Sutureless tension-free meshplasty of these rare hernias can be successfully performed with the posterior approach. This method of repair is easy, safe, and effective.

Introduction. In India the prevalence of gall stone disease varies in different parts of India. Malhotra in 1996 conducted an epidemiological study in Indian Railway employees and showed that North Indians has 7 times higher prevalence of gall stones compared to South Indian employees. It is said that Gall bladder is a disease of “Fatty, Fertile, Females in their Forties”. In our daily routine we observe that it is found not only in fatty females but common in average built patients also. Material and Methods. Study includes patients visiting to BPS GMC Khanpur Kalan with diagnosis of gall stone diseases and operated at our center with sample size of 135. Body mass index (BMI) and Waist to Hip ratio are calculated using their standard formulas. All data was compiled in IBM SPSS statistics (20.0). Result. Normal BMI is considered up to 25 and more than 50% patients lie in normal BMI range. Only 13% of cases lie in obese group that is BMI greater than 30. Waist to hip ratio, maximum patients that is BMI greater than 30. Waist to hip ratio, maximum patients that is (83%) lie in group more than 0.85. Minimum Waist to Hip ratio is .77 and maximum Waist to Hip ratio is 1.45. Out of 135 patients 90 patients are having high Waist to Hip ratio. Conclusion. Waist to Hip Ratio (abdominal adiposity) is better indicator of Gall stone diseases than BMI.

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The population studies have shown that peptic perforation remains a major health problem worldwide. The lifetime frequency of peptic ulcer diseases in United States has been shown to be approximately 10%. The epidemiology of peptic ulcer is showing declining trend in India over last two decades. The frequencies of both duodenal ulcer and gastric ulcer showed a decline from 1988 to 2008 that is from 12% to 2.9% and 4.5% to 2.7% respectively. Although there is decreasing trend in peptic ulcer diseases, complications are encountered in 10-20% of cases and 2-14% of ulcers perforate. Peptic ulcer can occur in body of stomach, lesser curvature, and pylorus to duodenum. These perforate most commonly on anterior aspect of duodenum. However anterior or incisural gastric ulcers may perforate posteriorly in to lesser sac, which can be particularly difficult to diagnose as these may not have symptoms of peritonitis even. If peritonitis is present and perforation not found on normal course then, they should be looked over in lesser sac also.

Abortion is considered taboo In our society so it is unreasonable to expect reliable data about abortion practices , especially in India more so in rural areas . Most of illegal abortions are conducted in rural areas of developing countries without adequate facilities and person with no knowledge of anatomy who operate with non sterile instruments which further add to morbidity and mortality. As per the world Health Organization (WHO) estimate for 2000, about 19 million unsafe abortions performed worldwide resulting in death of 70000 women. Uterine perforation during abortion is rare, with incidence of 0.05-0.4 % but up to 3.6 % in undeveloped counties. One rare complication following surgical abortion is bowel perforation , small bowel is most commonly perforated due to central pelvic location, length and mobility . Illegal abortion are performed especially in unmarried females with secrecy. These abortions are performed at clinics run by quacks, dais and nurses with little knowledge of procedures and its outcomes, most of patients belong to low socioeconomic status and delayed referral mostly contribute to increased morbidity and mortality . Here we are presenting 4 cases which presented to our emergency ( Rural Tertiary care center BPS GMC Khanpur kalan) over a period of 3 months with perforation peritonitis after unsafe abortion.