Background: Patients with bowel obstruction still represent some of the most difficult and vexing problems that surgeons face today. While the adage, “never let the sun rise or set on a bowel obstruction” remains true, there has been a trend towards selective non-operative management of this problem. Aims and objectives were to study the various causes and modes of presentation of intestinal obstruction and to evaluate the importance of different severity indicators of obstruction with early recognition, diagnosis and thus timely abdominal exploration.Methods: 2 years prospective study conducted in PDMMC college, Amravati, Maharashtra, India, from September 2013 to September 2015. Each intestinal obstruction patient was evaluated with specific severity indicators, scored and then analyzed.Results: The commonest cause of intestinal obstruction in adults in this study series was adhesions in 33.33% cases. Other causes were mesenteric ischaemia, i.e. 7 (11.67%), Koch’s abdomen, i.e. 5 (8.33%), sigmoid volvulus, i.e. 5 (8.33%) and carcinoma, i.e. 5 (8.33%). Resection anastomosis was most commonly performed procedure in 45.7 % cases, followed by adhesiolysis in 14% patients. 66.66% patients having a score less than 3 were managed conservatively, 95.83 % having a score of 3 or more where operated on.Conclusions: The evaluation of patients endeavours not only to confirm the diagnosis but also to determine the need for and timing of surgery. Certain severity indicators and scoring systems can help to optimize this timing of surgery and prevent mortality.

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INTRODUCTION - Spleen injuries are among the most frequent trauma-related injuries. At present, they are classied according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology with a multidisciplinary team. Thus, the study to determine the presentation of a patient and further its investigation management and outcome is necessary. OBJECTIVE: To study all the cases (investigation and outcome) of blunt abdominal trauma with splenic laceration with its incidence , mode of presentation, grade, management and factors responsible for morbidity and mortality. MATERIALAND METHODS:Astudy was conducted in our tertiary care hospital on 22 patients presented with blunt abdominal trauma with splenic injury in emergency department during July 2019 to June 2021. RESULTS: In our retrospective study , all the patients underwent primary radiological and pathological investigation with 36% having associated limb injuries (fractures);4.5% with ckd , 9% with thoracic injury, 40% amongst 20-40 age group , 86% being male, 59.5% resulted from RTA, 31.5 % resulted from fall from height,0% with assault, 4.5% along with head injury, 9% with associated rib fracture,0% patient with free gas under diaphragm ; 9% with grade 1, 22% with grade 2, 31.5% grade 3 , 13.5% grade 4, 22%grade 5 splenic injuries. 91% patients underwent splenectomy and were given vaccination 15 days post operatively against capsulated organisms.9% patients were managed conservatively. Patients were followed up for 6 months postoperatively with 4.5% mortality rate. CONCLUSION: Splenic injury is most common solid organ injury in blunt abdominal trauma in 20- 40 years age group majority male and results maximally by RTA; associated with limb fractures commonly with liver as associated solid organ injured. Aggressive resuscitation and emergency laparotomy (splenectomy) yields excellent outcome

Background: Hollow viscus perforation leading to peritonitis is a common emergency faced by a general surgeon. Late presentation, missed diagnosis and late interventions are frequent causes of morbidity and mortality. Thus in an interest to find out etiological factors, to assess the common type of perforations with their clinical presentation, surgical out come and finally prognosis and complications; forms the basis of present study.Methods: We carried out prospective study on total of 60 patients presenting with sudden onset pain in abdomen with guarding and rigidity per abdominally for etiology, surgical management and post- operative complications. Study was conducted between 1 January 2018 to 31 December 2018 (12 months), with follow up period up to 30 June 2019 (6 months).Results: Most common age group involved is 20-39 years (51.6%). Peptic ulcer perforation is the most common cause of hollow viscus perforation (46.4%). Abdominal pain and vomiting were the most common chief complaints and tenderness with guarding rigidity being the most commonly observed sign. Gas under diaphragm on X-ray standing abdomen is suggestive of hollow viscus perforation (41 out of 60 cases) but, it is not obligatory. Surgery is the main modality of treatment. Wound infection is the most commonly observed post-operative complication.Conclusions: Hollow viscus perforation leading to peritonitis is one of the most common emergencies faced by a general surgeon. Early presentation, Proper diagnosis and timely interventions decrease morbidity and mortality.

Background: Many acute scrotal conditions can present in similar way, Testicular torsion is a true surgical emergency because, the likelihood of testicular salvage decreases, as the duration of torsion increases. Other conditions that present in similar way to testicular torsion include, torsion of appendix testis, epididymo - orchitis, blunt trauma to testis, fournier's gangrene, haematocele, pyocele, etc. Aim: Assessment of clinico-epidemiological factors, diagnosis and management in patients with acute scrotal conditions. Methods: This observational, cross-sectional study was conducted on 75 patients which includes all cases of acute scrotal conditions within age group of 5 years to 70 years presenting to surgery OPD or casualty and getting admitted in a tertiary care centre in eastern part of Maharashtra during the period. Results: In our study acute epididymo-orchitis (46.7%) was the commonest cause of acute scrotal pathology followed by Fourneir's gangrene (24%).Incidence of scrotal cellulitis, pyocele, torsion testis, haematocele, were 9.3%,8%,6.7%, 2.7% respectively. One case each of testicular abscess(1.3%) and testicular tumour (1.3%) were also found. Out of 75 cases, 36 cases (48%) were managed conservatively. In Fournier's gangrene, only debridement was done in 8 cases, multiple debridement with secondary suturing was done in 5 cases, multiple debridement followed by skin grafting was done in 5 case. Scrotal exploration and drainage of testicular abscess was done in 1 case. Scrotal exploration with evacuation of hematoma was done in 2 cases of haematocele. Orchidectomy was done in total of 4 cases in which 3 cases have clinical diagnosis of testicular torsion and one case of testicular tumour. Also orchidectomy with contralateral orchidopexy was done in 2 cases of testicular torsion. Conclusion: The most common cause of acute scrotum was epididymo - orchitis which can be managed conservatively. Early exploration can salvage the testis in cases torsion of testis.