Ascariasis is one of the most common helminthic diseases in humans, occurring mostly in countries with low standards of public health and hygiene, thereby making ascariasis highly endemic in developing countries. In endemic areas, 30% of adults and 60–70% of children harbour the adult worm. Biliary ascariasis is a rare cause of obstructive jaundice. Conventional management involves endoscopic extraction of worm. We are reporting a rare case of ascaris which induced extrahepatic biliary obstruction in a young male who presented with acute cholangitis. The ascaris was removed by laparoscopic exploration of the common bile duct. Postoperative period was uneventful.

Introduction Laparoscopic cholecystectomy is now considered the gold standard for the treatment of symptomatic cholelithiasis. The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. Although the rate of conversion to open surgery and the complication rate are low in experienced hands, the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon. Various preoperative factors can help in deciding the difficult gallbladder and conversion to open cholecystectomy. The aim of this study is to predict the difficulty of laparoscopic cholecystectomy and the possibility of conversion to open cholecystectomy before surgery using the clinical and ultrasonographic criteria in our set up. Materials and methods A total of 200 patients presenting with symptomatic gall stone disease between January 2011 and June 2012 were included in the study. Every patient included in the study was subjected to the following assessments which were regarded as risk factors for laparoscopic cholecystectomy: patients' characteristics, complaints, history and clinical examination and laboratory data. Results Amongst the 200 patients admitted for laparoscopic cholecystectomy, 47 (23.5%) were male and 153 (76.5%) female, with an average age of 39 years (range 16-62 years).The body mass index ranged from 16.3 to 42.7 with a mean of 32.8 ± 6.28 kg/m 2. Five patients were considered obese (BMI > 35 kg/m 2). Conclusion Male gender, single large stone, thickwalled gallbladder, previous abdominal surgery and contracted gallbladder are the factors that proved to be significant factors in our study.

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Benign biliary strictures fall into two aetiological groups: traumatic

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Introduction Though abdominal tuberculosis is common in developing and endemic countries, pancreatic tuberculosis is rare. Pancreatic tuberculosis can present with non-specific signs and symptoms or with features of pancreatitis/neoplasm. Computerised tomography (CT) of abdomen can suggest pancreatic tuberculosis, but cytological/histological confirmation is required to establish the diagnosis. Ultrasound/CT-guided fine-needle aspiration biopsy can help in achieving the diagnosis. This paper discusses a case report of pancreatic tuberculosis. Case report We present a case of a 22-year-old young girl, who was admitted to the surgical outpatient department, with abdominal pain and night sweats for three months. The pain was located in the upper abdomen, with radiation to the back. Examination revealed tenderness in the epigastric region. Conclusion The majority of patients respond to anti-tubercular treatment and prognosis is good.

INTRODUCTION:Two-port mini laparoscopic cholecystectomy (LC) has been proposed as a safe and feasible technique. However, there are limited studies to evaluate the effectiveness of the procedure. This study is a prospective randomised trial to compare the standard four-port LC with two-port mini LC.MATERIALS AND METHODS:A total of 116 consecutive patients undergoing LC were randomised to four-port/two-port mini LC. In two-port mini LC, a 10-mm umbilical and a 5-mm epigastric port were used. Outcomes measured were duration and difficulty of operation, post-operative pain, analgesia requirements, post-operative stay, complications and cosmetic score at 30 days.RESULTS:Out of 116 patients, the ratio of M:F was 11:92, with mean age 40.79 ± 12.6 years. Twelve patients (nine in four-port group and three in two-port group) were lost to follow-up. The mean operative time were similar (P = 0.727). Post-operative pain was significantly low in the two-port group at up to 24 hrs (P = 0.023). The overall analgesia requirements (P = 0.003) and return to daily activity (P = 0.00) were significantly lower in two-port group. The cosmesis score of the two-port group was better than four-port group (P = 0.00). However, the length of hospital stay (P = 0.760) and complications (P = 0.247) were similar between the two groups.CONCLUSION:Two-port mini LC resulted in reduced pain, need for analgesia, and improved cosmesis without increasing the operative time and complication rates compared to that in four-port LC. Thus, it can be recommended in selected patients.