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Perforation peritonitis is the most catastrophic complication of peptic ulcer disease. 1 Peptic ulcer perforation occurs in 2-10% of patients with peptic ulcer disease. 2 Perforated peptic ulcer is mostly treated by omentopexy 3. The figure of 8 technique has been described in the literature especially when the patient comes late, that is after two, three or more days, when the edges of the ulcer and the wall of duodenum are very friable. 4 However, there has been no study comparing on this technique. The aim of this study was to study the safety of figure of eight suturing technique in comparison to omentopexy. METHODS The present study was conducted in department of surgery, Vardhman Mahavir medical college & Safdarjung hospital, New Delhi during the period of October 2012 to March 2014. Sixty patients included in the study were divided into two groups after ABSTRACT Background: Figure of 8 techniques has been described in the literature for peptic ulcer perforation repair especially when the patient comes late, when the edges of the ulcer and the wall of duodenum are very friable. Methods: Sixty patients included in the study were divided into two groups after randomization. Study group, patients underwent figure of eight suturing technique and Control group, patients underwent Grahm's technique of omentopexy for peptic ulcer perforation. Results: Only 1 patient from control group developed post-operative bile leak in this study, 3 (10%) patients from study group and 4 (13.33%) patients from control group developed septicaemia, 1 from study group and 2 from control group developed intra-abdominal abscess, 8 (26.66%) in study group and 9 (30%) in the control group developed wound infections, 4 (13.33%) in study group and 7 (23.33%) in the control group developed burst abdomen, 5 (16.66%) from study group and 6 (20%) from control group developed lung complications. Conclusions: The present study is non-inferior than omentopexy in terms of post-operative complications. It can be used as a safe alternative to omentopexy especially when the patient comes late.

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Pneumoperitoneum is more pathognomonic of ruptured hollow viscera which requires urgent surgical intervention. But uncommon surgical entities may present with pneumoperitoneum. Splenic abscess is a relatively rare medical condition that results from bacteraemia. Pneumoperitoneum in a ruptured splenic abscess is very uncommon and is often misdiagnosed as a perforation. Spontaneous rupture of splenic abscess is a life-threatening emergency mandating early surgical intervention. We report a case of ruptured splenic abscess which presented with peritonitis and pneumoperitoneum, managed successfully by splenectomy.

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