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Introduction: Gallstone is implicated for hepatocellular injury due to chronic extra hepatic large bile duct obstruction with or without repeated episodes of cholangitis. Aim:To study the liver changes in patients undergoing oper ative procedure for gallstone disease and to determine the relationship between severity of these changes with position of biliary calculus in biliary tree. Materials and Methods:Sixty patients who underwent operative procedure for gallstone disease between October 2013 and September 2015 were evaluated. The Liver Function Test (LFT) was done preoperatively and postoperatively. Intraoperative liver biopsy was taken. The histopathological changes of liver and their severity were noted.

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A 38-year-old man presented to emergency department with one day history of progressively worsening, cramping lower abdominal pain with abdominal distension. It was associated with anorexia and vomiting. He had no history of previous abdominal surgery or mental illness. He had no other co-morbid conditions. On examination, his pulse was 102/min. No lymphadenopathy. On inspection, abdomen was markedly distended. On palpation, abdomen was tense and mildly tender. Bowel sounds were increased in frequency. On per rectal examination, the rectum was empty. Hernia sites were intact. Laboratory examination reveals no significant changes except total count of 12000/mm 3 . Plain abdominal radiograph showed multiple dilated small bowel loops [Table/ Fig-1].Computed tomography (CT) of the abdomen demonstrated multiple loops of dilated, gas and fluid-filled small bowel measuring up to 4.5 cm with a 3.9×0.5 cm high attenuation linear structure lying transversely in the lumen of the distal small bowel, 30-40 cm from the ileo-caecal valve [Table/ Fig-2]. There was no free intraperitoneal gas. After taking informed consent, patient underwent laparotomy, intraoperative finding revealed dialated small bowel loop with trasition zone in distal ileum, where on palpation a long, thin bone fragment was lying transversely, along with two other small pieces just proximal to it lying longitudenly. Bone fragment removed through enterotomy [Table/ Fig-3,4]. Bowel decompression done, then enterotomy wound closed. Postoperatively on enquiry, he admits that he had consumed chicken meat 36 hours prior to presentation. The postoperative period was uneventful and patient was discharged on the 7 th postoperative day. DisCussionForeign body (FB) ingestion is rare in healthy adults without any mental health illness. Common influencing factor for foreign body ingestion in adults are alcohol or drug consumption, psychiatric illness, denture wearers and those with insatiable appetites. In most cases bone fragment used to pass through bowel without any complication, but in few, perforation of small bowel is well documented [1]. Till now there are only a few reported literature of bone fragment causing acute bowel obstruction [2,3]. Apart from bone fragment, bezoars and other inanimate objects like blister packs and plastic balls have also been documented as causing small bowel obstruction. As ileo-caecal region is narrowest part of bowel, it is usual site for foreign body impaction [4].Ingested FB present with non-specific symptoms usually simulates other causes of acute abdomen like perforation or acute obstruction. Pain abdomen is the most common complaint (95%), followed by fever (81%), nausea/vomiting (39%) and melena (10%) [5].Preoperative diagnosis in acute abdomen due to ingested FB is uncertain, as the patient often cannot recall FB ingestion.Computer tomography of the abdomen is considered the most useful imaging to detect foreign bodies in small bowel. It is also helpful in detecting associated complication and to rule out other causes of acut...