Lipomas and lipomatosis of colon are rare in clinical practice. We herein report a case of diffuse colonic lipomatosis, fifth such case in literature which presented as perforation peritonitis, a presentation, never been reported earlier. On laparotomy, the findings suggested malignancy and appropriate surgery was done. Diffuse Colonic Lipomatosis, a rare and benign condition mimicks malignancy and should be kept as a differential diagnosis is unusual cases of colonic perforations.

Traumatic injury to the diaphragm must be kept in mind while dealing with patients who have sustained abdominal trauma. The diagnosis can easily be picked up on chest x-ray. Treatment is surgical, with simple suturing of the diaphragm with non-absorbable suture giving good result.

Primary hydatid disease of musculoskletal system is rare. A 60 year old woman presented with soft swelling in medial aspect of thigh, of long duration which was gradually increasing in size. She was initially diagnosed as lipoma of thigh, but ultrasonography revealed to be a cystic swelling suggestive of hydatid disease. MRI further reinforced the diagnosis. However serologic test (ELISA) was negative. Patient was given albendazole preoperatively. The swelling was removed en bloc and advised for adjunctive albendazole chemotherapy (15 mg/kg/day) for three months.

Background: Laparotomy wound dehiscence is still a puzzle for most of the surgeons. Mortality associated with dehiscence has been estimated at 10-30%. Patients undergoing emergency laparotomy suffer from one of these comorbid conditions which are detrimental to healing. In this scenario interrupted suturing has been found to give good strength and have less incidence of wound dehiscence. The objective of the study was to compare the incidence of abdominal wound dehiscence in emergency midline laparotomy.Methods: This study was conducted on 300 consecutive patients undergoing emergency midline laparotomy in the Department of Surgery, Government Medical College and Hospital. Methods group-A: closed by suturing the rectus sheath using polydioxanone suture 1-0 (PDS) in continuous layer suturing method. group-B: closed by suturing the rectus sheath using polydioxanone suture 1-0 in interrupted layer suturing method.Results: The mean age in group A was 40.47 years and 37.47 in group B. In Group A 20.1% patients had burst abdomen and 5.4% in group B.Conclusions: Interrupted closure of abdominal wall fascia is better in emergency laparotomy as compared to continuous closure.

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Knowledge of the use of a nasogastric tube (NG) is integral in medical practice as a whole and more so in gastrointestinal diseases because of its wide range of uses. Accidental fixation of the nasogastric tube during surgery is a rare complication. Various methods have been described for retrieval of an entrapped, retained or stapled nasogastric tube. We describe here a novel technique in which an endoscopic needle knife sphincterotome using a side-view endoscope was used successfully to cut the knots and release the entrapped NG tube. Although stress should always be laid on prevention, the flexible endoscopic approach is a small-duration procedure, a minimally invasive, cost-effective technique for the removal of a nasogastric tube that avoids the need of redo surgery and unnecessary exposure to anaesthesia.

Necrotizing soft-tissue infections (NSTI) are characterized by extensive and rapidly progressing soft tissue inflammation with necrosis. It typically involves a gas-forming bacterium such as group A b-hemolytic Streptococcus or a Clostridium species. This gas formation leads to the radiographic finding of subcutaneous emphysema. It is recognized as a surgical emergency. NSTI of the abdominal wall, flank, or thigh resulting from break-in bowel integrity is an atypical presentation that may cause delayed recognition and treatment, resulting in a mortality rate greater than that in Fournier gangrene. Early detection and aggressive surgical debridement are crucial to reduce patient mortality and morbidity. We present the case of a 30-year-old patient presenting with fasciitis of lower limb. Surgical exploration revealed the source of the emphysema to be an entero-cutaneous fistula. The patient had an unstable and prolonged hospitalization after debridement of the thigh and abdominal surgery and was discharged after one month. It suggested that clinical presentation can be highly variable and range from early sepsis with obvious skin involvement to minimal cutaneous manifestations of underlying disease.

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