Background: Peptic ulcer disease is very common disease in developing countries and so are its complications. With the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer (PU) disease has decreased dramatically, although complications of peptic ulcer disease such as perforation and bleeding have remained fairly constant.Methods: A prospective study was conducted on43 patients presenting to KIMS Hospital, Hubli with features suggestive of hollow viscus perforation and intraoperative findings suggestive of peptic ulcer perforation from January 2015 to June 2016.Results: In this study, there were 43 cases of peptic ulcer perforation. Peptic ulcer perforation was common in third decade of life(n=12) with the mean age(SD) 39.88 years. Perforation is more common in males as compared to the female population 7.6:1. Post-operative morbidity is seen in 31 (72.1%) of patients and mortality in 4 (9.3%). Smoking, Alcohol beverage consumption, regular ingestion of NSAIDs were commonly seen in patients with peptic ulcer perforation but these factors were not significant risk factors for postoperative mortality and morbidity. Age ≥60 years (p-value 0.051), Female gender (p-value 0.012), Presence of co-morbid conditions (p-value 0.055), Shock on admission (p-value 0.029, perforation-surgery interval >24 hours (p-value 0.001), preoperative higher-grade ASA, purulent intraperitoneal collection (p-value 0.002) were statistically significant predictors of mortality.Conclusions: Perforated peptic ulcer (PPU) is a life-threatening disease with historically reported high morbidity and mortality rates. Age ≥60 years, female gender, presence of co-morbidities, preoperative shock, higher ASA grade, perforation-surgery interval >24 hours, Purulent intraperitoneal collection are inter-related statistically significant predictors of mortality. Therefore, proper resuscitation from shock, improving ASA grade and decreasing delay in surgery is needed to improve overall results.

Introduction Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases. Materials and Methods This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period. Observation A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a p-value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had p-value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a p-value of 0.047. Conclusion Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.

Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the major salivary glands, accounting for 15.5% of all cases benign and malignant.1 It has multiple types of morphological variants and thus poses a significant challenge in diagnosis on Fine needle aspiration cytology (FNAC). The aim of this article is to report a case of MEC in a 70-years-old male patient who presented with a painless firm fluctuant swelling in left preauricular area on left cheek to Karnataka Institute of Medical Sciences, Hubli. Detailed history was noted, and the swelling was examined clinically. Radiological investigations were carried out. Fine-needle aspiration cytology was done for the lesion and report suggested tumor of the parotid gland. Total parotidectomy procedure was done. There were no intra operative complications and post operatively there was grade 4 Housemann Brackmann facial nerve palsy on left side. The weight of the tumor was 1.45 kg. The histologic picture confirmed that the tumor was MEC of parotid gland. Through this article we want to report the management of giant MEC, the largest to be reported in world literature.

Background: Aute appendicitis being the most common surgical emergency poses a significant diagnosing dilemma. Early diagnosis has very favourable outcomes and if diagnosis is delayed leads to significant morbidity and mortality. USG has some limitations and best investigation computed tomography (CT) is being overused which leads to unnecessary exposure to radiation especially in children and young adult. Scoring systems are a valuable aid when it comes to diagnosing appendicitis.Methods: Study done in department of surgery in KIMS, Hubli. The study period was December 2015– September 2016, and 107 patients with right lower abdomen pain were studied. History, clinical examination, biochemical, haematological, radiological investigations were done. Alvarado and AIR scores were calculated. Considering HPR report as gold standard the scores were compared.Results: There were 70 male patients (66%) and 37 female patients (34%). The mean age in our study population was 28.1 years ±13.57 years. The overall area under the receiver operating characteristic (ROC) curve of the AIR score was 0.967 and significantly better than the area under the curve of 0.825 of the Alvarado score (p=0.05).Conclusions: This study externally validates the AIR score for patients with acute appendicitis. The scoring system has a high discriminating power compared to Alvarado score especially in cases in which appendicitis is difficult to diagnose such as females, children, elderly, in advanced cases and very effective supplement to available radiological investigations.

BACKGROUND Gallstone disease is one of the most common problems affecting the digestive tract. The clinical spectrum of cholelithiasis ranges from an asymptomatic state to fatal complications. The prevalence of gallstones appears to be rising and each year approximately one million new cases are discovered. In India it is estimated to be around 4%, whereas in the western world it is about 10%. It is possibly due to change in dietary habits and lifestyle modifications. Studies on gallstone composition carried out in different parts of the world indicate a close link with dietary habits and ethnicity. MATERIALS AND METHODS This is a descriptive study conducted in Department of Surgery, KIMS, Hubli from April 2014 to Nov 2015. Totally 56 patients diagnosed to have symptomatic cholelithiasis with or without choledocholithiasis on Ultrasonography, who underwent surgery were studied. Initially all cases were examined, investigated, detailed history was taken and operated during the period. All patients have undergone detailed investigations; relevant investigations like Bile Culture and Cytology and Biochemical Analysis of Gallstones. RESULTS The highest incidence of cholelithiasis was in the 5th and 6th decade with maximum incidence in the 6th decade. There was an increased incidence in females, i.e. M: F= 1: 27. Pain was the most common symptom present in 94.64% of the patients, nausea and vomiting were the second most common symptoms presenting in 26.78% of patients and jaundice in 7.14% of the patients. Tenderness in the right hypochondrium was the most common sign present in 66.07% and guarding in 5.35% of the patients. 75% patients had mixed diet and 25% patients were vegetarian. Ultrasonography was the investigation of choice in our hospital. 78.57% patients had gallstones, 7.14% of patients had CBD stone, 17.85% of patients had single stone, 60.71% of patients had multiple stones, 19.64% of patients had thickening of gallbladder, 14.28% had dilated CBD, 21.42% had contracted GB and 25.00% patients had associated findings. 53.58% of patients underwent laparoscopic cholecystectomy, 14.28% of patients underwent open cholecystectomy and associated procedure with cholecystectomy done in 17.86% of patients. Wound infection was the most common post-operative complication occurring in 12.50% patients and 5.35% patients had post-operative bile leak. Histopathology revealed 69.63% patients had chronic cholecystitis, 10.70% patients had calculous cholecystitis and 3.57% had acute cholecystitis with cholelithiasis. Bile culture revealed no growth in 39.28% patients. Gallstones analysis showed pigmented stone in 47.36% of the cases as the most common variety, mixed stones in 42.10% of cases followed by cholesterol stones in 10.52% of the cases. There was no mortality in the present study. CONCLUSION Gallstones disease is more common in female sex. The incidence of gallstones was higher in the 5th and 6th decades of life. Gall stones incidence is more in non-vegetarians than vegetarians. Upper abdominal ultrasonography was t...