary adipofascial flap has been used as an autologous flap in conjunction with prosthetic-based breast reconstruction subsequent to nipple-sparing mastectomy (NSM). In this instance, the Latissimus dorsi muscle flap was employed in the axillary and breast regions. The Latissimus dorsi (LD) flap was deemed suitable as it can provide extensive coverage without any delay in the transfer procedure. Anatomically, this flap and its vascular supply are quite consistent. The arterial supply is provided by the thoraco-dorsal artery which provides a large branch to the serratus anterior muscle and provides a cutaneous branch. Successful management of the infection, postoperative partial weight bearing, and restricted range of motion in the affected breast was anticipated. Conclusion: The latissimus dorsi flap is a safe choice for skin regeneration after a nipple sparing mastectomy. This procedure has the advantage of minimizing donor site morbidity.

Thymic epithelial tumors, including thymomas and thymic carcinomas, are rare and their management remains challenging due to limited and predominantly retrospective data. We report the case of a 28-year-old woman with ileocolic Crohn’s disease in remission who developed a B2 thymoma while receiving infliximab-based anti-TNF therapy. She presented with features of superior vena cava syndrome, and imaging revealed an anterior mediastinal mass. Histopathology and immunohistochemistry confirmed the diagnosis of B2 thymoma. Although anti-TNF agents have been associated with increased risks of certain malignancies—particularly skin cancers and lymphomas—current evidence does not demonstrate a clear link between anti-TNF therapy and thymic tumors. To our knowledge, no previous reports have described thymoma occurring during anti-TNF treatment. This case highlights the need for further investigation into the potential association between anti-TNF therapy and rare malignancies such as thymic tumors.

Fibrous dysplasia is a bone disorder of unknown origin in which normal bone is replaced with fibrotic tissue and disorganized bone trabeculae leading to deformity, pain and functional impairment. The clinical features depend on the anatomic location. The temporal bone is rarely affected. We present the case of a female patient with extensive polyostotic fibrous dysplasia involving the left temporal bone, sparing the middle ear and the otic capsula revealed by a retroauricular mass. A surgical management was preconized for this case, and recurrence of the mass was marked shortly after surgery.   We present this case of extensive polyostotic form of temporal bone FD sparing the middle ear and the otic capsula to supplement the rare literature data concerning this rare entity and propose the therapeutic abstention regarding its high potential of recurrence.

Background: One of the most frequent causes of a Massive hemothorax, which refers to a buildup of blood in the pleural area, is either blunt or penetrating injury to the chest wall. In the USA, the majority (70-80%) of cases of hemothorax occur as a result of accidents involving motor vehicles that inflict harm on structures in the mediastinum such as the heart, vessels of major importance, thoracic spine, mammary or intercostal arteries, the diaphragm, or the lung tissue. Case Description: A 16-year-old teenager arrived to the Emergency Room (ER) with stab wound on the left side of the chest caused by a scissor. The patient presented with chest pain, breathlessness and hypoxia. A general surgeon performed emergency management by inserting a chest tube due to the significant left hemothorax. The patient's respiratory problem necessitated the immediate insertion of a chest tube in order to assess future treatment needs. Because the patient was hemodynamically unstable, resuscitation was performed immediately and we then performed a chest X-ray. We did not perform a CT scan of the thorax because the patient's hemodynamics were unstable. The thoracic and vascular surgeon performed an emergency posterolateral thoracotomy to address and stopped the bleeding from the intercostal artery. The patient had been discharged from the hospital seven days after surgery with no complications and stable hemodynamics. A week later, the patient visited the outpatient department for follow-up. Conclusion: The initial step for an emergency physician in treating a hemothorax is to diagnose the condition with imaging techniques like a chest x-ray, ultrasound, or CT scan of the thorax. When dealing with hemothoraces, a chest tube should be inserted to prevent the development of empyemas and fibrothorax. Massive hemothoraces require a thoracotomy, consultation with a trauma surgeon and volume resuscitation. The key to reducing morbidity and mortality from hemothoraces is prompt diagnosis and treatment. Additional testing is required to determine if the aesthetic and motor functions of the left hand joint space are impaired.

Dentigerous cyst is a developmental odontogenic cyst, most oftenly found associated with unerupted teeth, impacted or supernumerary teeth. Around 95% of the dentigerous cysts involve permanent dentition, out of which the association with a supernumerary tooth accounts for about 5%. Early detection and removal of cysts is important to reduce potential disturbance in the eruption pattern of teeth. This article describes a case of a 29-year-old male with the presence of a dentigerous cyst associated with impacted supernumerary tooth in the maxillary anterior region, along with the treatment strategy employed in this case.

Background: Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder which affects the adolescent girls. It affects 5% to 10% of women in their reproductive age. Awareness and accurate diagnosis is the first step in managing PCOS as it improves quality of life of the patient. This study aimed to determine the awareness about PCOS among school going adolescent girls of Himachal Prades. Material and Methods: This cross-sectional survey among school going adolescents girls of the state of Himachal Pradesh was carried out between October 2022 to December 2022 utilising a Google form. Up until 400 replies were gathered, the Google form was distributed among school going adolescents children for responses via online means like email and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin. We collected data on their socio-demographic traits and awareness about PCOS. Epi info v7 software was used to evaluate the data using the necessary statistical tests. Results: The study included 400 School Going Adolescents Girls. The participants' average age was 15.2±5.4 years. In the present study, 24.5% (98) participants had very good knowledge (16-20 marks) towards Polycystic ovarian syndrome, 30.25% (121) had good knowledge (12-15 marks), 34.0 % (136) had fair knowledge (8-11 marks) and 11.25% (45) having poor knowledge (<8 marks). Conclusion: According to the study's findings, adolescent girl’s children have an average level of personal awareness and knowledge about PCOS. Thorough knowledge of the disorder and counseling for adolescent girls should be included in the curriculum which will provide awareness towards the disorder and lifestyle modification.

Background: One of the most frequent causes of acute abdomen that necessitates surgical intervention is acute cholecystitis. This study was conducted to determine how well-informed the general populace of Himachal Pradesh is about the causes, symptoms, and available treatments for acute cholecystitis. Material and Methods: This cross-sectional survey of residents of the state of   Himachal Pradesh was carried out between October 2022 to December 2022  using Google forms. Until 400 replies were gathered, the questionnaire was distributed among state citizens in both rural and urban areas of Himachal Pradesh via email and social media sites such Whatsapp groups, Facebook, Instagram, and Linkedin. We collected data on their socio-demographic traits and awareness regarding causes, symptoms and treatment options for acute cholecystitis. Epi info v7 software was used to evaluate the data using the necessary statistical tests. Results: In the present study 36% (144) of the participants fall below 40 years of age while 64% (256) were above 40 years.  53% (211) of patients were male and 47% (188) were female. In the present study 74 (18.5%) study participants had very good knowledge (9-10 marks) towards causes for acute cholecystitis, 189 (47.25%) had good knowledge (7-8 marks), 127(31.75%) had fair knowledge (4-6 marks) and 10(2.5%) had poor knowledge (<4 marks) towards causes for acute cholecystitis. In our study, 95(23.75%) study participants had very good knowledge (9-10 marks) towards symptoms for acute cholecystitis, 213(53.25%) had good knowledge (7-8 marks), 87(21.75%) had fair knowledge (4-6 marks) and 5 (1.25%) had poor knowledge (<4 marks) towards symptoms for acute cholecystitis. Similarly, 79(19.75%) study participants had very good knowledge (9-10 marks) towards treatment for acute cholecystitis , 197 (49.25%) had good knowledge (7-8 marks), 112 (28%) had fair knowledge (4-6 marks) and 12 (3%) had poor knowledge (<4 marks) towards treatment for acute cholecystitis. Conclusion: Early detection and complication avoidance are made easier with a clear grasp of the causes, symptoms, and available treatments for acute cholecystitis.

An elderly patient with long standing diabetes and obstructive uropathy presented with low grade fever, significant weight loss and sterile pyuria with active urinary sediment. After investigation, PET-CT of kidney suggests granulomatous nephritis of evaluation. He underwent renal biopsy, that showed features suggestive of granulomotus interstitial nephritis, considering sterile pyuria, examination of two urinary sample revealed acid fast bacilli. since than he was prescribed standard ant tubercular drugs, that result a significant improvement of physical and biochemical parameters. It is a rare case that was not published previously in our country.

Systemic Anaplastic Large Cell Lymphoma (ALCL) is a rare and very aggressive form Non-Hodgkin’s Lymphoma (NHL). ALCL rarely involves extensive bone tissue. Here we report a 16-year-old male with systemic ALCL with bone metastasis. Painless enlargement of the left thigh with a history of pelvic pain, the difficulty to walk and a prolonged fever of unknown origin have been complained in the last 6 months prior to hospital admission. The diagnosis of ALCL stage IV ECOG I was established and it was accompanied by a pathological fracture of the left sub trochanter of the femur. The patient was initially given 8 cycles of CHOP chemotherapy. Since the patient did not respond well to the therapy, the patient was given 7 cycles of CVP+brentuximab chemotherapy and the response was quite well. CVP+brentuximab chemotherapy in this case report can be used for refractory anaplastic large cell lymphoma.

The nasolabial flap (NLF) reconstruction technique is the oldest soft tissue flap technique since 700 BC. NLF is a very resourceful flap for the defect of basal cell carcinoma in the maxillofacial region. This case report presents a 45 year old female, farmer by occupation for more than 20 years, came to our hospital with an ulcerated nodule lesion on the upper lip for five years. The lesion was located above the left oral commissure. It was approximated one-sixth of entire upper lip size. There were purulent discharge and infrequent bleeding from the ulcerated lip and no associated with pain. The fine-needle aspiration biopsy revealed BCC. The lip reconstructive option was left nasolabial flap for lining and cover. Histopathology confirmed the BCC diagnosis without metastases in the ulcerated margin. The NLF is a very useful and reliable flap for the lip defect coverage. It gives better color and contour match with surrounding soft tissue of the lip. Despite some cases reported that majority of lip reconstruction required prolonged post-operative time and sometimes need a second surgical intervention. NLF still represents as a good option for achieving good oral opening for speech, chewing and dental hygiene.

Retropharyngeal haematoma is a rare entity with multiple aetiological factors. Individuals with hemophilia and those taking anticoagulants such as warfarin appear to be at an increased risk of retropharyngeal hematomas. We described a case of 14-year-old male child presented with retropharyngeal haematoma with its detailed clinical presentation and management.