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Traumatic diaphragmatic hernia rarely affects right side due to protective effect of liver. In adult it is mainly caused by blunt abdominal trauma. Acute presentations are often life threatening and usually clinch the diagnosis early. It may remain asymptomatic for many years unless being detected incidentally during investigations for some unrelated reason or getting complicated by some pathology of herniated viscera. High degree of suspicion is required to detect this delayed presentation particularly in a post-trauma patient as this condition may require modifications in management. We report a case of acute cholecystitis which revealed a rare association of traumatic right diaphragmatic hernia and hepatothorax.

Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.

BACKGROUND:In the last decade, laparoscopic cholecystectomy (LC) has become a regular daycare surgery at many centres across the world. However, only a few centres in India have a dedicated daycare surgery centre, and very few of them have reported their experience. Concerns remain regarding the feasibility, safety and acceptability of the introduction of daycare laparoscopic cholecystectomy (DCLC) in India. There is a need to assess the safety and acceptability of the implementation of short-stay DCLC service at a centre completely dedicated to daycare surgery.PATIENTS AND METHODS:Comprehensive care and operative data were retrospectively collected from a daycare centre of our hospital. Postoperative recovery was monitored by telephone questionnaire on days 0, 1 and 5 postoperatively, including adverse outcomes.RESULTS:A total of 211 patients were admitted for DCLC during the period from November 2011 till November 2014, of whom 211 were discharged on the day of surgery. Two hundred and two patients could be discharged within 6 h of surgery. Mean operation time was 72 min. No patient required admission. No patient needed conversion to open surgery. Only 1 patient was re-admitted due to bilioma formation and was managed with minimal intervention.CONCLUSION:The introduction of short-stay DCLC in India is feasible and acceptable to patients. High body mass index (BMI) in otherwise healthy patients and selective additional procedures are not contraindications for DCLC.

Extrapulmonary tuberculosis affects an isolated organ or presents secondary to pulmonary involvement. Lymph nodes are the common sites for extrapulmonary tuberculosis. Primary extrapulmonary tuberculosis involving parietal wall is an unusual presentation. Tubercular abscess of the abdominal wall perforating to large bowel has not been reported. Here, we are reporting a very rare case of anterior abdominal wall abscess of tubercular origin in a 57-year-old female patient who presented with complaints of pain in upper abdomen for four months. CT scan and intraoperative findings revealed perforation of the abscess into transverse colon. Histopathology report confirmed the aetiology and origin of the abscess.

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Background: The anterior approach (AA) technique has been advocated recently for right hepatectomy. However, the indications to opt for AA or conventional approach (CA) remain inconsistent. Objective: To evaluate preoperative factors influencing the approach for hepatectomy. Methods: A prospective study was performed on 17 patients who underwent hepatic resection from January 2014 to December 2015. All patients were planned to undergo hepatectomy with CA. The decision to adopt an AA was determined by the operating surgeon at the time of laparotomy when mobilization of the tumor before parenchymal transection was considered dangerous or difficult. Results: Comparing the pre operative characteristics of AA group with CA, there was no significant difference except for the total liver volume (TLV) (p = 0.0001), Tumor volume (TV) (p = 0.0001), and Largest Tumor Dimension (LTD) (p = 0.0001). Using Receiver Operating Characteristic Curve the volume with optimal sensitivity and specificity which may alter the intra-operative plan from conventional to anterior approach was at 1858 cc, 1130 cc and 11 cm for TLV, TV and LTD respectively. Outcome of hepatectomy in both groups were comparable to each other and to the available data. Conclusion: Of all the analyzed preoperative factors which may affect the approach for hepatectomy TLV, TV and LTD appear to be significant determinant factors.