Background: Perforation peritonitis is the most common surgical emergency in India. The spectrum of etiology of perforation in tropical countries continues to be different from its Western counterpart. The objective of the study was to highlight the spectrum of perforation peritonitis as encountered by us at RKDF medical college and research centre, Bhopal, Madhya Pradesh, India.Methods: Our prospective observational study was conducted at Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of August 2013 to August 2015. Total 110 cases of perforation peritonitis were included. Patient detailed history, symptoms, sign, blood investigation finding, cause of perforation, site of perforation, type of surgery, post-operative complications and mortality were assessed and result were compared with other studies.Results: The most common cause of perforation in our series was perforated peptic ulcer (52 cases) followed by typhoid fever perforation (21 cases), appendicular (16 cases) and tuberculosis (11 cases). Despite delay in seeking medical treatment, the overall mortality (16.36%) was comparable with other published series though the overall morbidity (63%) was unusually high.Conclusions: In contrast to western literature, where lower gastrointestinal tract perforations predominate, upper gastrointestinal tract perforations constitute the majority of cases in Central India.

INTRODUCTION:One very important complication of abdominal surgeries is postoperative ileus which results in severe patient discomfort, prolonged hospitalization, and enhanced treatment cost. This study was conducted with an aim to analyze the clinical outcome of effect of chewing gum mainly to avoid post-operative paralytic ileus in post-operative patients of abdominal surgeries. MATERIAL AND METHODS: In this study total 200 patients were included, 100 were cases and remaining were controls. The cases were given chewing gum to chew after the surgery while the controls were allowed to heal without chewing gums in conventional style and both were observed hourly for clinical outcome. RESULTS: Among cases the mean duration of first sound heard was 26.3 hours while among controls this was 38.8 hours [p<0.001], the mean duration of first flatus passed among cases was 50.7 hours while that among controls was 68.5 hours, the mean duration of first Bowel passed among cases was 92.4 hours while that among controls was 128.3 hours [p<0.001]. On comparing cases of routine with emergency surgeries, gastric with small bowel surgeries, and traumatic with pathological bowel surgeries it was observed that the first bowel sound, first flatus and first bowel passed appears significantly earlier in routine surgeries, gastric surgeries and traumatic surgeries respectively. CONCLUSIONS: It was observed that chewing gum has significant effect over bowel motility as bowel sounds appeared significantly earlier in cases than control and time for first flatus passed and first bowel passed were also noted significantly earlier in cases than controls. Hospital stay of cases were found significantly lesser than control hence simple intervention like chewing can decrease the burden of disease of paralytic ileus from community.

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

Development of electric lamp by Thomas Elva Edison had significant impact on human civilization. With increasing production of electrical energy to meet ongoing demands of increased frequency of electrical injuries. Despite increased awareness of potential dangers, electricity is responsible for many fatalities all over the world. Electrical burn accounts for ~3% of all burn related injuries. Estimated 3, 000 annual admittions to burn units. Electrical burn have bimodal distribution ~1/3 children <6 yrs (Electric cords & wall outlets) ~2/3 miners, construction, & electrical workers. Our case is one that of a 12 year old male child having electrical injury over face and neck with exposed angle of mandible which was covered by Deltopectoral flap with caterpillar advancement of flap. KEYWORDS: Electrical burn, Flap Necrosis, Flap Divison, Deltopectoral flap with caterpillar advancement. INTRODUCTION:Deltopectoral flap is a fasciocutaneous type of flap. Standard Flap size of 10 X20 cm and Delayed flap size of 10 X 27cm. Sensory nerve supply is from second to fourth intercostal nerve. Dominant pedicle of flap is largely based on first, second and perforating branches of internal mammary artery. Standard flap will reach neck, lower face and oral cavity but delayed flap has a longer reach and may be folded for intra-oral reconstruction or for an extended arc of rotation to the midface. For standard flap, it is located b/w sternum and anterior axillary line and extends from clavicle to 4 th or 5 thc IC space. For extended flap, it is extended over deltoid muscle. A preliminary flap delay is required to extend flap length. The donor site is rather obvious and almost always requires a skin graft for closure.