<b><i>Background:</i></b> COVID-19 patients are at increased risk of coagulopathy. This coagulopathy may be due to a severe pro-inflammatory state (cytokine storm) and/or by viral sepsis. This can sometimes lead to consumption coagulopathy and decreased platelet count, leading to increased risk of bleeding and may manifest like hematomas in atypical locations. These bleeding manifestations may be spontaneous or can be induced by even minor trauma. <b><i>Cases:</i></b> It is a single-center retrospective analysis. Four patients with a confirmed diagnosis of COVID-19 depicting increased risk of bleeding manifestations were included. Patients in our study were managed as per guidelines recommended by the Ministry of Health and Family Welfare Directorate General of Health Services, Government of India. <b><i>Results:</i></b> All patients were male. The mean age was 56 ± 18.64 years. One patient was managed conservatively with discontinuation of anticoagulants, volume resuscitation, and transfusion of blood products. Drainage with incision was done for 2 patients. One was managed with pigtail drainage. <b><i>Conclusion:</i></b> The effect of anticoagulants given in therapy and their varied presentations are discussed in this article. The article concludes that we need vigilant observation to identify this complication in the early period, resulting in successful management.

Background. Nonthyroidal neck swellings are common and cause diagnostic challenges. This study highlights various diagnosis associated with non-thyroidal neck swellings and their management challenges. Objective. This pilot study highlights the various diagnosis associated with nonthyroidal neck swellings and their management challenges. The clinical spectrum of two most common aetiology of nonthyroidal neck swelling: tubercular cervical lymphadenopathy and lymphomas, are also compared. Methods. This prospective study was conducted in a tertiary care teaching hospital from 01 Jun 2018 to 31 Dec 2019. The first 100 nonthyroidal neck swellings presented to the surgical outpatient department were included and assessed clinically, radiologically and histopathologically. Comparison was carried out between the first two common diagnosis of tubercular cervical lymphadenitis and lymphoma. Continuous variables were analysed using Student’s t-test and categorical data were analysed using the Chi square test. A statistical p value <0.05 was taken as significant. Results. There were 73 lymph node swellings and 27 non-lymph node swellings in the study. The most common diagnosis was tubercular cervical lymphadenitis (n=38) and lymphoma (n=17). The mean volume of lymph nodes in the lymphoma group (38.72±22.12 cm3) was significantly bigger than in the tuberculosis group (9.44±5.99 cm3) P=0.00001. The mean age (33.81±11.8 years) of tubercular patients was significantly less than the lymphoma (52.38±25.3 years) with P=0.000167. The clinical diagnosis was nearly accurate in 85% of cases. However, in 15 cases clinical diagnosis was changed after fine needle aspiration cytology. Conclusions. Ultrasonography and fine needle aspiration cytology are very useful adjunct in arriving at a definite diagnosis of a lymph node swelling in neck. Tubercular cervical lymphadenopathy and lymphoma were two major diagnosis. Tubercular cervical lymphadenopathy is significantly different from lymphomas in terms of early age of presentation and smaller size at the time of presentation.

Internal hernia through foramen of Winslow (FoW) is rare condition as there are only 200 cases reported so far in the literature. Our patient a 78 years man presented with a clinical picture suggestive of small bowel obstruction for 5 days. Patient underwent emergency laparotomy following suspicion of internal hernia on imaging. On exploratory laparotomy there was grossly dilated bowel loops and a small segment of terminal ileum and omentum was found herniating through FoW in to the lesser sac. The bowel segment was reduced with gentle traction and herniated segment of omentum was excised due to questionable viability. Opening of FoW was unusually large and to prevent hernia recurrence it was closed partially. Postoperative period was uneventful. This unusual case presented to us diagnostic confusion and management challenge considering the previous history, multiple comorbidities and geriatric profile.

Scar following caesarean section surgery is an important aspect affecting aesthetics and function in young ladies. This study was done to compare the effectiveness of scar modulation using topical silicone gel in post-lower segment caesarean section scar in primigravida. Case series analysis was conducted between 01 Jul 2018 and 30 Jun 2019 in a tertiary care centre. Post-lower segment caesarean section scars in 52 primigravida were randomised into 2 groups. Group A used topical silicone gel once daily for 3 min of massage. Group B had normal natural scar maturation without any intervention. Observational data collected and photographs were taken at 2 weeks, 4 weeks and 12 weeks. Vancouver scar score used to assess observed data and result compiled. Topical silicone gel gave superior results in reducing overall scar quality at 1 month and 3 months. Topical silicone gel was a superior product for initial management of caesarean scars.

Background. Laparoscopic cholecystectomy has become the choice of treatment for symptomatic cholelithiasis and has replaced open cholecystectomy. Numerous studies and scoring system have been develo­ped over the past 2–3 decades which predict the rate of conversion of laparoscopic to open cholecystectomy. Recently, few scoring systems have been developed which incorporates various intraoperative findings to predict this conversion. No studies are available in literature to assess gender-specific and body weight complications in laparoscopic cholecystectomy. The purpose of this study was to compare the outcome of laparoscopic cholecyst­ectomy between male and female patients in terms of preoperative factors, intraoperative difficulties and rate of conversion to open cholecystectomy and common postoperative complications. Materials and methods. This non-randomized, prospective, observational study was conducted at a tertiary care hospital in Northern India from June 2019 to May 2021. Various preoperative data was collected from the patients like age, the American Society of Anesthesiologists (ASA) class, comorbidity, indication for surgery, preoperative ultrasonography findings and any previous surgery. Surgeries in all patients were started with laparoscopic cholecystectomy under general anae­sthesia. The outcomes were measured in terms of time taken to complete surgery, whether laparoscopic cholecystectomy was converted to open cholecystectomy, common bile duct/cystic duct injury during surgery, common postoperative complications and average length of hospital stay in days. Results. A total of 300 patients were included in the study: 222 females and 78 males. Mean age of presentation in women was (46.45 ± 11.55) years ranging from 21 to 71 years and in men (51.78 ± 11.49) years ranging from 36 years to 76 years. This difference was statistically significant (p = 0.001). The other significant preoperative differences between males and females were comorbidity (p = 0.001) and previous surgeries (p = 0.001). However, the ASA class under which the patients were operated was not significant (p = 0.998). The various indications for surgery to include chronic cholecystitis, resolved acute cholecystitis, gallstone-induced pancreatitis and common bile duct stone had no statistical diffe­rence between men and women (p = 0.072). Conclusions. This study concludes that intraoperative difficulties were more often in male patients as compared to females. The average operating time, conversion of laparoscopic to open cholecystectomy and postoperative hospital stay were significantly higher in men than in women.