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Background: Peptic ulcer perforation is the commonest perforation of the gastrointestinal tract affecting 2-10% population showing a shift from older to the younger population. With this statistics a study for incidence of peptic ulcer perforation in young adults 18-30 years was carried out. Methods: Prospective study of patients admitted on emergency basis and diagnosed as peptic ulcer perforation either gastric or duodenal perforation intraoperatively in patients 18-30 years were studied from June 2009 to October 2011. Results: Of 175 patients, 70 (40%) patients were between 18 and 30 years age. 58 (82.85%) were males and 12 (17.14%) were females. Twenty-three (32.85%) patients had history suggestive of acute peptic disease/ulcer and had taken some treatment in the form of antacid H-2 blocker or proton pump inhibitor while 47 (67.14%) patients had no history. Pain was the consistent symptom while tachycardia, tenderness, and guarding were the signs present in all 70 (40%) patients. Gas under diaphragm (pneumoperitoneum) was found in 67 (95.71%). Ultrasonography abdomen S/O pyoperitoneum was found that all 70 (100%). 57 (81.42%) patients had an anterior duodenal perforation, 12 (17.14%) patients had a gastric perforation with a ratio of 4.7:1, and 1 patient had a combined gastric and duodenal perforation. 1 (2.43%) patient expired in the post-operative period, 55 (78.57%) patients come for regular follow and 14 (20%) patients were lost to follow-up. Only 4 (7.2%) patients had mild to moderate symptoms of peptic ulcer disease which were controlled by anti-ulcer drugs. Conclusion: Peptic ulcer perforation is a disease more common in the young population with a male preponderance.

Background: Laparoscopic cholecystectomy is considered the gold standard treatment for most gallbladder diseases. It has now become one of the most common operations performed by general surgeons. At times, it is difficult and takes longer time or some complications may occur or has to be converted in to open cholecystectomy. This study is undertaken to determine predictive factors for difficult laparoscopic cholecystectomy.  The aim of the study was to study pre-operative factors in the patients to predict whether the laparoscopic cholecystectomy will be easy or difficult. And to co-relate the pre-operative factors predicting a difficult Laparoscopic Cholecystectomy with intra-operative findings.Methods: This prospective study was carried out in the Department of General Surgery in IGGMC, Nagpur, Maharashtra, India over a period of 2.5 years. Total 52 patients were included in the study. All patients were evaluated for risk factors preoperatively and intraoperative findings were noted. A chi-square test has been used to find the significant association of findings of the preoperative score with postoperative outcome.Results: History of hospitalization for gall stone diseases, ultrasound abdomen showing gall bladder wall thickness >4 mm, presence of pericholecystic collection, and impacted stone can be considered as individual significant positive predictive factors to predict a difficult laparoscopic cholecystectomy preoperatively. While age >50 years, gender, BMI >25 kg/m2, and history of supraumbilical surgery/scar can’t be considered as an individual positive predictive factor.Conclusions: A uniform scoring system needs to be assessed and thoroughly evaluated by combining all these factors to predict a difficult laparoscopic cholecystectomy.

Post-operative outcomes of large bowel obstruction in adults. METHODS: This is a prospective observational study of large bowel obstruction in adults and was carried out from Nov 2010 to Oct 2012. RESULTS: A total of 211 cases of intestinal obstruction were diagnosed out of these 25(11.85%) cases were of large bowel obstruction. Maximum patients 8(32%) cases belonged to age group 51-60yrs and 15(60%) cases were males. Obstipation seen in 25(100%), pain 22(88%), distension 21(84%), tenderness 22(88%) and increased bowel sounds 21(84%). X-ray and ultrasonography was useful in 21(84%) cases while CT scan was used in only 7 cases and proved 100% effective.13(52%) cases were of sigmoid volvulus, 1(4%) of caecal volvulus and 9(36%) cases of malignancy.15(60%) cases underwent primary resection anastomosis and 10(40%) cases had a decompressive colostomy.8(32%) patients developed immediate wound complication, 3(12%) cases had anastomotic leak, 1(4%) case developed burst abdomen and 6(24%) cases had septicaemia. Mortality of the study was 6(24%) cases. CONCLUSION: Patients with large bowel obstruction in adults form a small percentage of patients. Commonest causes are sigmoid volvulus and obstructing colorectal malignancies. X-ray abdomen, Ultrasound of abdomen and Computerized Tomography of abdomen are very helpful in diagnosing. Single stage resectional procedure without colostomies can be done in patients even in emergency surgeries and Proximal diverting colostomies may be safely performed in patients with pre-existing sepsis, shock, gangrene of large bowel and excessively loaded colon with reversal of colostomies and a definitive procedure may be performed later, after stabilisation of patients. Post-operative complications are more because of late presentation associated with comorbidities and large bacterial load of colon during resectional procedure large bowel obstruction carries an increased rate of mortality because of its presentation in old age with associated comorbid factors requiring major resectional procedures. INTRODUCTION: Intestinal obstruction accounts for one of the most common surgical emergencies resulting into high morbidity and if timely aid isn't provided mortality sets in .The incidence of this condition has not changed though a different etiological pattern is present from place to place and time to time over the last century. The mode of presentation is same in all but certainly with varied causes. With time, better understanding of pathophysiology, improvement in radiological techniques of diagnosis, high degree of refinement in correction of fluid and electrolyte imbalance, introduction of antibiotics with effective bacteriological control, introduction of techniques in