Signet ring cell carcinomas of the colon and rectum are well documented in the adult population, but the incidence is very low in the paediatric population. Signet ring cell carcinoma has more malignant potential, mostly present as advanced stage and carries very poor prognosis. We are describing a 10-year-old male patient who presented with acute intestinal obstruction; radiology revealed large bowel obstruction and was diagnosed metastatic primary signet ring cell carcinoma of rectum on biopsy. We have discussed the diagnostic work-up and the management of this rare entity. Due to the high mortality that can be caused by a delay in making the correct diagnosis, signet ring cell carcinoma of colorectum represents a special diagnostic and surgical challenge.

Background: The present study is designed to study the indications of intestinal stoma formation, type of stoma formation, complications of intestinal stoma made in patients under emergency or elective setting and postoperative care of the intestinal stomas.Methods: The study was carried out in Department of surgery at J. L. N. Medical College, Ajmer from January 2016 to September 2017. In this study only >12 years age patient were included. The data were collected prospectively and analysed.Results: It was observed that most patients were operated in emergency (90%) as compare to elective (10%) setting for the formation of intestinal stomas. The stoma was formed more in male (58%) as compared to female (42%). There were two peak age group 31-45 year and 45-60 years in which more stoma formation occur. The common indications for stoma were found to be ileal perforation with gangrenous ileum. The common stoma formed was ileostomy (64%) in compared to colostomy (34%). The loop stomas were formed in compared to end stoma and temporary stoma (84%) more formed compared to permanent stoma (16%). The most common complications were found to be skin excoriation (64%) as compared to other complications.Conclusions: Despite increasing surgical expertise, complications of intestinal stomas still occur frequently in all setups and result in high morbidity. Meticulous skin care with regular follow-up, early detection of complications with their timely management along with education and counselling can decrease morbidity.

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.

A 50-year-old woman presented to the outdoor patient department of our hospital with chief complaint of right-upper quadrant pain, dyspepsia, nausea especially after meals and on-and-off fever for one year. On examination there was no icterus and mild tenderness was present in right hypochondrium but there was no guarding, rigidity or rebound tenderness. No underlying swelling or lump could be appreciated. Bowel and bladder habits were normal. Patient was admitted and investigated with provisional diagnosis of gallstone disease. All blood investigations are essentially normal except serum alkaline phosphatase which is slightly increased. Abdominal ultrasound revealed multiple echogenic shadowing area in lumen with contracted gallbladder, common bile duct and gallbladder wall appears to be normal [Table/ Fig-1]. A diagnosis of chronic cholecystitis with cholelithiasis was made. Patient was prepared for laparoscopic cholecystectomy. During laparoscopy, it was evident that there were dense adhesions between the gallbladder, transverse colon and the omentum. The callot's triangle was virtually inaccessible. It was therefore decided to convert to an open cholecystectomy and a right subcostal incision was used. Dissection in callot's triangle was extremely difficult. Dense adhesions between gallbladder and omentum were separated. A tubular structure was connected to body of gallbladder and right transverse colon, which was not disturbed. Cystic duct and cystic artery was dissected, tied and cut. Gallbladder was separated from liver without disturbing the tubular structure. Now gallbladder was opened from body and multiple tiny calculi were removed. On removing the gall stones it became evident that there was a fistula between gallbladder and right transverse colon [Table/ Fig-2].A cholecystectomy was performed with excision of the fistula and primary repair of colon. The patient made an uneventful recovery and was discharged on the 8 th postoperative day. Histopathological examination of specimen revealed no evidence of malignancy. The patient was followed-up for a period of two months and no complaints were noted. ABSTRACTCholecystocolic fistula is a rare billiary-enteric fistula with variable clinical presentation. Despite modern diagnostic tool a high degree of suspicion is required to diagnose it preoperatively. These fistulae are treated by open as well as laparoscopic surgery, with no difference in intraoperative and postoperative complications. We are describing a 50-year-old female patient with the diagnosis of chronic cholecystitis with cholelithiasis, which was investigated with routine lab investigations, and abdominal ultrasonography but none of these gave us any clue to the presence of fistula, were discovered incidentally during an open surgery and were appropriately treated.[ Table/ DiSCuSSiOnBilliary-enteric fistulae have been found in 0.9% patients undergoing biliary tract surgery. Most common site of communication is cholecystoduodenal fistula, followed by cholecystocolic fistula, and least common ...

Background: The POMPP (Practical scoring system of mortality in patients with perforated peptic ulcer) score is a simple method which is new and easily applicable scoring system. Our aim is to predict the post operative mortality rate in patients with perforated peptic ulcer by using POMPP scoring system in Indian population. Method: A prospective study of total 100 patients of perforated peptic ulcer operated in J.L.N. Hospital, Ajmer were included in our study. Three parameters corresponding score 1 for each are included in this multivariate analysis which are age > 65 years, albumin ≤ 1.5 g/dl and BUN (Blood urea nitrogen) > 45 mg/dl. All data that may be potential predictors with respect to hospital mortality were analyzed and compared with previous studies. Results: In our study of 100 patients with M: F ratio 7.33 around 17 deaths was recorded out of which 14 were males and 3 were females. We have observed that mortality rates were signicantly affected by the parameters of POMPP scoring system with 0%, 11.76%, 35.29% and 52.95% mortality for scores 0, 1, 2 and 3 respectively. We also observed out of 17 deaths 15 deaths were seen in age group > 65 years, 11 deaths were associated with albumin < 1.5gm/l and 16 deaths were associated with blood urea nitrogen > 45mg/dl. Data analysis was done using chi square method. Conclusion: POMPP scoring system consists only age and routinely measured two simple laboratory tests (albumin and BUN), its application is easy and prediction power is satisfactory. It provides early detection of high risk peptic perforation cases; allow other supportive treatment modality apart from surgery which can decrease the mortality

Background:In emergency settings, several surgical procedures are described while dealing with pathology of terminal ileal lying within 15 cm of the ileocecal valve, but there is still confusion and controversy over the optimal surgical treatment.Methods:A nonrandomized study of 210 patients with near terminal ileal pathology (within 15 cm) was carried out over a period of 10 years. The study included 112 cases in which an ileocecal anastomosis with inclusion of appendicular stump was used in terminal ileal pathologies, and in rest 98 cases, other surgical procedures were used. The outcomes were measured in relation to postoperative complications and mortality.Results:Postoperative complications encountered in emergency ileocecal anastomosis with the inclusion of appendicular stump were wound infection in 31 patients (34.72%), respiratory complications in 10 patients (11.2%), septicemia in 6 patients (6.72.%), and anastomotic leak in one patient (1.12%).Conclusion:The technique of ileocecal single-layer anastomosis with the inclusion of appendicular stump was found to be very effective in dealing this common problem and had less morbidity and mortality.