Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0 gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.

Tuberculosis is one of India's public health problems. It involves various systems of the body, including the skeletal system. Osteoarticular tuberculosis is the second most common form of extrapulmonary tuberculosis next to lymph nodes and constitutes about 13% of all extrapulmonary cases. It is generally accepted that osteoarticular tuberculosis is the result of a haematogenous or lymphatic spread from a reactivated latent focus, usually pulmonary; however, previous infection is not always encountered, and in only 40-50% of the cases, it is possible to demonstrate another active infection site. The commonest site for skeletal tuberculosis is the spine followed by the hip, knee and ankle joints. Tuberculosis can involve literally any bone or joint. Pubic symphysis is an uncommon site for tuberculosis in the case of the skeletal system. We present a rare case of pubic symphysis tuberculosis in a 25-year-old woman presented to the general surgical department with a swelling in the right thigh region.

Abstract:Gall bladder perforation is itself a rare entity and its presentation as cellulitis of anterior chest wall is unique. We present a case of 80 year old lady who presented to us as abscess of anterior abdominal wall. Though cholecystectomy was performed but the patient expired two days later due to multiple organ dysfunction syndrome. Thus gallbladder perforation is a rare but life threatening complication of cholecystitis and must be dealt aggressively.

Background: This study was randomized clinical trial carried out in 100 patients to study the effect of surgical stress on serum potassium and calcium and to relate these changes to age of the patient and duration of surgical stress. Materials and Methods: The study was done in the Department of General Surgery SMS Medical College, Jaipur from June 2015 to June 2017. Patients equally distributed in two groups A and B on the basis of timing of collection of sample. Blood was taken from the patients who were operated under spinal anaesthesia only, so that the chemical effect of anesthetic was as minimal as possible. For comparison few cases were investigated who were operated under general anaesthesia. In all the patients operated under spinal or general anaesthesia same drug and techniques were used to overcome bias. Observations and Results: In the study we observed that variation in serum electrolyte seen in period of stress. Range of hypokalemia and hypocalcemia were 2.8 to 3.7 meq/lt and 7.6 to 8.4 mg% respectively in group A and hypokalemia and hypocalcemia were 3.0 to 3.4 meq/lt and 7.6 to 8.4 mg% respectively in group B. Maximum incidence of hypokalemia and hypocalcemia seen during 30-60 minutes duration of operation. Conclusion: Surgical stress is main cause of fluctuation in blood calcium, and blood potassium levels in surgical ward. The variation consists of increase or decrease of both electrolytes because of activation of the pituitary adrenocortical systems and maximally seen in immediate post operative period. Keywords: Calcium (Ca+2), Potassium (k+), Serum electrolytes, Surgical stress

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