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BACKGROUND Acute intestinal obstruction is one of the most common surgical emergencies in all age groups, all throughout the world. Whether caused by hernia, postoperative adhesions, neoplasm or related biochemical disturbances, intestinal obstruction of either sma ll bowel or large bowel continues to be a major cause of morbidity and mortality. While the main causes of intestinal obstruction may vary from country to country or among regions within a specific country, knowledge of the local disease patterns and outcomes may raise the index of suspicion, and reduce delays in diagnosis and intervention. This is helpful in settings with limited diagnostic modalities where making a definitive diagnosis may be challenging. The aim of the study is to analyse the profile of acute intestinal obstruction in operated cases and to analyse the morbidity and mortality factors in these cases. MATERIALS AND METHODS A prospective study of 210 patients with features of acute intestinal obstruction and was operated in MKCG Medical College Hospital, Berhampur, Odisha from August 2014 to July 2016. Inclusion Criteria-Patients in all age groups with clinical picture suggestive of acute intestinal obstruction and underwent laparotomy. Exclusion Criteria-Patients with provisional diagnosis of intestinal obstruction managed non-surgically. RESULTS The maximum incidence was seen in 41-60 years age group with male predominance. Pain abdomen, constipation, abdominal distension and vomiting were present in majority of cases. Common aetiologies were external hernias, bands, adhesions, volvulus and colon cancer. Small bowel was involved in 64.7% cases and large bowel in 33.8%. Resection-anastomosis, adhesiolysis and hernioplasty were the common procedures done. Postoperative complications were seen in 20.47% of cases. The mortality rate was 8.09%. CONCLUSION Acute intestinal obstruction still remains a major cause of morbidity and mortality. The pattern of obstruction is changing with increasing adhesions and decreasing hernias. The diagnosis of strangulation is still a challenge. Prompt intervention in cases of strangulation is the key for a better outcome. Even though there are great advances in technology at the investigation level, clinical judgement based on history, physical examination and radiography of the abdomen forms the main part in diagnosing a case of acute intestinal obstruction.

Pancreatitis is one of the most frequent gastrointestinal tract disease for hospitalization all over the world, leading to tremendous emotional, physical and financial human burden. The spectrum of aetiological factors for pancreatitis varies according to continents. Hyperlipidaemia is a rare but known and established risk factor for pancreatitis and goes undetected in most of the clinical settings. Early diagnosis of hyperlipidaemia induced pancreatitis is important to prevent its recurrence and complications. METHODThis is a prospective study carried out on patients with pancreatitis over a period of two years in M.K.C.G. Medical College and Hospital, Berhampur, Odisha, India. Fifty cases of pancreatitis of different age group and both sexes were selected. Equal number of age and sex matched patients other than pancreatitis were taken as control from the indoor. The mean serum lipid profiles of cases were compared with the control group. RESULTIn this study it was observed that the Serum Total Cholesterol, Triglycerides, Low Density Lipoprotein and Very Low Density Lipoprotein were significantly higher in cases than controls, while HDL was found to be higher in controls. Young males were commonly affected and alcohol abuse is the most common risk factor followed by biliary stones. CONCLUSIONAll pancreatitis patients should be evaluated for any alteration in their serum lipid profile, if found to be treated with antilipidaemic drugs, dietary modulation, lifestyle change and physical exercise to limit the occurrence of this disease, pre vent its complications and to control the possibility of future recurrences.

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information

IntroductionAcute appendicitis happens to be increasingly common in school-going children and early part of adult life, peak incidence reaching in the teens and early twenties. Luminal obstruction of the vermiform appendix is thought to be essential for the development of appendicular ischemia, gangrene, and perforation. The treatment of choice in acute appendicitis is emergency appendectomy. Appendicitis particularly puts the surgeon in a dilemma whenever the patient presents late by around four to seven days. In case of delay in presentation, complications like appendicular lump formation occur. The factors that make the clinical presentation inconsistent which in turn makes the diagnosis challenging in the case of acute appendicitis are the variable position of the appendix, the degree/grade of inflammation, and the age of the patient.At present, the standard treatment is the Ochsner-Sherren regimen universalized by Oschner and has been mostly practised over many decades as the standard care for the appendicular lump. Conservative regimen does not work in a few cases where urgent surgical exploration is necessary. This study was conducted to compare early appendectomy versus conservative management followed by interval appendectomy in case of appendicular mass and to make a better strategy for effective management of patients with complicated appendicitis. MethodsA total of 112 patients were diagnosed as having an appendicular lump as per the available records between June 2018 and June 2021. The total study population was divided into two comparative groups depending upon the treatment they received. The patients in group-1 received medical treatment and those in group-2 had undergone surgical management. The patients in group-1 were treated according to the Ochsner-Sherren regimen. The patients in group-2 were the patients in whom emergency appendectomy was done. If the general condition of the patient did not improve, pain and tenderness didn't subside, the size of phlegmon or abscess was increasing and other features of the acute abdomen were persistent, then it was regarded as a failure of medical treatment and the patient was prepared for surgery on an emergency basis. ResultsOut of 1192 cases of acute appendicitis admitted between June 2018 and June 2021, a total of 112 patients were diagnosed with an appendicular lump. As per the record, 64 patients were managed conventionally as per the Ochsner-Sherren regimen followed by elective interval appendectomy (group-1) and 48 cases were managed with an emergency surgical procedure (group-2).In group-1, out of 64 patients, non-operative treatment was successful in 58 patients (90.62%). Among the remaining patients, there was a failure of non-operative treatment in six patients and they were subjected to emergency surgical exploration (9.37%). So a total of 58 patients underwent interval appendectomy after six weeks. Out of 54 patients who had undergone emergency appendectomy in both groups, the per-operative finding was an appendicular lump in 55.5% of patien...