Background: Gall bladder perforation (GBP), is an uncommon complication of acute cholecystitis but it often remains a cause for diagnostic dilemma among surgeons while managing patients presenting with signs and symptoms of peritonitis. This study was undertaken to study the clinical profile of the patients diagnosed to have GBP which would aid in early diagnosis and surgical intervention thus improving the patient's outcome. Methods: A retrospective study from May 2013 to April 2018 with a sample size of 12 cases were studied. All cases were diagnosed either pre-operatively (based on radiological findings) or intra-operatively. Perforations of gall bladder caused due to trauma or iatrogenic reasons were excluded from the study. Intra-operative findings, postoperative sequelae and the outcome of the patient were evaluated. Results: The mean age of the patients was 66 and females were more affected than the males. USG done preoperatively could pick up only 1 out of 12 cases. Whereas CT showed gall bladder perforation in 3 out of 4 cases for whom CT was done giving it a sensitivity of 75%. Gall bladder perforation was commonly found to be located in the fundus followed by corpus and infundibulum. Conclusions: GBP is a rare complication of acute cholecystitis. It can present with full blown peritonitis features or vague abdominal symptoms. If promptly diagnosed and treated aggressively by laparotomy and cholecystectomy, the patient's outcomes are improved.

Background Reconstruction of large foot and ankle defects is a difficult task due to less available local soft tissue and more critical from functional point of view. To overcome the limitations associated with locoregional flaps and free flaps, reverse peroneal artery (RPA) flap was selected and its usefulness in reconstruction of distal large defects of the ankle and foot and its complications were studied. Materials and Methods This is a prospective observational study done in 20 patients treated as cohort within 2 years and 8 months from January 2018 to August 2020. Large defects of foot and ankle were reconstructed with RPA flap and evaluated for its usefulness. Three cases were evaluated with computed tomography angiography postoperatively, to assess the vascular pattern. Conclusion RPA flap is a versatile and very reliable flap for the reconstruction of large and distal defects of foot and ankle. It is safely done in children and in acute trauma without any major complications.

Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Diagnosing acute appendicitis clinically still remains a common surgical problem as the clinical signs and symptoms of other abdominal pathologic conditions mimic the diagnosis of acute appendicitis. Delay in diagnosis and surgery for this condition may lead to various complications like perforation, abdominal abscess etc. By knowing perforation prior to the exploration, we can manage the condition very effectively in terms explaining the prognosis of disease, morbidity of surgery, wound infection, and requirement of emergent nature of surgery. Aim of the study is to determine of role of hyperbilirubinemia as a new diagnostic marker to predict gangrenous/perforated appendicitis.Methods: It’s a retrospective study was conducted in the department of surgery, MMCRI, Mysore during the period of January 2015 to December 2015 total of 100 patients with clinical as well as ultrasonographic diagnosis of acute appendicitis or appendiceal perforation were made. The serum bilirubin test was carried out in all the patients pre-operatively.Results: In the study, the total 100 patients enrolled for the study, hyperbilirubinemia (> 1.2 mg/dL) in present study was found in 47 patients with 19 acute and 28 patients perforated appendicitis of all the 100 patients while 53 patients had normal bilirubin levels (≤ 1.2 mg/dL) 51 patients acute and 2 patients perforated appendix.Conclusions: Total serum bilirubin appears to be a new promising laboratory marker for diagnosing appendicular perforation. The patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia without elevation of liver enzymes should be identified as having a higher probability of appendicular perforation, suggesting total serum bilirubin levels have a predictive potential for the diagnosis of appendicular perforation.

Background: Cholelithiasis is the most common disease state involving the gallbladder and the biliary tree. Once the USG is reported as cholelithiasis, the patient is usually taken up for cholecystectomy. The patients with cholelithiasis usually present with upper gastro intestinal (UGI) symptoms which may also be attributed to other UGI pathologies. This study focuses on evaluating upper GI endoscopy as an investigative modality to diagnose other associated upper GI pathologies in patients with USG proven gallstones presenting with dyspeptic symptoms.Methods: An observational study was undertaken over a span of 2 years, from June 2016 to May 2018. All the patients who presented with complaints of upper GI symptoms were subjected to undergo USG abdomen. The patients with positive USG findings for cholelithiasis were included and further evaluated by upper GI endoscopy.Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common presenting symptom was heartburn (69%), followed by dyspepsia (58%), belching (56%) and nausea/vomiting (53%). Out of 100 patients 44 patients presented with biliary colic and nausea/vomiting (14%). 44 of the subjects were found to have normal mucosal study. Remaining 66% of the subjects had positive endoscopic findings. The most common endoscopic finding was gastro-esophageal-reflux-disease (GERD) (31%).Conclusions: In this study it was found that 66% of the subjects had co-existing UGI pathologies. It is advisable to get UGI endoscopy routinely for patients being planned for cholecystectomy pre-operatively.