This study concludes that the use of free omental sheet graft on typhoid enteric perforation site is effective in lowering the repair leak rate and thereby decreases the morbidity and mortality associated with these procedures. By lowering the complication rates, it also entails reduction in financial burden.

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Background: Bowel ischemia is a life-threatening condition which may arise from a number of causes affecting the arterial and venous compartments of the mesenteric circulation. The rapid onset of acute mesenteric ischemia and the potential rapidity with which bowel infarction may occur explain the lethality of this disease. The aim of this study was to evaluate the role of serum lactic dehydrogenase (LDH), glutamic oxaloacetic transaminase (SGOT), creatine phosphokinase (CPK), alkaline phospatase, serum phosphorus in the cases of bowel ischemia in acute abdomen.Methods: Above mentioned serum enzymes were measured preoperatively in the fifty patients of acute abdomen. Biomarker levels were compared in patients between equal two groups on the basis intra operative findings of bowel ischemia and non-bowel ischemia.Results: Preoperative estimated serum levels of all described enzymes found to be significantly elevated in patients of group A (with bowel ischemia) in comparison with group B (with no bowel ischemia). Sensitivity and specificity for elevated levels of S. LDH were 88% and 68%, for SGOT 68% and 80%, for S. ALP 72% and 68%, for S. CPK-MB 76% and 84%, and for S. phosphorus 76% and 68% respectively.Conclusions: Preoperative estimated serum levels of all described enzymes found to be significantly elevated in patients of group A (with bowel ischemia) in comparison with group B (with no bowel ischemia). Sensitivity and specificity for elevated levels of S. LDH were 88% and 68%, for SGOT 68% and 80%, for S. ALP 72% and 68%, for S. CPK-MB 76% and 84%, and for S. phosphorus 76% and 68% respectively.

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A 25-year old male was brought to the emergency room with colicky abdominal pain, abdominal distension, vomiting and blood in stools since 3 days. There were also multiple hyper pigmented patches seen on the palms, soles and lower lips and buccal mucosa of the patient (Fig. 1). On examination, bowel sounds were increased with signs of acute intestinal obstruction and rectal examination revealed ballooning and black stools with mucus. Ultrasonography showed intussusception in left lumber region with features of acute intestinal obstruction. Patient was taken for emergency laparatomy. On exploration, there were multiple intussuscepted segments present as jejuno-jejunal, ileoileal and in sigmoid colon (colo-colic) with serosal surface showed some visible nodule as a lead point for new forming intussusceptions in the ileum (Fig. 2). Resection of jejuno-jejunal, ileo-ileal and colo-colic intussuscepted segment with jejunojejunal, ileo-ileal and colo-coloic anastomosis was performed. Resected specimen shows multiple polyps and hemorrhagic © 2017 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E153-E155