Purpose. To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures. Methods. 44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score. Results. Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures

Congenital segmental dilatation (CSD) of the intestine is a rare developmental anomaly characterized by sharply demarcated dilatation of a gastrointestinal segment and may present with intestinal obstruction. We report three cases of CSD of the intestine in neonates with varied presentation. First patient was mistaken as pneumoperitoneum on abdominal radiograph, which led to initial abdominal drain placement. The 2nd patient was a case of anorectal malformation associated with congenital pouch colon (CPC) and CSD of ileum; and the third case presented as neonatal intestinal obstruction and found to have CSD of ileum. All the patients were successfully managed in our department.

Background: The management of adhesive small bowel obstruction is quite debatable. Gastrograffin, a water-soluble hyperosmolar contrast is used as a diagnostic tool widely but it also has impressive therapeutic role. Hence this study was to determine its therapeutic role in management of adhesive bowel obstruction after failure of conservative treatment. Methods: This cross-section observational study of 42 patients was conducted in 1-year duration from 01 July 2018 to 30 June 2019 using non-probability purposive sampling technique. All the patients were first managed conservatively for 48 hrs, and then given 100ml of gastrograffin through NG tube and clamped. Appearance of dye in cecum on radiograph at different time frame (4, 8, 12 and 24 hours of administration) signifies the success and who failed to do so within 24 hrs. were planned for laparotomy. Results: A total of 42 patients with their age ranged 14-80 years (mean 44.6) were included. Among them 32 (76.19%) were male and 10 (23.80%) female. Most had open appendectomy followed by gynaecological surgery and exploratory laprotomy. Majority had midline incision followed by gridiron and pfanensteil incision. After 8 hrs of gastrograffin administration, it was positive in 12 patients while 19 had at 24 hrs. Total 31 patients showed complete resolution, while remaining 11 showed no improvement and undergone exploratory laparotomy. Conclusion: Thus, the administration of gastrograffin is an effective approach in the management of adhesive small bowel obstruction after failed conservative management and prevents surgeries.

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Intestinal knotting is a rare cause of acute intestinal obstruction and in most cases is diagnosed intraoperatively due to its rarity and uncommon presentation. Out of different types of intestinal knots, ileo-ileal knotting is rarest and very few such cases have been reported in the literature. Due to very high mortality, early diagnosis and immediate surgical intervention are needed. Here we present a case of a 52-year-old male patient who presented with a history of non-passage of stool and flatus, after resuscitation patient was planned for exploratory laparotomy. Findings revealed gangrenous ileal loops and an ileo-ileal knot masquerading as an internal hernia. End-to-end anastomosis of the gangrenous ileum was done along with a decompressive proximal loop ileostomy. The patient was transferred to the intensive care unit after surgery. He died on postoperative day 1 due to metabolic acidosis with endotoxic shock. By reporting this case we want to emphasize on the need of keeping intestinal knots as a differential diagnosis while operating a case of acute intestinal obstruction.