New Indian Journal of Surgery

Perforation of the gallbladder is a rare but dreaded complication following cholecystitis.1 Spontaneous perforation is most commonly seen in the elderly, and in patients suffering from diabetes mellitus.2 The most common site of perforation is the fundus of gall bladder.3 The gall bladder distension and edema associated with acute inflammation leads to venous and arterial obstruction. Subsequently, this leads to ischaemia and necrosis of the gall bladder wall. The fundus is most susceptible to this injury due to maximum distance from the cystic arterial supply. Aggravating factors include atherosclerosis, focal vasospasm and localized vasculitis. If diagnosed and treated late, perforation of gallbladder may be associated with high chances of morbidity and mortality.4-6 Here, we report a case of a 66-year-old male with perforation of gallbladder following acute calculous cholecystitis.

In the present scenario, laparoscopic cholecystectomy remains the most common surgery performed by the general surgeons but there is constant fear of the common bile duct injury associated with it. We have moved from the era of open to laparoscopic cholecystectomy with a long initial learning curve for surgeons.2,3 During this period, the most vulnerable structure to injury is the common bile duct1,4 which can lead to serious complications like biliary peritonitis, hepatic failure and death. 22 Majority of the patients are identified later with the progression of jaundice and a few are recognized on table as requiring immediate repair. Our study is focused on the role of ultrasound in the postoperative period as a tool for detecting common bile duct injury within 72 hours of cholecystectomy.

Electrical burns constitute 3–5% of all burn cases; in developing countries, this ratio increases up to 21–27% and the mortality rate is reported to be between 3.75% and 58.8%. Most of the acute burns are life threatening, and require various types of surgical interventions such as eschar excision or split thickness skin grafting, depending on the size, location and depth of the lesion. The deep electrical burns to the scalp were difficult to manage as it was more prone to exposure of the calvarial bone. In our case, a calvarial bone at the vertex was exposed post-eschar excision. Tissue expansion is based on the principle that all living tissues respond in a dynamic fashion to mechanical stress placed on them. Below we present a case of electrical burns wound to the calvarium utilizing the use simple cost-effective external tissue expansion technique for preventing wound retraction and for holding the dressing of the scalp wound.

Introduction: Fistula-in-ano is a very common ano-rectal condition with wide spectrum of aetiology with a prevalence 8.6 to 10/100,000 of the population per year. Establishing a cure is problematic due to location of the diseased part, that makes the patient refrain from early consultation and this delays in treatment. Fistula causes appreciable morbidity and inconvenience to the patient and there is scarcity of studies on its etiopathogenesis, clinical features, investigations and treatment. Hence, this study was undertaken to study the clinical and pathological presentations, efficacy of surgical modalities and treatment outcomes.

Material And Methods: An observational study was conducted during the study period (April 2017 to March 2018) on patients admitted at Kamalnayan Bajaj Hospital for the evaluation of Fistula in ano, 90 patients were enrolled in the study after fulfilling inclusion and exclusion criteria and taking written/verbal informed consent. The patients underwent either fistulectomy and fistulotomy according to the criteria decided.

Results: In our study, incidence was noticed more in the age group of 31-40 years 40%, and more in males. 70% of patients belonged to lower socio-economic status; incidence was more common in among drivers 30%. The commonest mode of presentation was discharging pus in 70% of cases. Majority of the patients 80% underwent fistulectomy. Among 72 patients who underwent fistulectomy, all the patients responded with complete healing after surgery.

Conclusion: It was concluded that history, clinical examination, per rectal and perineal examination helps to diagnose the condition. Proctoscopy, sigmoidoscopy and MRI examination helps in diagnosing complicated cases. It is curable disease by the treatment of surgery along with necessary antibiotics, analgesics and good post-operative wound management.