A 40-year-old female presented to the neuro physician with complains of headache, giddiness, vomiting and loose stools and altered sensorium since past one day. On examination, deviation of angle of mouth towards right, weakness of left upper and lower limbs, GCS 8/15 and an extensor plantar reflex was seen.CT scan showed bilateral diffuse cerebral oedema. Suspecting a cerebrovascular stroke and increasing intracranial tension, the patient was intubated and started on Inj. Mannitol (150 ml i.v. Q4H) and antibiotics. As the patient was intubated, she was sedated using Inj. Midazolam till fifth day of treatment, when she was extubated. Inj. Dexomethasone (8 mg iv QD) and intravenous fluids were also started. The patient was extubated on fifth day and was started on Inj. Enoxaparin 60 mg subcutaneously BD on sixth day.On the eighth day of treatment (day 3 on enoxaparin) patient complained of sudden development of abdominal pain. This was accompanied by tachycardia and sudden fall in blood pressure. The general surgery department was consulted for the above complaints. On examination, the patient was found to have extreme tenderness, and a vague mass was felt in the right iliac fossa, suprapubic region and left iliac fossa with positive Carnett's sign and Fothergill sign. Repeat complete blood count, ultrasonography abdomen and pelvis, and CT scan abdomen and pelvis were advised.Blood count reports showed a drop in haemoglobin level from 14.6 gm% at the time of admission to 7.1 gm% on the fourth day of enoxaparin treatment. Platelet count which was 353,000 cells/cu mm on admission had fallen to 252,000 cells/cu mm on the day of pain and then fell to 183,000 cells/cu mm the next day. The ultrasonography abdomen and pelvis showed a focal thick walled heterogeneous pelvic collection in the infra-umbilical region.CT scan abdomen and pelvis showed a large (15.3 cm 3 x 12.2 cm 3 x 7.4 cm 3 ) collection, approximately 720 ml, heterogeneous hyper dense collection in the right infra-umbilical anterior abdominal wall, proximally limited to the rectus sheath in epigastric region. Inferiorly extended to preperitoneal space of abdominal cavity crossing the mid line and extending to left side. There was extension into suprapubic region posterior to pubic symphisis and in prevesical region. Compression of bowel loops and bladder was also seen. The reports were suggestive of a Grade III rectus sheath haematoma [Table/ Fig-1].Fluid aspiration cytology report from the infra-umbilical region showed few scattered polymorphs with abundant red blood cells in the background with no evidence of malignant cells. Keywords: AbSTRACTRectus sheath haematoma is a well-documented condition with an elusive diagnosis. It is an uncommon complication of anti-coagulation therapy, which can have a mortality of upto 25%. The patient discussed here is a 40-year-old female who was on Inj. Enoxaparin, who developed severe abdominal pain and hypovolemia after three days of treatment. Ultrasonography and CT scan showed a large rectus sheath haematoma on the...

Background: Fistula in ano (FIA) is a chronic complex condition of ano-rectal sepsis characterized by cylical-pain and intermittent chronic purulent discharge. The management of fistula is challenging. In spite of all the advances in the management of FIA, no single method is univresally applicable to all types of FIA due to incontinence and recurrences associated with the individual procedures.Methods: Aims of this study were to compare the outcomes between ligation of intersphincteric fistula tract (LIFT) and conventional fistulectomy (CF) with 60 patients randomized into 2 groups, 30 in each group.Results: Mean age in LIFT was 44.17 years and in CF was 41.1 years. Successful primary healing was observed in 86.7% of LIFT and 100% of CF. Mean pain scores were lower in LIFT compared to CF when checked on Postoperative days 1, 3 and 7 significantly. Anal incontinence was seen in 10% of CF and none in LIFT and recurrence was seen at same site in LIFT in 6.66% of LIFT and none in CF both being not statistically significant.Conclusions: LIFT is a promising and sphincter saving technique which is simple and easy to learn with faster healing rates and better patient contentment but with risk of failure and recurrence. Modifications of LIFT have to be probed for minimizing the failures.

Background: Burns due to accidents are a common cause of morbidity and mortality in the Indian sub-continent. The causes being preventive, warrant a better understanding of the epidemiology to know the seriousness of the situation, implement better medical care and prevent such accidents. Aim was to study the morbidity and mortality related to percentage of burns.Methods: This is a retrospective observational study where patients admitted with burns 2013 and 2015 were evaluated. Data with respect to sex, age, percentage of burns, air-way burns, mode and cause of burns, cause of death and length of hospitalization were analyzed.Results: 65.3% of the patients were females and 34.7% males, with a male: female ratio of 0.53:1. A total mortality of 43.71% was seen. Maximum patients belonged to age group 21-40 years which also constituted 28.74% (highest) of the above total mortality. More than 50 % mortality was seen in patients with more than 41% burns. Air way burns were present in 41.31% of the cases; of which 85.51% of cases did not survive. Death due to hypovolemic shock (42.47%) was the main cause of death in the initial 4 days of admission; whereas septicemic shock (57.53%) from the 5th day onward.Conclusions: Morbidity and mortality due to burns is still very high in India, especially in young adults of age groups 21- 40 years. A higher case load for females as seen, being nearly double in in relation to males. Better fluid resuscitation regimens with adequate control of infection is the need of the hour to bring down the mortality. Female sex and more than 41% burns predicts higher mortality. Involvement of the respiratory tract, also predicts higher mortality and may be taken as a reliable indicator of the severity of burns. In the present scenario, we should stress more over the prevention of burns, to easily make available affordable and cheap medical care for the patients and to minimize post burn disability as much as possible.

Background: Incisional hernia (IH) remains a very frequent postoperative complication and common hernias in middle aged population more commonly in females. The two techniques most frequently used are the onlay repair and sublay repair. Various studies have been conducted to compare the advantages and disadvantages of sublay and onlay mesh repair in incisional hernia and the superiority of sublay mesh repair. These studies whether they hold good for the population is a pertinent question. In view of this, author need to study the appropriate surgical techniques sublay versus onlay repair in the set up.Methods: Author conducted randomized comparative study of 100 patients having incisional hernia admitted to various surgical units of SNMC and HSK Hospital, Bagalkot during the period December 2014 to June 2016.Results: In present study of 100 cases, females have more incidence of incisional hernias than males. In onlay technique seroma formation was found in 72% of patients postoperatively and 4% in sublay technique. Surgical site infection (SSIN) was noticed in 8% of sublay technique whereas 12% in onlay technique. There is no recurrence in sublay group whereas onlay had 12% recurrence.Conclusions: Sublay technique is superior to onlay concerning the hospital stay, complications and recurrence.

Background: Fissure in Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF).Methods: Prospective comparative study conducted on 90 patients randomly divided into two groups Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA) respectively. The primary outcome variables studied were postoperative pain, hospital stay, and cost effectiveness.Results: A total of 90 patients randomly divided into 45 patients in each group. There was no statistically difference in the pain at surgery, but post-operative pain was significantly less in LA group at 5th hour, 24 hours after surgery. Hospital stay in LA group is significantly less when compared to SA group (1.92, 3.75 respectively).Conclusions: LAS can be comfortably performed under LA with added advantages.

INTRODUCTIONAbdomen is like Pandora's Box. Diseases of the abdomen constitute a topic full of curiosity. A meticulous examination of the abdomen is one of the most rewarding diagnostic procedures available to the doctor, especially the surgeon. As it had been said by Bailey, "A correct diagnosis is the hand maiden of successful operation" Despite the advancements in the fields of diagnosis the surprises never caese.1 Acute appendicitis is the most common acute surgical condition of the abdomen. 2 ABSTRACTBackground: Now a day there is a trend to rely more on high-tech investigations rather than taking thorough history and clinical examination of the patients in the diagnosis of acute pain abdomen. Commonest cause of acute abdomen in the surgical practice is appendicitis. Delay in the diagnosis and treatment of acute appendicitis, leads to complications. Objective of this study was to evaluate the accuracy of clinical diagnosis versus sensitivity and specificity of ultrasound examination and histopathological examination of the resected specimen of appendix. This study also assesses the incidence of negative appendectomies in a medical college hospital of North Karnataka. Methods: This study included one hundred and fifty patients with history of pain abdomen where clinical diagnosis of acute appendicitis was made. The study period was of 18 months between February 2014 to July 2015. Routine blood investigations and abdominal ultrasonography were done in all cases. All ultrasound positive cases were subjected to surgery. Some ultrasound negative cases were also taken to surgery on the high suspicion of diagnosis of acute appendicitis depending upon thorough history taking and clinical examination. The diagnosis made depending on the ultrasound findings were compared with clinical findings, operative findings and histopathological examination reports. Results: Out of 150 patients, 104 were male and 46 were female. The common symptoms were pain in the RIF (100%) and anorexia (80%).The overall sensitivity and specificity of clinical diagnosis was 96.9% and 90.48% respectively. The same for ultrasound was 86.99% and 33.33% respectively. The present study shows negative appendectomy rate 6.66% in females and 7.33% in males. Conclusions: The diagnostic accuracy of ultrasound was 84.87% whereas clinical diagnosis was 96%. Thus, detailed history taking, and thorough clinical examination still holds good in the diagnosis of acute appendicitis and should be stressed in the clinical teaching.

Background: Acute appendicitis is the commonest cause of acute surgical abdomen. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Delay in diagnosis and treatment results in increased rate of perforation, morbidity, mortality and hospital stay.Methods: A prospective study where a total of 100 patients with clinical, radiological and histopathological diagnosis of acute appendicitis or appendicular perforation were studied. The liver function tests were carried out in all the patients.Results: In a study group of 100 patients (74 males and 26 females); 59 cases were acute appendicitis and 41 cases were appendiceal perforation proven histopathological. Out of which 48 cases had elevated serum bilirubin levels i.e., 17 in acute appendicitis group and 31 in appendicular perforation group. The mean serum total bilirubin is 1±0.4 in acute appendicitis cases and 1.9±1.13 in the appendicular perforation cases. Similarly, the sensitivity and specificity of elevated serum bilirubin as a diagnostic marker in appendicular perforation was found to be 75.6% and 71.2% respectively.Conclusions: Elevated serum bilirubin levels appears to be a promising new supplemental diagnostic serum marker in Appendicular Perforation and perhaps be a decision-making investigation.

Background: Despite technological advances the diagnosis of appendicitis is still based primarily clinical assessment. The diagnosis of atypical appendicitis remains clinically challenging and is one of the most commonly missed problems in the emergency department. Ultrasonography is highly operator dependent with a consequently wide reported sensitivity range.Methods: This is a prospective study conducted in the department of surgery. All patients with right lower abdominal pain, admitted to HSK hospital Bagalkot, in whom acute appendicitis was suspected were analysed from January 2013 to June 2014.Results: In the present study appendix was visualized in 85% of the patients and periappendiceal collection was found in 7% of patients. Faecolith was found only in 1 case. Out of these 74 cases were uncomplicated acute appendicitis. Perforated acute appendicitis was diagnosed in 6 cases. One case was diagnosed as appendicular abscess and 4 cases were diagnosed as chronic appendicitis. Based on clinical assessment 4 patients were subjected to surgery after 48hours.Conclusions: Graded compression US remains our first line method in rural setup in the evaluation of patients referred with clinically suspected acute appendicitis.