Asian Journal of Research in Surgery

Diagnostic Dilemma of Radiopaque Lesion: A Series of Two Cases of Complex Odontoma

Sharanbasappa Japatti — 2026-06-02

Complex odontomas are benign odontogenic hamartomatous lesions composed of enamel, dentin, cementum, and pulp tissue arranged in a disorganized pattern. They are usually asymptomatic and are commonly detected incidentally during routine radiographic examinations. However, erupting complex odontomas associated with pain, infection, cortical perforation, and impaction of adjacent teeth are uncommon and may present a significant diagnostic dilemma because of their resemblance to other mixed radiopaque lesions of the jaws. This case series presents two rare cases of erupting complex odontoma involving the mandibular posterior region in young patients aged 19 and 17 years. Both cases were associated with pain, swelling, and eruption disturbance of the mandibular second molar. Cone Beam Computed Tomography (CBCT) revealed large radiopaque masses associated with impacted teeth and close approximation to the inferior alveolar nerve. Surgical excision of the odontomas along with removal of the associated impacted molars was performed successfully under local anaesthesia. Histopathological examination confirmed the diagnosis of complex odontoma. Postoperative healing was satisfactory, with only minimal transient paraesthesia observed in one case. These cases highlight the importance of detailed radiographic evaluation, particularly CBCT, in establishing an accurate diagnosis and surgical plan for large radiopaque lesions of the jaws. Early diagnosis and timely intervention are essential to prevent complications such as cortical perforation, infection, pathological fracture, and nerve compression, thereby ensuring favourable functional and aesthetic outcomes.

Port-Site Complications Following Laparoscopic Gynaecological Surgery: An experience from a Camp-Based Surgical Setting

Jahar Lal Baidya — 2026-06-06

Background: Gynaecological laparoscopy has become the standard of care for a wide range of benign and malignant conditions. Despite its advantages, port site complications remain a source of morbidity and concern for both patients and surgeons.

Aim: To determine the morbidity associated with port-entry complications during gynaecological laparoscopy.

Materials and Methods: This study included 739 patients undergoing laparoscopic procedures for various gynaecological indications between May 2013 and January 2020. Demographic data, surgical details, and postoperative outcomes were recorded. Port site complications were classified according to CDC and NNIS definitions. Microbiological evaluation (Gram stain, AFB stain, GeneXpert, culture sensitivity, biopsy) was performed when indicated. Statistical analysis was conducted using SPSS v15.0.

Results: Of 739 laparoscopic procedures, 18 patients (2.44%) developed port site complications. The most frequent complication was port site infection (n=13; 1.76%), of which 9 were due to atypical mycobacteria (Mycobacterium fortuitum, M. chelonae). Other complications included abdominal wall vessel injury (n=2), ecchymosis (n=2), and omental entrapment (n=1). Port site complications showed a statistically significant association with the type of laparoscopic procedure performed (p = 0.004), indicating that the occurrence of complications varied meaningfully across different surgical categories. Port site infections were most common at the left lower secondary port. All aerobic infections responded to sensitive oral antibiotics, while atypical mycobacterial infections required prolonged second‑line antimicrobial therapy and surgical exploration in selected cases.

Conclusion: Port site complications in gynaecological laparoscopy are infrequent but can be clinically significant. Port site infections, particularly those caused by atypical mycobacteria, are the most agonising for patients and surgeons. Strict adherence to aseptic protocols, meticulous sterilisation of reusable instruments, and early recognition with appropriate antimicrobial therapy are essential to minimise morbidity.

Analysis of Risk Factors Associated with Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: Experience from a Tertiary Care Center

Md. Arifuzzaman — 2026-06-11

Background: Pancreaticoduodenectomy (PD) remains the standard surgical procedure for malignant and selected benign lesions involving the pancreatic head and periampullary region. Although advances in surgical techniques and perioperative care have substantially reduced postoperative mortality, morbidity remains high. Postoperative pancreatic fistula (POPF) is one of the most common and clinically significant complications following PD and is associated with prolonged hospitalization, increased healthcare costs, and mortality. This study aimed to identify risk factors associated with POPF following pancreaticoduodenectomy in a tertiary-care center.

Methods: This prospective observational study was conducted in the Department of Hepatobiliary Surgery, National Institute of Gastroenterology and Hospital, Dhaka, Bangladesh, from January 2025 to December 2025. Fifty consecutive patients who underwent pancreaticoduodenectomy were included. Patients were categorized into two groups: Group A (without POPF) and Group B (with POPF). Demographic, clinical, laboratory, operative, and postoperative variables were analyzed. Risk factors associated with POPF were evaluated using univariate and multivariate logistic regression analyses. A p-value of less than 0.05 was considered statistically significant.

Results: Among the 50 patients included, 42 (84.0%) did not develop POPF, whereas 8 (16.0%) developed POPF. Clinically relevant POPF (Grade B/C) occurred in 6 patients (12.0%). The mean age of the study population was 53.4 ± 8.6 years, and most patients were male. Periampullary carcinoma was the most common indication for surgery (70.0%). Patients who developed POPF had significantly lower serum albumin levels (2.9 ± 0.4 vs. 3.6 ± 0.5 g/dL, p=0.002), a higher prevalence of pancreatic duct diameter <3 mm (75.0% vs. 11.9%, p=0.001), and a greater frequency of soft pancreatic texture (62.5% vs. 9.5%, p=0.001). Operative time, intraoperative blood transfusion, postoperative hospital stay, and mortality were significantly higher in the POPF group. Grade B fistula was the most common subtype (62.5%). On multivariate analysis, soft pancreatic texture (OR 4.81, 95% CI 2.12–9.74; p=0.001), pancreatic duct diameter <3 mm (OR 3.72, 95% CI 1.89–7.45; p=0.001), serum albumin <3 g/dL (OR 2.97, 95% CI 1.54–5.84; p=0.001), and type of pancreatojejunostomy (OR 2.41, 95% CI 1.38–4.62; p=0.001) were identified as independent predictors of POPF.

Conclusion: The incidence of POPF following pancreaticoduodenectomy was 16.0%, while clinically relevant POPF occurred in 12.0% of patients. Soft pancreatic texture, pancreatic duct diameter <3 mm, low preoperative serum albumin level, and the type of pancreatojejunostomy were identified as independent predictors of POPF. Careful preoperative optimization and appropriate reconstruction techniques may reduce the occurrence of POPF. Larger multicenter studies are required to validate these findings.

Predictors of Delayed Extubation Following Paediatric Cardiac Surgery: A Retrospective Study

Ahmad M. Aburumman — 2026-06-13

Background: Early extubation after paediatric congenital cardiac surgery is an important component of fast-track perioperative management and may reduce ventilator-associated complications, shorten intensive care unit (ICU) stay, and improve postoperative recovery. Identification of factors associated with successful early extubation may help optimize perioperative care and patient selection.

Aim: To identify preoperative, intraoperative, and postoperative factors associated with early versus delayed extubation after paediatric congenital cardiac surgery.

Methods: This retrospective observational study included 57 paediatric patients undergoing congenital cardiac surgery between 2023 and 2024 at Queen Alia Heart Institute (QAHI), a tertiary cardiac centre in Amman/Jordan. Patients were categorized into early extubation (including on-table extubation) and delayed extubation groups. Demographic, operative, and postoperative variables were analysed, including age, surgical complexity, cardiopulmonary bypass (CPB) duration, aortic cross-clamp time, ICU stay, and haematocrit changes. Statistical analysis was performed using independent t-tests, Mann–Whitney U tests, Chi-square tests, and Fisher’s exact tests.

Results: Early extubation was achieved in 22 patients (38.6%), including 7 patients (31.8%) who underwent successful on-table extubation, while delayed extubation occurred in 35 patients (61.4%). Delayed extubation was significantly associated with younger age (newborns and neonates) (p=0.041), complex cyanotic congenital heart disease (p=0.011), prolonged CPB duration (81.4 ± 67.2 vs 43.9 ± 28.4 minutes, p=0.021), longer aortic cross-clamp time (47.2 ± 31.5 vs 24.7 ± 14.1 minutes, p=0.031), and high-complexity procedures including Tetralogy of Fallot repair, arterial switch operations, Glenn procedures, and TCPC procedures (p=0.009). Early extubation was associated with significantly shorter ICU stay (2.1 ± 1.2 vs 5.4 ± 2.8 days, p=0.004). On-table extubation was strongly associated with simple acyanotic heart lesions and successful fast-track recovery (p<0.001).

Conclusion: Early extubation after paediatric congenital cardiac surgery is feasible and safe in selected patients. Low body weight was an independent predictor of delayed extubation, while lower surgical complexity and shorter cardiopulmonary bypass duration favoured successful fast-track recovery.

Reliability and Safety of 1% Methylene Blue for Sentinel Lymph Node Localisation: A Prospective Study

Swapandeep Kaur — 2026-06-24

Aim: The present study evaluates the feasibility and diagnostic performance of 1% methylene blue dye for sentinel lymph node localisation in patients with clinically node-negative early-stage breast cancer.

Study Design: Hospital-based prospective study.

Place and Duration of Study: Department of Surgery, SGRDIMSR, Amritsar, from July 2024 to December 2025.

Methodology: This prospective study included 69 female patients aged 25 years and above with operable early-stage breast cancer classified as T1-T2 and clinically node-negative. Patients underwent sentinel lymph node mapping using 2-5 ml of 1% methylene blue dye injected intradermally or subdermally in the peritumoral region, followed by sentinel lymph node identification and excision. Histopathological findings from sentinel lymph nodes were compared with final axillary lymph node status. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, false-negative rate, and false-positive rate.

Results: Sentinel lymph node identification was successful in 66 of 69 patients, giving an identification rate of 95.6%. The largest age group was 41-50 years, comprising 24 patients (34.78%). Invasive ductal carcinoma was the most frequent histological subtype, observed in 56 patients (81.16%), and most tumours were T2 lesions, reported in 56 patients (81.15%). Among the 66 evaluable patients, sentinel lymph node status correctly predicted axillary nodal status in 48 cases. Sensitivity was 77.42%, specificity was 68.57%, positive predictive value was 68.57%, negative predictive value was 77.42%, and overall diagnostic accuracy was 72.73%. The false-negative rate was 22.58%.

Conclusion: Methylene blue dye demonstrated a high sentinel lymph node identification rate in clinically node-negative early breast cancer. However, the observed false-negative rate indicates that negative sentinel lymph node findings should be interpreted cautiously. Larger comparative studies are needed to further evaluate its clinical utility.

A Systematic Review on Breast Cancer Surgery in Cameroon: Current Practice, Challenges and Future Perspectives

Jean Paul Engbang — 2026-06-08

Background: Breast cancer is the most frequently diagnosed malignancy among women worldwide and has become the leading female cancer in Cameroon. Surgery remains the cornerstone of curative treatment for non-metastatic disease, yet the type and quality of surgical care depend heavily on diagnostic capacity, multidisciplinary coordination, and access to adjuvant therapies. In Cameroon, most patients present with locally advanced tumors, resulting in a predominance of modified radical mastectomy and limited opportunities for breast-conserving approaches. This systematic review evaluates current surgical practices, outcomes, and structural barriers affecting breast cancer surgery in Cameroon.

Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, African Journals Online, and Google Scholar were searched for studies published between January 2010 and April 2026. Eligible articles reported epidemiological, surgical, pathological, therapeutic, or health-system data related to breast cancer management in Cameroon. When national evidence was scarce, data from comparable sub-Saharan African countries were incorporated to contextualize findings. Data were synthesized narratively because of substantial methodological heterogeneity.

Results: Forty-two studies met the inclusion criteria. Breast cancer in Cameroon affects predominantly women aged 40–55 years, approximately a decade younger than in high-income countries. Between 60% and 85% of patients present with stage III or IV disease. Modified radical mastectomy remains the most commonly performed procedure, accounting for more than 80% of curative operations in most reported series. Breast-conserving surgery is uncommon because of large tumor size at diagnosis, limited access to radiotherapy, and inadequate preoperative imaging. Sentinel lymph node biopsy is rarely available, and axillary lymph node dissection remains the standard approach. Surgical outcomes are constrained by delayed diagnosis, financial barriers, insufficient pathology services, limited reconstructive options, and restricted access to systemic and radiation therapies.

Conclusion: Breast cancer surgery in Cameroon remains dominated by radical procedures performed under significant structural constraints. Earlier diagnosis, expanded radiotherapy capacity, improved pathology services, and development of multidisciplinary breast units are essential to enable more conservative and personalized surgical care. Strengthening surgical oncology infrastructure should be considered a national priority to improve both survival and quality of life for women with breast cancer in Cameroon. Improved histopathological confirmation, margin assessment, and multidisciplinary decision-making are also necessary to optimize surgical quality and reduce inappropriate treatment decisions.

Acute Pancreatitis Complicated by Rapunzel Syndrome in a Patient with Incomplete Situs Inversus: A Case Report

Ichrak Bouali — 2026-05-28

Background: Situs inversus is a rare anatomical anomaly that renders surgical presentations atypical. The association of acute pancreatitis, a gastrointestinal trichobezoar, and Rapunzel syndrome in a patient with situs inversus is exceptional.

Case Report: We report the case of a 17-year-old female patient with unknown situs inversus who presented with biochemical acute pancreatitis that progressed to multiple digestive perforations associated with gastrointestinal trichobezoars fulfilling the criteria for Rapunzel syndrome.

Conclusion: This case highlights the importance of a thorough and multimodal diagnostic evaluation in the setting of acute abdominal symptoms, and the need to anticipate rare complications — particularly Rapunzel syndrome — in patients with congenital anatomical anomalies.

Complicated Pelvic Appendicitis Presenting as a Pelvic Pseudotumoral Mass with Intraoperative Suspicion of Gynecological Malignancy: A Case Report

Kamal Khadija — 2026-06-02

Pelvic appendicitis is an uncommon anatomical variant that may create significant diagnostic challenges because of its proximity to gynecological, urinary, and colorectal structures. In elderly women, delayed diagnosis may lead to perforation, abscess formation, and inflammatory extension to adjacent organs, occasionally mimicking pelvic malignancy.

We report the case of a 72-year-old woman who presented with prolonged right lower quadrant pain associated with vomiting, diarrhea, intermittent fever, and deterioration of general condition. Laboratory investigations revealed severe inflammatory syndrome and anemia. Contrast-enhanced computed tomography demonstrated a large multiloculated pelvic abscess of probable appendiceal origin with significant compression of adjacent pelvic structures.

Surgical exploration was initially performed laparoscopically but required conversion to laparotomy because of dense inflammatory adhesions. Intraoperative findings revealed a retro-uterine abscess, severe pelvic appendicitis, uterine perforation, parametrial infiltration, and suspicious pelvic lymphadenopathy, raising concern for gynecological malignancy. Retrograde appendectomy, subtotal hysterectomy, peritoneal lavage, pelvic drainage, and biopsies were performed.

Histopathological examination demonstrated extensive suppurative inflammation without evidence of malignancy. The postoperative course was favorable, and the patient remained asymptomatic at follow-up.

This case highlights the diagnostic complexity of complicated pelvic appendicitis and demonstrates how severe inflammatory disease may mimic gynecological cancer both radiologically and intraoperatively. Histopathological analysis remains essential for definitive diagnosis.

Transmesenteric Internal Hernia: A Case Report

El Wassi Anas — 2026-06-05

Transmesenteric internal hernias are a rare cause of small bowel obstruction and are most frequently described in pediatric patients. Their occurrence in adults, particularly in the elderly, is exceptional and often associated with diagnostic difficulty because of non-specific clinical and radiological findings. We report the case of an 80-year-old man with no previous medical or surgical history who presented with acute diffuse abdominal pain associated with vomiting and obstipation. Imaging findings suggested small bowel obstruction without a clearly identified etiology. Emergency surgical exploration revealed a congenital transmesenteric defect of the terminal ileum with incarceration of a small bowel loop. The herniated bowel was congested but viable, allowing reduction without intestinal resection, and the mesenteric defect was closed with interrupted sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day two. Congenital transmesenteric internal hernia should be considered in cases of unexplained small bowel obstruction in patients without prior abdominal surgery, and early surgical management is crucial to prevent bowel ischemia and ensure favourable outcomes.

Late Isolated Abdominal Wall Recurrence of Uterine Carcinosarcoma: A Favourable Outcome in a Case Report Treated with Wide Surgical Excision and Prosthetic Reconstruction

Taha Kabbaj — 2026-06-22

Introduction: Uterine carcinosarcoma is a rare and highly aggressive malignancy associated with a high risk of recurrence. Relapse usually involves the pelvis or distant organs, whereas isolated abdominal wall recurrence is exceptional. This report describes a late isolated abdominal wall recurrence and its surgical management, highlighting the need for prolonged surveillance in affected patients.

Case Report: A 71-year-old postmenopausal woman presented with metrorrhagia. Diagnostic curettage revealed grade 2 endometrioid adenocarcinoma, and pelvic magnetic resonance imaging suggested stage IA disease. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy in July 2021. Final histopathological examination confirmed uterine carcinosarcoma with myometrial invasion greater than 50%, cervical stromal involvement, lymphovascular space invasion, negative pelvic lymph nodes, and clear vaginal margins. Adjuvant external beam pelvic radiotherapy, vaginal brachytherapy, and six cycles of paclitaxel-carboplatin chemotherapy were completed in April 2022. After more than two years of complete remission, routine surveillance imaging in March 2025 identified an isolated median subumbilical abdominal wall mass. Magnetic resonance imaging showed features suggestive of abdominal wall metastasis. Core needle biopsy demonstrated a poorly differentiated carcinoma, and immunohistochemistry showed CK7 and PAX8 positivity with oestrogen and progesterone receptor negativity, supporting recurrence of the known gynaecological malignancy. Wide en bloc resection of the abdominal wall lesion was performed, followed by reconstruction using a 30 × 30 cm dual-layer intraperitoneal mesh. No peritoneal carcinomatosis or ascites was observed intraoperatively. Final histopathological examination confirmed abdominal wall localisation of spindle cell sarcoma with heterologous osteosarcomatous differentiation, complete resection, and R0 margins. The postoperative course was uneventful.

Conclusion: This case illustrates that, in selected patients with isolated abdominal wall recurrence of uterine carcinosarcoma, complete surgical excision with prosthetic reconstruction may provide effective local control. Long-term surveillance remains essential because atypical late recurrence may occur after an apparently sustained remission.