Although accounting for 90 % of the intestinal surface area, small bowel adenocarcinomas are not common. The majority of these lesions are incidentally detected during laparotomy for intestinal obstruction or perforation. The symptoms associated with these lesions are not very specific and preoperative diagnosis is rare. We report two cases of jejunal adenocarcinomas detected in patients undergoing laparotomy for acute abdomen and review the literature for small bowel adenocarcinomas.

Background: Acute pancreatitis has widely variable clinical and systemic manifestations spanning the spectrum from a mild, self-limiting episode of epigastric pain to severe, life-threatening, multiorgan failure. Since the morbidity and mortality of Acute Pancreatitis differ markedly between mild and severe disease (mild < 5% vs severe 20–25%), it is very important to assess severity as early as possible. Various scoring systems like APACHE II scoring, RANSON scoring and BISAP have been used to asses Severity in Acute Pancreatitis. Aim and objective: To assess the accuracy of BISAP scoring system vs RANSON scoring system in predicting Severity in an attack of acute pancreatitis. Materials and methods: In this study, 60 in-patients presenting with features of acute pancreatitis at Department of Surgery, Govt. Medical College and Hospital, Bettiah, W. Champaran, Bihar from April 2019 to March 2020 had been studied. It was a perspective and a retro prospective study. BISAP score and Ranson’s score was calculated in all such patients based on data obtained within 48 hours of hospitalization. Results: According to Atlanta Revised criteria, 30 patients had mild pancreatitis, 20 patients had moderately severe pancreatitis, 10 patients had severe pancreatitis. Of the 60 patients, 37 patients had Ranson's score less than or equal to 3. 23 patients had a score of more than 3.Of the 60 patients, 39 patients had a BISAP score less than or equal to 3, 21 patients had a score more than 3. Conclusion: From this study, we can conclude that the BISAP scoring system is not inferior to Ranson’s scoring system in predicting the severity of acute pancreatitis. BISAP scoring system is very simple, cheap, easy to remember and calculate. BISAP scoring system accurately predicts the outcome in patients with acute pancreatitis. Moreover, the values in BISAP score are instantaneous and there is no time delay. Ranson’s score takes a minimum of 24 hours.

The conventional technique of thyroidectomy normally requires a long skin incision and wide skin flaps on the anterior neck. The target of Minimal invasive surgery is to achieve the same results as those obtained with traditional surgery, less trauma, better postoperative course and improved cosmetic results. The aim of this Prospective Cohort study is to compare Small Incision (3.5-4cm) Thyroidectomy with conventional large incision Thyroidectomy with respect to post-op complications & Cosmesis. Most of the patients were in the age group 30-50yrs. There was no statistically significant difference between the two groups with respect to complications, which were Hematoma (6%), Seroma (25%), Hypocalcemia (52.5%)[Transient (37%), Permanent (15%)], Recurrent Laryngeal Nerve Involvement (33%) [Complete (6%)]. The scar in Small Incision surgery was cosmetically far better compared to the large incision Surgery & this difference was statistically significant. This technique not recommended in huge goiter, Retro-sternal goiter, thryroiditis and malignant thyroid. We believe that MINET can be an alternative to the classic approach in selected cases, but cannot be recommended as a standard therapy. Study on a large number of patients and longer follow up periods is recommended.

Background: Fissure-in-ano is a very common anal disorder which predominantly presents with severe pain. Lateral internal sphincterotomy remains the main treatment modality. This may be performed using open or closed method, each with their attendant complications. Objective: This prospective study compared the results and complications of open versus closed technique of lateral sphincterotomy in patients with chronic anal ssure. Materials and Methods:Atotal of 64 patients with chronic anal ssure were enrolled in this study. Of these, 34 patients underwent open lateral sphincterotomy, and 30 underwent closed sphincterotomy. They were followed up for 6 months postsurgery. The results and complications of the two groups were compared and statistically analyzed. Results: Post-operative complications such as pain, bleeding, infection, incontinence, and recurrence were compared between the two groups. Pain, bleeding, and incontinence to atus were signicantly lesser in the closed group (P < 0.05), while there was no difference in the incidence of infection and recurrence between the two groups. Conclusion: Closed lateral internal sphincterotomy is a better alternative compared to open sphincterotomy in the treatment of chronic anal ssures.

Background: Following injury to the extremities and head, abdomen is the third most commonly injured part of the body. Blunt abdominal trauma (BAT) is particularly deceptive because of the delay in clinical manifestations for hours or even days, even though the damage to the internal organs might be serious and lethal. Road traffic accident (RTA) is the most common mode of injury to cause BAT. Diagnostic modalities like FAST and CT scans have caused a significant change in the trends regarding management from surgical to a more conservative approach. Current research aimed to study the blunt trauma abdomen with respect to management and outcome in GMC, Bettiah, W. Champaran, Bihar. Material and methods: This observational study is based on 50 cases of BAT who presented in Department of Surgery, Govt. Medical College & Hospital, Bettiah, Bihar with respect to clinical presentation, investigations, management and outcome. Results and outcomes will be depicted in various tables. Results: In the present study, demographic data like age and sex, the mode of injury, presenting Hb (in gm%), commonly injured organs, the management done and the associated mortality was observed and compared. It was found that BAT commonly involves young males in the age group of 30-40 years. RTA is found to be the most common mode of injury. Spleen was the most commonly injured solid organ followed by liver. Hollow viscus injury was seen in 10 out of 50 patients in our study. Conservative management was done in 37 out of 50 patients. Mortality was observed in 3 out of 50 cases. Conclusion: The study was conclusive of the fact that young males who sustained BAT due to RTA were the most commonly affected group. It also was conclusive that spleen and liver are the most commonly injured organs in BAT and conservative management should be followed wherever possible. Mortality was significantly higher in patient presenting with decreased hemoglobin.

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies. Methods: A total 140 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of WBC count, C-Reactive protein (CRP), USG and Alvarado scoring system and were subsequently operated, were included in the present study in our institute. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients.Most of the patients of acute appendicitis presented with more than one of above symptoms. The most common presenting symptom was right iliac fossa pain affecting 96.19% of cases (migratory 62.86% and non-migratory 33.33%), followed by anorexia (78.10%) and nausea (66.67%). The other symptoms were fever (65.71%), vomiting (46.67%), constipation (28.57%), right sided flank pain (22.86%), dysurea (19.05%), suprapubic pain (15.24%), diarrhoea (14.29%) and generalized abdominal pain (13.33%) in decreasing order of frequency. Right iliac fossa pain was the most common presentation in non-appendicitis group, followed by anorexia. There was no significant difference in symptoms among these two groups.In this study 54.29% of patients with acute appendicitis had Alvarado score between 7 – 8 and 34.29% of patients with acute appendicitis had Alvarado score between 9 – 10. On the other hand majority of the patients of non-appendicitis group had a score below 7. Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.