Traumatic pseudoaneurysm occurring in face and temple is commonly reported to occur in superficial temporal artery, and so far only four cases have reported involvement of the occipital artery. We report a case of 25-year-old male patient presented to us with a pulsatile swelling in the occipital region following a trauma at the same site 5 years ago. A CT angiogram revealed the pseudoaneurysm of the left occipital artery and was surgically excised after ligation of proximal and distal parts along the course of the occipital artery.

Background: Perforation peritonitis constitutes one of the most common surgical emergencies encountered by surgeons. Even with modern treatment, diffuse peritonitis carries a high morbidity and mortality rate.Methods: The prospective study was conducted at department of surgery on 50 patients of perforation peritonitis admitted in emergency department of hospital. Detailed history, clinical examination and investigations were carried out. Patients were operated upon and findings were noted. Comparisons were done for postoperative ICU stay, morbidity/ mortality, oral feed and total hospital stay between the patients who reported within 24 hours and after 24 hours of onset of symptoms to determine golden period for operative intervention.Results: Out of total 50 patients, 21(42%) patients presented within 24 hrs of onset of first symptom of perforation while 29(58%) patients presented after 24 hours. Postoperative ICU stay, morbidity/ mortality, delay in oral feed and total hospital stay was statistically more in patients presenting after 24 hours.Conclusions: It can be concluded that the golden period of 24 hrs between the onset of symptom and start of treatment is the most important factor to determine the outcome.

Background:Estimation of the outcome is paramount in disease stratification and subsequent management in severely ill surgical patients. Risk scoring helps us quantify the prospects of adverse outcome in a patient. Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) the world over has proved itself as a worthy scoring system and the present study was done to evaluate the feasibility of P-POSSUM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in our demographic profile.Materials and Methods:Validity of P-POSSUM was assessed prospectively in fifty major general surgeries performed at our hospital from May 2011 to October 2012. Data were collected to obtain P-POSSUM score, and statistical analysis was performed.Results:Majority (72%) of patients was male and mean age was 40.24 ± 18.6 years. Seventy-eight percentage procedures were emergency laparotomies commonly performed for perforation peritonitis. Mean physiological score was 17.56 ± 7.6, and operative score was 17.76 ± 4.5 (total score = 35.3 ± 10.4). The ratio of observed to expected mortality rate was 0.86 and morbidity rate was 0.78.Discussion:P-POSSUM accurately predicted both mortality and morbidity in patients who underwent major surgical procedures in our setup. Thus, it helped us in identifying patients who required preferential attention and aggressive management. Widespread application of this tool can result in better distribution of care among high-risk surgical patients.

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Background: One of the most common reasons for admission to hospital is cholecystectomy and it has a mortality rate of 0.45% to 6%. Many risk factors have been found to be associated laparoscopic cholecystectomy that make it difficult like advance age, male gender, fever, obesity, previous abdominal surgeries, thick gall bladder lining, distention of bladder, presence of gall stones. There have been different scoring systems in literature that determine the risk of conversion to open cholecystectomy. The aim of present study is to determine the role of scoring system in predicting difficult laparoscopic surgery.Methods: The present prospective study was conducted for a period of 1 year in the Department of Surgery at Guru Gobind Singh Medical College, Faridkot, Punjab. The study included all the patients with symptomatic gall stones reporting to the OPD of the hospital. Patients were categorized into two groups after the surgery. Group I included patients who underwent successfully laparoscopic cholecystectomy and group II included those who were converted into an open case. In this study all the entities were provided with a score. Patients with score less than 4 were grouped as difficult. At the end of the study all the data were analyzed to see how scoring system can predict which patients will have easy or difficult laparoscopic cholecystectomy based on postoperative scoring. All the data was recorded in a tabulated form and analyzed using SPSS software.Results: The present prospective analytical study involved 112 subjects; out of these 94 were males and 18 females. The mean age of subjects was 48.2±3.7 years. There were 98 patients in Group I and 8 patients in group II who had didn’t show presence of peri cholecystic fluid. There was 1 patient in Group I and 5 patients in group II who had peri cholecystic fluid on ultrasound. There were 104 subjects with gall was thickness less than 4 mm. There were 95 patients in Group I and 9 patients in group II who had who had who had bladder wall thickness of less than 4 mm.Conclusions: The scoring tool evaluated in our study is useful in evaluating the risk of conversion of laparoscopic cholecystectomy into open cholecystectomy.

Pleomorphic hyalinizing angiectatic tumor (PHAT) of soft parts is a low grade, rare, soft tissue tumor which commonly occurs on the lower extremities of adults of either sex, though lesions in other anatomic locations have been described. We present a case of a 65-year-old female patient who presented with a left forearm swelling and underwent a wide local excision. Histopathology revealed it to be a PHAT.

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Central venous catheterization is generally a safe procedure, but several complications such as pneumothorax, arrhythmias, arterial puncture, infection, and thrombosis are known to occur even in the experienced hands. Complications related to guide wire are very rare and mostly relate to the expertise of operating person. We hereby report a rare but completely avoidable complication, that is, complete loss of the guide wire into the subclavian vein which was successfully retrieved by surgery.