New Indian Journal of Surgery

Pelvi-ureteric junction obstruction (PUJO) is commonly seen in infants and children. Rarely it may go undetected and presents in adults with either minimal symptoms or is detected incidentally. We report the case of a previously healthy lady aged 26 years who presented with acute abdomen, respiratory distress and shock mimicking peritonitis. During resuscitation, a bedside percutaneous abdominal drain was placed in view her poor general condition. The patient improved dramatically following drainage of intra-abdominal collection and an emergency abdominal exploration was deferred for further diagnostic evaluation. Imaging findings suggested a massively dilated crossed fused ectopic left kidney with PUJO and drain in renal pelvis. A dismembered pyeloplasty was performed electively and the patient made an uneventful recovery. We present the clinical profile and imaging characteristics of this unknown presentation of PUJO with review of unusual clinical presentation of PUJO in adult patients from published literature. We also emphasize that this presentation of PUJO be entertained when dealing with a patient of acute abdomen and shock.

 Pilonidal sinus excision is a common procedure and many forms of flaps like Limberg’s flap close the defect. We are introducing a novel technique of “Lapog Unev unequal Zplasty”. This is found to be very useful and getting completecure without much scar. The residual scar is deviated from the midline with curvature to lateral side and hence recurrence is nil. Same procedure is used in few cases of pressure sore over the sacrum and found to be very good in healing and pressure bearing property.

Background: The tele-ICU has an off-site command center in which a critical care team (intensivists and critical care nurses) is connected with patients in distance intensive care units (ICUs) through a real-time audio, visual and electronic means and health information is exchanged. Care provided in intensive care units (ICUs) is notable for its high cost and high rates of morbidity and mortality.

Methods: The study is an observational retrospective study conducted in the Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry from March 2015 to April 2016. The tele-ICU system consisted of an audiovisual monitoring aid comprising IP camera. At the end of the study period, the feedback was obtained from consultants, residents and analysed.

Results: The consultants and residents found the tele-monitoring system to be userfriendly, good quality, economical and frequent interaction and advice from consultants and experts possible.

Conclusion: Tele-monitoring of ICU patients is found to be a promising path, especially where there are a limited number of consultants. It is Userfriendly, good quality, economical and frequent interaction possible between consultant and resident.

Segmental infarction of omentum was first described by Bush in 1896.Incidence is <.1% of laparotomies done for the a/c abdominal cases [5] .Incidence is more in males (2:1). Exact aetiology is not known so we take it as idiopathic. There are different postulates for its occurrence. One is fragile blood vessels of right lower segment of omentum and another is embryological maldevelopment of right sided omental blood supply [5]. It has also been described that it occurs after exertion, after heavy meal and in obese patients. Clinicallyit may present as a/ c appendicitis, diverticulitis or cholecystitis. CT scan abdomen will help to diagnose thiscondition [3]. There are different schools of thought. One is conservative line of management and other is surgical line of management. There are pros and cons of both management. Here we discuss 6 patients who presented in our institute with abdominal pain and were managed by both surgically (Laparoscopic resection) and conservatively. After surgery patients were asymptomatic after 1 week except minimal tenderness over port sites, whereas patients managed conservatively had to take analgesics for 4-6 weeks.We found early resolution of symptoms in surgically managed patients in comparison to conservatively managed patients.

Introduction: Despite the advances in surgical sciences post operative wound infection remains one of the common complications which surgeons encounter. This problem if not evaluated and treated in a timely manner can have significant sequel. Infection is encountered by all surgeons by nature of their crafts; they invariably impaired the first line of host defence

Methodology: The material for the present study was obtained from patient’s undergone surgery in Department of General Surgery, BMC & RI, BANGALORE, from 1st Jan 2012 to 30th June 2013. Surgical site were considered to be infected according to the definition by NNIS. The wounds were classified according to the wound contamination class system proposed by U.S. National Research Council.

Results: Incidence of infection among Emergency surgery is 26% where as among Elective is 3.33%.25 Cases (69.44%) of total infected cases had superficial SSI, 8 cases (22.22%) deep SSI and 3 cases (8.33%) had organ space infection.

Conclusion: As expected the rate of infection increased from clean wounds to contaminated wounds.

Introduction: Surgical Site infections (SSI) still remain a significant problem following an operation and the third most frequently reported nosocomial infections. SSI contributes significantly to increase health care costs in terms of prolonged hospital stay and lost work days. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life have been studied extensively.

Methodology: The material for the present study was obtained from patient’s undergone surgery in Department of General Surgery, BMC & RI, Bangalore, from 1st Jan 2012 to 30th June 2013. Surgical site were considered to be infected according to the definition by NNIS. The wounds were classified according to the wound contamination class system proposed by U.S. National Research Council.

Results: A study of 400 operated cases was carried out of which 39 were diagnosed to be having surgical site infection as per the CDC criteria.

Conclusion: Thus the incidence of SSI in this study is 9%.

Introduction: Septic shock is a medical condition as a result of severe infection and sepsis, though the microbe may be systemic or localized to a particular site. It can cause multiple organ dysfunction syndrome (formerly known as multiple organ failure) and death. Its most common victims are children, immuno-compromised individuals, and the elderly, as their immune system cannot deal with infection as effectively as those of healthy adults.

Methodology: All patients with suspected/confirmed sepsis admitted in the surgical unit were included in the study. This included operated, non-operated and trauma patients (eg: perforation peritonitis, Diabetic ulcer foot with gangrene Necrotizingfascitis). Patients had to fulfill two or more criteria of systemic inflammation. The parameters involved in calculating the SOFA score were collected on a daily basis.

Results: Among the 41 patients ventilated 33 (80.5%) expired and among the 59 patients who did not require ventilator support 14 (23.7%) expired.

Conclusion: Out of 32 patients whose SOFA score on admission was low (less than 8), 8 patients died. This data depicts, even with low SOFA score on admission, few patients died, because so many other factors are also contributing to the death of critically ill patients.

Introduction: Peritoneum becomes inflamed secondary to bacterial invasion or chemical insult. Pathogenic organisms reach the peritoneal cavity through viscus perforation, through intraperitoneal visceral suppuration, from abdominal wound, through the blood, lymphatics or via open ends of fallopian tubes. Chemical peritonitis results from blood, bile gastric fluids, or foreign bodies left after surgery like glove lubricant such as talc, cellulose fibres from gauze pads, drapes and gown. Peritonitis may be acute or chronic, septic or aseptic, primary or secondary, localized or generalized.

Methodology: Cases clinically diagnosed as peritonitis underwent X-ray erect abdomen, and blood investigations like CBC, Blood urea, serum creatinine, urine routine and microscopy. Serum amylase and widal test was done if pancreatitis or enteric fever was suspected respectively. After stabilization, patients were taken up for surgery. Laparotomy was done under general anaesthesia or epidural anaesthesia.

Results: Duodenal ulcer perforations were closed using omental patch (Grahms patch). All appendicular perforation cases underwent appendicectomy. All cases of gastric perforation were closed with simple closure only. Jejunal and ileal perforations were closed with simple closure only. One case of sealed ileal perforation was treated with peritoneal toilet. One case of colonic perforation underwent resection of gangrenous part and transverse colostomy. All cases underwent peritoneal lavage and drainage after surgery.

Conclusion: Wound infection is a most common postoperative complication.

Cellulitis of the lower limbs is common in patients on maintenance haemodialysis on account of depressed immune status of these patients. In the patients with normal renal function conservative treatment with anti biotics is usually adequate. Surgical intervention is needed only when the complications like abscess formation or necrosis is suspected. This is not so in the patients on maintenance haemodialysis, Conservative treatment with antibiotics has limited response in patients on maintenance haemodialysis and the cellulitis quickly gets complicated leading to a life-threatening situation. Hence early surgical intervention is recommended and is beneficial in these patients.

Introduction: The Sequential Organ Failure Assessment (SOFA) score is a simple and objective score that allows for calculation of both the number and the severity of organ dysfunction in six organ systems. It is a six-organ dysfunction score measuring multiple organ failure daily. Each organ is graded from 0 (normal) to 4 (the most abnormal).

Methodology: Patients which are included in the study are perforation peritonitis with Septicemia, Diabetic ulcer foot with gangrene, Necrotizing fascitis of limbs and abdomen, Burns, Mesenteric ischemia with bowel gangrene, Intestinal Obstruction, Carcinoma, Blunt injury abdomen with solid organ injury.

Results: SOFA score of 12 and above at 48 hours of admission shows an increase in the number of non survivors. The minimum SOFA score of the study population at 48 hours is 8. Among the 47 non survivors, 3 patients had these minimum score. Patients who had a score of 12 and above were 40.

Conclusion: So using SOFA scoring we can improve the overall prognosis and prevent the mortality to some extent.

Introduction: Peritoneum consists of single sheet of simple squamous epithelium of mesodermal origin, termed mesothelium lying on thin connective tissue stroma. Peritoneal membrane is divided into parietal and visceral peritoneum. Parietal layer lines the abdominal wall and visceral layer covers abdominal viscera. Peritoneal cavity is the potential space between parietal and visceral peritoneum.

Methodology: This study comprises of 50 cases of acute peritonitis coming to Medical College & Hospital.A pre-tested proforma was used to collect the relevant information by history, clinical examination of patients, relevant investigations required and treatment. Patients were admitted as and when they presented with the following inclusion and exclusion criteria.

Results: Vomiting was seen with 54% of cases with duodenal ulcer perforation, 50% of cases with ileal perforation, and 50% of cases with appendicular perforation. 75% of cases of peritonitis due to other causes had vomiting. In total 56% of cases had vomiting. The next most common symptom was fever which was seen in about 50% of the total number of cases studied.

Conclusion: Guarding, rigidity, tachycardia and absent bowel sounds are most common signs seen in peritonitis.

Introduction: There is little agreement about the effect of dietary components on the risk of gallstones. Fasting is normally associated with increased biliary cholesterol saturation and this phenomenon persists or even becomes more accentuated in obesity. A large clinical study showed that being even moderately overweight increases the risk for developing gallstones. Obesity also reduces gallbladder emptying

Methodology: Fifty patients diagnosed with Cholelithiasis were included in the study after applying inclusion, exclusion criteria were examined, investigated and operated during the study period. An unrestricted materials and methods are gathered. Detailed history of all Patients was collected according to the proforma.

Results: Higher incidence of gallstones is common in patients with BMI of 18.5- 24.9 Kg/m2 constituting 82% of 50 patients, other BMI group forming small subset. Mean age being 29 years.

Conclusion: High BMI and Low middle SES was statistically associated with gall stones.

Introduction: Mortality and morbidity are dependent on early recognition and correct diagnosis of obstruction. If untreated, strangulated obstruction causes death in 100% of patients. If surgery is performed within 36 hours, the mortality decreases to 8%. The mortality rate is 25% if surgery is postponed beyond 36 hours in these patients.

Methodology: A minimum of 50 consecutive cases presenting with acute intestinal obstruction in hospital was selected for the study. This was a prospective study of 50 cases presenting with symptoms and signs suggestive of acute intestinal obstruction. A detailed structured Proforma was used to collect this information. All data was entered on master chart for analysis.

Results: The commonest presenting symptom was abdominal pain (100%) followed by vomiting (92%), distention of abdomen (84%) and absolute constipation (60%).

Conclusion: The incidence of intestinal obstruction is more common in males compared to females. Small bowel obstruction was more common than large bowel obstruction.

Introduction: Gall stones have been classified into three classes based upon their physio-chemical characteristics. Cholesterol stones, pigment stones and mixed stones. Cholesterol stones are formed in gallbladder, while pigment stones are mostly formed in bile canaliculi of liver and mixed stones in entire biliary tract and ultimately grow and settle down in gallbladder. Chemical analysis of these gallstones has revealed that cholesterol stones contained cholesterol, a principle constituent and mixed stones have calcium bilirubinate as principle constituent and a mixed stone consists of salts of cholesterol and bilirubin as major constituent.

Methodology: All adult patients diagnosed as Cholelithiasis admitted in hospital during the study period formed the study subjects.

Results: Study population had mean age of 49 years. Majority of patients were in 51-60 years age group. Age group of 31-40 and more than 60 years group had equal incidence, while other age groups form small subset.

Conclusion: The relation between gender and gall stone formation is not statistically significant in this study

Introduction: Postoperative adhesions are the most common cause of mechanical SBO, which cause extrinsic compression of the intestine. Malignant tumors or strictures of the small bowel can cause intrinsic blockage and are the second leading cause of SBO. Hernias cause extrinsic compression and are the third most common cause of SBO.

Methodology: All patients are subjected to required preoperative biochemical investigations. Plain X-ray erect abdomen was carried out in almost all patients except in obstructed inguinal hernias. Ultrasonography of abdomen was done in some cases whose diagnosis by X-ray was in conclusive.

Results: Release of adhesions and bands was done in 22 cases. Resection and end-to-end anastomosis was done in 16 cases, which included cases of intussuception, adhesions, stricture, ileocaecal growth, colonic growth. In cases of hernia with strangulation and gangrene of bowel; resection and repair of hernia was done depending upon the type i.e., Bassini’s repair in inguinal, Lotheissen operation in femoral hernia.

Conclusion: Morbidity was due to anastomotic leak, would infection, chest infection and wound dehiscence.

Introduction: Intracavernosal injection for pharmocological erection is an important tool for diagnosis and treatment of erectile dysfunction. Commonly the three drugs Papaverine, Phentolamine and Prostaglandin E1 have been used either alone or as combinations.

Aim: To determine the efficacy and safety of a bimix combination of Papaverine and Chlorpromazine administered intracavernosally in patients with erectile dysfunction( ED) of various origins as compared to Papaverine alone.

Methods: This was a randomized prospective comparative dose titration study as a part of diagnostic armamentarium in the evaluation of erectile dysfunction. Two hundred forty patients diagnosed with Erectile dysfunction were enrolled Injection was subsequently titrated to the dose producing an effective response i.e. an erection sufficient for vaginal penetration lasting for atleast 20 minutes with atleast 48 hrs interval between the successive doses. The response was measured in terms of time for erection(latency period),grade of erection and duration of erection. Any adverse effect or complications were noted.

Results: Satisfactory erectile response was 85% with Papaverine-CPZ combination in the dose range of 0.1 to 1 ml and and 65% with Papaverine alone in the dose range of 15 to 60 mg respectively. Of 42 men who had failed erection with 60mg of Papaverine, 18 produced erection with Papaverine-CPZ combination. Incidence of prolonged erection were 10% and 12.5% in PPV and Combination groups respectively. Altogether 56 adverse events occurred. 12.5% in PPV alone and 15% in combination group had erection lasting for more than 4 hrs and were aborted by intracavernosal injection of Phenylephrine. 10 in PPV alone and 5 in Combination had penile pain. Eight patients in PPV group had penile haematoma which resolved spontaneously whereas there was no haematoma reported in the combination group. Patients were followed up for a maximum of four years. Seven patients developed fibrotic plaque in the PPV group and there was none in the combination group.

Conclusion: Papaverine-CPZ combination has proved a cheap and effective alternative to other combinations with better efficacy than Papaverine alone. Side effects like penile pain, hematoma and fibrotic plaque formation was significantly less in the combination group.

Acute appendicitis is one of the most common diseases, needing surgical intervention at its time of presentation. A histologic basis on diagnosis is essential in further workup and management of the patient in view of prognosis of the patient. Resection of the appendix whether via an open or laparoscopic approach is a very common procedure. Patients who were clinically and sonologically diagnosed with acute appendicitis, were taken up for this study. The resected specimen is sent for routine Histopathological Examination(HPE). The Histopathologic data of such patients were studied in PSG hospitals from the period of January 2015 to December 2016. 158 appendicectomy specimens were recovered of the said duration and amongst which 85(53.79%) werefrom males and 73(46.2%) from females. Perforated appendix (0.6%), lymphoid hyperplastic changes (52.38%) was seen at the maximum in the age group of 20 and below and a maximum feature of acute appendicitis (53.12%) was seen in the age group of 21- 40 years.

Background: Video-assisted anal fistula treatment (VAAFT) is a novel minimally invasive and sphinctersaving technique for treating complex fistulas. The present study was planned with an objective to asses the late post operative complications (discharge and recurrence), outcome with VAAFT technique day care, sphincter saving procedure in management of peri anal fistula. Methodology: The present prospective study was conducted on 50 patients of Perianal fistula admitted in Sir T General Hospital, Bhavnagar during September 2015 to September 2016. All of them underwent Video Assisted Anal Fistula Treatment (VAAFT) and were followed up immediately post operatively for pain and wound infection. They were also followed after 1 month and 3 months for pain/ discomfort on defecation. Results: 26 (52%) patients had intersphincteric fistula, 20(40%) had transphincteric fistula while 4(8%) had sinus track. The cure rate was 94%. Median operating time was 35 minutes; mean pain score on the day of surgery was 5.3. Six (12%) patients had serous discharge on 15th day while only 3 (6%) patients had on 3 month follow up. On 3 month follow up, 47 (94%) patients having healed external opening. Recurrence was found in 3(6%) patients and no patient had complaint regarding stool incontinence on 3 month follow up. Conclusion: The advantages from the present study showed no surgical wound on the perianal region, hospital stay for 1 day, and higher cure rate at three month follow-up with low recurrence rate. The patient does not have postoperative problems with faecal incontinence.

Background: Thyroid carcinoma is one of the common cancers affecting the women in their young age. They vary from being indolent to aggressive cancers. Improvements in diagnostics and understanding the pathophysiology have made the treatment more effective with good long-term results.

Methods: this is Cross sectional record based study.12 months (August 2015 to July 2016) at Dept. of Surgery, S.P. Medical College and P.B. M Hospital, Bikaner.

Results: Maximum 36% belonged to 31-40 years age group followed by 26% individuals in 21- 30 years age group. Minimum 6% individuals were found in 11-20 years and >60 years age group. Among 50 patients, 68% were euthyroid, 28% were hypothyroid and 4% were hyperthyroid. 58% patients were having Solitary Thyroid Nodule, Followed by 18% with Diffuse Multi Nodular Goitre (MNG), 12% with thyroid adenoma, 4% patients each with thyroid swelling with palpable neck nodes, follicular neoplasm and toxic goitre.

Conclusion: 58% patients were having solitary thyroid nodule, followed by 18% with Diffuse Multi Nodular Goiter (MNG), 12% with thyroid adenoma, 4% patients each with thyroid swelling with palpable neck nodes, follicular neoplasm and toxic goiter.Majority (90%) patients were Benign and 10% patients were malignant.

Breast carcinoma is the most common malignant tumor and the leading cause of carcinoma death in women. Tissue evaluation gives information about various receptors which are yield prognostic information for further treatment. Identification of clinically predictive and prognostic factors is considered as an important issue in treatment of breast cancer. There are a number of tumor related features available to predict the prognosis of breast cancer. The involvement of axillary lymph nodes (ALNs) is the most important prognostic factor in operable primary breast cancer. In our study we try to find out the correlation between human epidermal growth factor Receptor (HER-2/neu) and hormonal receptor status (Estrogen/Progesterone ER,PR) with grade and nodal status in carcinoma breast.

Aim of the Study: To evaluate solitary thyroid nodules clinically, to study the role of FNAC in these lesions, and to correlate clinical findings with cytology and histopathology.

Materials and Methods: This was a prospective study done over a period of two years, in the department of General Surgery, Kakatiya Medical College, MGM Hospital, Warangal, Telangana. A total of 110 patients were included in the study. Clinical examination, cytology and histopathology findings were correlated.

Results: Age of the patients ranged from 11 to 68 years and the male to female ratio was 1:2.6. Majority of cases were seen in the fourth decade. After comparison of results of FNAC with histopathology, FNAC showed overall diagnostic accuracy of 89.8% with specificity of 100%, sensitivity of 50% for malignant lesions, positive predictive value of 100 % for malignancy and negative predictive value of 88.7%.

Conclusion: Solitary thyroid nodules are more common in the fourth decade of life and have a female preponderance. Fine needle aspiration cytology of these lesions has a good overall diagnostic accuracy of almost 90% but is less sensitive in detecting malignant lesions. FNAC is a very useful procedure for assessment of solitary Thyroid nodules especially in conjunction with complete clinical evaluation whenever a malignancy is suspected.

Background: The present study is designed to compare laparoscopic total extra peritoneal repair and Lichtenstein’s mesh repair For Inguinal Hernias, in terms of duration of operation, post operative pain, Intraoperative complications, postoperative complications and Post operative convalescence period.

Methods: A prospective observational study of 50 patients with inguinal hernia was conducted at J.L.N. Medical College, Ajmer Rajasthan India; patients were assigned into two groups through randomization. Hernia repairs performed by either laparoscopic totally extra peritoneal route (TEP) or Lichtenstein repair (LR) according to group allocation. Data was recorded prospectively and each TEP repair was matched with a LR for analysis.

Results: The mean duration of surgery was 84.60 minutes (SD=33.99) in the laparoscopic group, which was significantly more (P=0.0000) than the open group in which time duration was 51.56 minutes with SD of 5.53. The overall rate of complications in the 50 patients was 14/50 (28%). The complication rate was not significantly different in the two groups (P=0.0584).The minimum average time to return to normal activity was taken by the Laparoscopic TEP repair group (5.32 days, S.D. =1.35), which was statistically significant in overall comparison (8.28 days, P=0.000).

Conclusion: Results for laparoscopic TEP hernia repair seem to be superior to results for open Lichtenstein’s mesh (LR) repair in terms of length of hospital stay, wound infection, major complications, and overall return to normal activity.

Acute appendicitis is the commonest cause of “Acute abdomen”. Appendicectomy is the most frequently performed emergency operation. The aim of this study is to determine the diagnostic accuracy of the total bilirubin in acute and perforated appendicitis as well as it’s value in excluding the condition. The study is an prospective study.This study was performed on 100 patients who have been clinically diagnosed of having acute appendicitis and who were posted for emergency appendicectomy have been clinically and radiologically diagnosed of acute appendicitis. Out of 100 patients, 52 were males and 48 are females, so male predominance is seen in the present study. Appendicitis is common in the age group of 21 - 30 years and <20 years in this study. Appendicitis reaches its peak incidence in the teens and early 20’s.Clinical diagnosis was found to be correct in 88% of cases and hence the rate of negative laprotomies for acute appendicitis in our study is 12%. Patients presenting with elevated levels of serum bilirubin in the context of right iliac fossa pain warrant early surgical intervention.The diagnosis of acute appendicitis, however remains multifactorial and such test simply help to guide the surgeon in the decision making process.

Introduction: Fistula in ano is one of the most common benign anorectal disorder associated with appreciable morbidity and inconvenience to the patient. The chronicity of its symptoms makes an otherwise healthy and active person lose their earning capacity, with lowered self-confidence. These are difficult to treat as there is no satisfactory treatment procedure available which can manage these fistulas with a high success rate and minimal risk of incontinence. Open Fistulectomy, though considered as the standard treatment for fistula in ano, fistulectomy with primary closure has the merits of short hospital stay for patients, early wound healing, lowers costs and is a safe procedure.

Aim and Objectives: To study the outcome of wound closure over nonclosure of wound after fistulectomy in cases of fistula in ano and to compare the pain, wound healing, postoperative hospital stay, and recurrence. Material and Methods: The present study was a randomized prospective study of 41 cases of fistula in ano presenting at surgical OPD of the tertiary care center. Out of 41 cases, 28 cases were managed by fistulectomy and 13 cases by fistulectomy primary closure during the period of Dec 2012 to June 2015.

Results: In the present study, the male 31(75.60%) to female 10(24.39%) ratio was 3:1. In majority of the cases 17(41.45%) the cause of fistula was spontaneous rupture or inadequately drained or treated perianal abscess. The main presenting symptoms were discharge, swelling and pain. In the present study, patients those who had undergone fistulectomy with primary closure had a mean pain score of 4.3 on day one and 9.8 in patients with lying open of wound. In primary closure group all the 13 patients were discharged from hospital in less than 10 days. The time taken for complete wound healing by fistulectomy with primary closure in 13 cases was less than 3 weeks.

Conclusion: It was concluded that primary closure is a better alternative in the surgical management of fistula in ano, considering the benefits of less postoperative pain, early healing, early discharge, early return to normal activity, cost effective and less recurrence above the nonclosure method.

Patients will chronic abdominal pain are the most difficult to diagnose and treat. Potentially it can be unrewarding for both patients and treating physician 1. Thereby affecting patients both physically and mentally. Chronic abdominal pain is associated with poor quality of life 2 and onset of depressive symptoms. 3 Most patients in this group have already undergone numerous diagnostic procedures, including upper and lower gastrointestinal endoscopies, Ct scans, screening for undetected carcinomas, apart from routine blood investigations. This is the time when surgeon is approached, when all other non-invasive investigations have failed to reach a satisfying conclusion. Clearly diagnostic laparoscopy is an important intermediate option between refusing to explore a patient’s abdomen and performing laparotomy 4. Diagnostic Laparoscopy with advances in optics gives perfect visual of whole abdomen and further gives therapeutic advantages as well, which includes target biopsies, staging of cancers, various gynaecological pathologies. Laparoscopy is as much a surgical procedure as an exploratory laparotomy, often just as informative, and to a skilled laparoscopic surgeon affords a better view of entire peritoneal cavity than usual exploratory laparotomy. To achieve a high rate of positive diagnosis from laparoscopy requires much more than trained hands, it requires thorough background of surgery, sound clinical knowledge and perception of abdominal pathologies. Most importantly it avoids unnecessary negative laparotomy in many cases. Moreover early recovery and ambulation of patients helps them get back to daily chores and is source of delight for treating doctor.

Introduction: Primary peritonitis results from bacterial, chlamydial, fungal, or mycobacterial infection in the absence of perforation of the gastrointestinal tract. Secondary peritonitis occurs in the setting of gastrointestinal perforation. Frequent causes of secondary bacterial peritonitis include peptic ulcer disease, acute appendicitis, colonic diverticulitis, and pelvic inflammatory disease.

Methodology: This study comprises of 50 cases of acute peritonitis coming to Medical College & Hospital. A pre-tested proforma was used to collect the relevant information by history, clinical examination of patients, relevant investigations required and treatment. Patients were admitted as and when they presented with the following inclusion and exclusion criteria.

Results: Total of 6 patients expired. 4 patients died of septicemia and multiple organ failure. Mortality in duodenal perforation cases is 7.2% and in ileal perforation cases its 50%. Only 1 case of colonic perforation present so mortality cannot be considered. 2 patients of duodenal perforation died of septicemia and multiple organ failure. A case of colonic perforation died of myocardial infarction.

Conclusion: Mortality is proportional to age, derangement of physiological parameters like hypotension, delay in surgery and as perforation site becomes distal from duodenum to colon.

A gallstone is one of the most common digestive diseases, with incidence ranging from 10 to 20%. Acute cholecystitis is major morbidity following gallstones. Hence in our study by defining the pattern and type of gallstone, and establishing correlation with severity of acute cholecystitis we will open new windows for further investigations in the future helping in implementing the non-surgical interventions measures. A prospective study was done between July 2016 to March 2017 Patients diagnosed as acute calculus cholecystitis in department of general surgery, Adichunchanagiri institute of medical sciences were included in the study. Full history, clinical examination, ultrasound abdomen and laboratory blood investigations done, after which cholecystectomy was done and subjected to biochemical analysis. In our study, highest incidence was in fifth decade, with increase incidence in female, pain and fever wore most common symptom. Gallstone analysis showed mixed stone in 76% of cases and pigment stones in 16% of the cases as most common variety. Most of them were associated with grade one acute calculus cholecystitis. In our study we have found out that biochemical analysis of gallstones show there is no correlation between the type of gallstone and severity of acute calculus cholelithiasis by chi square test.

Background: Abdominal tuberculosis denotes involvement of the gastrointestinal tract, peritoneum, lymph nodes, and solid viscera. Tuberculous bacteria reach to the gastrointestinal tract via hematogenous spread, ingestion of infected sputum or contiguous spread from adjacent organs. The present study was undertaken to study the various clinicopathological manifestations of abdominal tuberculosis presented as acute abdomen. Methods: This study was conducted on 67 patients of acute abdomen diagnosed as a case of abdominal tuberculosis admitted in department of Surgery, Nehru Hospital attached to B.R.D. Medical College, Gorakhpur, from Jan 2015 to Dec 2015 & have given consent for the study. Results: This study demonstrates that intestinal TB is more common in males (M:F::2.1:1) & average age of presentation was 42.7 yrs. Abdominal pain, altered bowel habits, vomiting and fever were common symptoms, while common diagnosis were that of subacute intestinal obstruction, ileal perforation, adhesions, plastered abdomen and multiple bowel strictures, Diversion loop ileostomy & segmental resection were commonly done procedures, Pulmonary complications & surgical site infection were common complications. Hyperplastic type of intestinal Tuberculosis was more common than Ulcerative type in our study. Conclusion: Abdominal TB has spectrum of presentation from vague abdominal pain with mild fever vomiting and loss of appetite to subacute intestinal obstruction, ileal perforation and plastered abdomen. Surgical intervention were needed whenever the presentation was like acute abdomen, Diversion loop ileostomy was commonly done procedure. On histopathological examination hyperplastic variety was more common than ulcerative type. Rest findings were comparable to the other studies done on abdominal tuberculosis.

Keywords: Acute Abdomen; Intestinal Obstruction; Intestinal Tuberculosis; Ileostomy; Perforation; Stricture. 

Introduction: Surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections Methodology: In the microbiology department, the swabs were inoculated onto blood agar plate, McConkey’s agar plates and nutrient broth. Inoculated media were incubated aerobically at 37°C for 24-48 hrs. Nutrient broth was sub cultured if the original plates did not yield organisms. The bacteria isolated were identified by their morphological and cultural characteristics. Results: E-coli cause 86.6% of infection upto 5 days pre op hospitalisation and pseudomonas causes 60% infection in the same period. Klebsiella causes 75% of infection in 6 -10 days pre op period. During >10 days period staphylococcus. Conclusion: Apart from this regular review and monitoring of the implementation of guidelines is equally important.

With the advent of ERCP in 1974 it provided an alternative to CBDE. The CBD calculi could be removed endoscopically and subsequently only a cholecystectomy needed to be performed. Thus ERCP with Endoscopic sphincterotomy(ERCP-S) gained popularity as it provided an alternative to open CBDE for choledocholithiasis diagnosed preoperatively as well as intraoperatively. However, with the development of better techniques and instrumentation LCBDE is a feasible option now. Subsequent studies showed that LCBDE has similar duct clearance rates and morbidity as compared to ERCP-S followed by LC [5,6]. Therefore, a randomized prospective study with N= 56 was done to compare the efficacy of laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for cholelithiasis and also to compute complications of the individual procedure.In conclusion, our study shows that both LC+ LCBDE and ERCP-S+LC were equally effective in the management of choledocholithiasis and were equivalent in patient satisfaction. However, the overall duration of hospitalization was longer for LC+ LCBDE. Laparoscopic CBDE significantly reduces the risks of ERCP- associated pancreatitis, anaesthesia and another procedure. Hence, LCBDE+LC is a feasible, cost-effective, and safe procedure and ultimately should be offered as a treatment option for most patients.