Background: Anal fissure is a tear in anal canal just below dentate line. It can be acute or chronic. In most patients, it is located in posterior midline. Its treatment is both conservative and surgical. In conservative management, there are no clear guidelines and its goal is to break the cycle of anal sphincter spasm allowing improved blood flow to fissured area for healing. Surgery is considered for patients not responding to conservative measures and its gold standard is lateral internal sphincterotomy.Methods: This prospective study was conducted among 60 patients with acute anal fissure. Patients were randomly divided into two study groups based on treatment protocols conservative management and Bilateral LSIAS. Prior informed written consent was obtained. Demographic profile, history, investigations, diagnosis, treatment and follow-up data was recorded and analyzed.Results: Patients with Bilateral LSIAS got pain relief immediately after surgery. 57% patients with conservative management reported head-ache and perianal itching. Over 86% of patients with Bilateral LSIAS got relief from pain and discomfort after treatment; around over 46% patients with conservative approach, had pain and discomfort after 6 weeks of treatment.Conclusions: Results show that Bilateral LSIAS surgery is a better approach than conservative management of anal fissure. Further, the Bilateral LSIAS surgery has maximum chances of early recovery and pain relief and reduced chances of progression to chronic anal fissure. Hence, we can conclude that for anal acute fissure, Bilateral LSIAS surgery procedure is the treatment of choice.

Background: Two most demoralizing things in life are physical pain and bad body odour. A counted few body pains are as terrible, as oppressive and as tormenting, almost on daily basis as the pain of fresh acute fissure in ano. It pins your whole being, your awareness of life and focus of living on to your painful anus. Anal fissures are commonly encountered in routine colorectal practice. Fissure has traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment.Methods: 40 patients with acute fissure in ano were divided into 02% diltiazem gel and unilateral subcutaneous internal anal sphincterotomy (USIAS) groups. Patients in the two groups were followed up subsequently.Results: Anal fissures were found completely healed in 14 (70%) out of 20 patients treated with 02% diltiazem gel between 4-8 weeks. Healing was 100% with “USIAS” group. The mean healing duration of fissure was 04.45 weeks in diltiazem gel group and 03.45 weeks in “USIAS” group. 65% patients were free from pain after treatment with diltiazem gel whereas 95% patients were free from pain after treatment with “USIAS”.Conclusions: This prospective study, demonstrates that “USIAS” is superior to pharmacological treatment of anal fissure with good symptomatic relief, high rate of healing with very low rate of complication. Patients who are not willing to undergo surgery may be managed by 02% diltiazem as pharmacological line of management for fissure in ano.

Pulmonary herniation is an uncommon phenomenon. It has been described sporadically in obscure case reports and rare case series. Owing to its sparse occurrence, a calibrated algorithm for its management does not exist. Even then, the popular consensus advises surgical management comprising prosthetic mesh repair. Hereby, authors report a case of a 24-year-old male, who developed left lung herniation after blunt trauma to the chest wall. Non Contrast Computed Tomography (NCCT) of chest revealed herniation of left lung through 3rd intercostal space, a hernia defect of 1.8 cm and a small left pneumothorax. Patient was managed conservatively with intercostal drainage and was discharged on day 5 of admission. This case report aims to delineate the conditions where conservative management of lung hernias can be undertaken successfully.

Background: In 1952, Professor Bryan Brooke described his technique for everting an ileostomy in order to minimise skin excoriation1. Pouting, mucosa-everting Brooke’s ileostomy have been accepted as the best technique for stoma formation in almost all cases, save a few difficult situations – such as edematous friable bowel with bulky short mesentry! In such cases formation of standard Brooke’s ‘Pouting’ ileostomy is not only difficult, but an impossible and a dangerous surgical exercise! In these situations where the bowel is “Un-Brookeable” due to aforementioned causes. Over a period of 12 years we could device a formula – “Ray’s Criteria” to decide at operation, if a given ileum in a particular patient, is safely “Brookeable” (i.e. evertable into a neat Brooke, spouting ileostomy) or is   “Un-Brookeable”.Methods: 23 patients were included in this study over 12 years, who due to the peculiarity of their body morphology (obesity or thick abdominal fat), edematous friable bowel with bulky mesentry, the ileum could not be drawn outside the abdomen and everted as Brooke’s ileostomy. The “Brookeability” of the exteriorized ileum was decided based on satisfying two issues of Ray’s criteria.Results: By using “Ray’s criteria”, we could seggregate patients safely as “Brookeable” and “Un-Brookeable”. Those deemed “Un-Brookable” underwent “Long segment Hanging snout” end ileostomy, which is the theme of our study.Conclusions: We are emphatic in stating that by using “Ray’s criteria” we could accurately segregate cases into “Brookeable” and “Un-Brookeable” ileum.

Xanthogranulomatous epididymitis is a rare benign process with destruction of tissue and replacement by cellular infiltration of foamy macrophages, dense lymphocytes and plasma cells. Literature has very few case reports. We reported here a case of a 72 years old male who presented as scrotal abscess with bilateral hydrocele on ultrasound. On exploration he had normal right testis with abscess localized to epididymis underwent right epididymectomy with orchidopexy. Histopathology reported necrosis and abundant foamy macrophages and plasma cells findings suggestive of xanthogranulomatous epididymitis.