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Laparoscopic appendectomy has the advantage of providing better access and good visualization of the peritoneal cavity through small incisions, as compared to open appendectomy. we evaluated the safety, outcome and feasibility of laparoscopic appendicectomy in patients presenting with or withput complications. we observed Appendicular lump was predominantly seen in male patients presenting after 48 hours of acute onset of abdominal pain with associated history of leukocytosis and fever.Laparoscopic appendectomy may potentially have more prominent clinical advantages over conventional surgery, when compared with the impact of LA on uncomplicated appendicitis.

Aims: The aim of the present study is to evaluate the accuracy of ultrasonography and fine needle aspiration cytology (FNAC) in diagnosis of thyroid nodules in comparison with other diagnostic modalities and to make early and accurate differentiation of benign and malignant thyroid nodules with incidence of malignancy in thyroid nodules. There is 4-5 % incidence of clinically apparent thyroid nodules in the general population. The majority (90%) of thyroid nodules are benign as malignancy occurs in only 1 in 10 thyroid nodules. The overall incidence of malignancy in solitary thyroid nodule ranges between 10% and 30%. Material and Methods: A prospective study was carried out on 42 cases with nodular goitre attending the surgery OPD, NKP Salve Institute of Medical Science & Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Hingna Road, Nagpur from October 2010 to October 2012. All patients were subjected to USG and FNAC. Results: In this prospective study of 42 cases with nodular goitre, clinically 29 patients had solitary thyroid nodule and 13 patients had multinodular goitre. Out of these 42 patients 35 (83.33%) were female and 7 (16.67%) were male with ratio of 5:1, the age of the patients ranged from 18 years to 65 years. Out of these 29 patients of solitary thyroid nodule, 5 patients had malignancy on histopathological examination. So the incidence of malignancy in clinically solitary thyroid nodule was found to be 17.24%.It was observed that USG was 71.43% sensitive and 90.62% specific in detection of malignancy in nodular goitre whereas FNAC was 75% sensitive and 100% specific in the same regard. Conclusion:The sensitivity and specificity of these diagnostic modalities were evaluated and it was found that USG and FNAC have a high specificity. No investigation was found to be 100% accurate in diagnosing malignancy in nodular goitre but a combination of various diagnostic modalities (ultrasonography and FNAC) rather than any single modality will give optimal results and avoid unnecessary surgery in a great number of patients without missing any malignancy.

BackgroundThe certainty of diagnosing acute appendicitis in patients presenting with right iliac fossa pain still remains a mystery though acute appendicitis being the commonest surgical procedure done in emergency. In acute appendicitis, serum bilirubin levels are raised due to hepatocellular damage as a result of direct insult caused by Gram-negative bacterial endotoxemia. The need for the study is to conclude whether the serum bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about appendicular perforation.Materials and methodsThis is a prospective study carried out at rural tertiary healthcare center and includes 213 patients clinically diagnosed as acute appendicitis.ResultsOut of 213 patients, raised serum bilirubin ≥1.2 mg/dl was present in 195 (91.5%) patients, out of which 194 (99.4%) patients had histopathologically inflamed appendix and this difference was statistically highly significant with p-value < 0.0001. In this study, 32 patients had perforated appendix. Out of those, 30 patients had bilirubin ≥ 4 mg/dl and 2 patients had bilirubin level between 1.2 and < 4 mg/dl. Raised serum bilirubin (≥4 mg/dl) was present in 35 (17.9%) patients, out of which 30 (87.7%) patients had perforated appendix.How to cite this articleSaxena D, Tandon M, Shah Y, Gedam BS. Hyperbilirubinemia as a Diagnostic Tool for the Prediction of Appendicular Perforation: A Prospective Study. Euroasian J Hepato-Gastroenterol 2015;5(2):87-89.

HighlightsLithopedion results from primary or secondary abdominal implantation.It is a rare event where only about 330 cases reported.We report a 60-year-old female with pain and abdominal-pelvic mass.She had skeletal structures, bilateral hydronephrosis and hydroureter on CT.A skeletonization type of lithopedion was the final diagnosis.

Internal hernia involving the sigmoid mesocolon is extremely rare cause of intestinal obstruction. It is associated with early development of strangulation and gangrene. Therefore, high suspicion is necessary in the evaluation of such cases in order to prevent the related high morbidity and mortality. We present a case of an internal hernia occurring through a congenital defect in sigmoid mesocolon leading to strangulation of small bowel.

Introduction: Laparoscopic cholecystectomy has become the procedure of choice for the management of symptomatic gallstone disease. Difficulty in laparoscopic cholecystectomy is often encountered by surgeons and is associated with complications and a higher conversion rate. This study aims at identifying difficult laparoscopic cholecystectomies by clinical and imaging assessment and determining the utility of a pre-operative difficulty scoring system based on intra-operative findings.  PATIENTS and METHODS: A hospital based observational study was conducted including all patients above age 18 years undergoing laparoscopic cholecystectomy. Randhawa’s preoperative score was calculated for every patient based on history, clinical and imaging parameters and the degree of operative difficulty was predicted. Another scoring was done using Sugrue’s scoring system based on intra-operative findings. The outcome factors studied were degree of operative difficulty or need for conversion and intra-operative and post-operative complications. The statistical analysis was done by using EPI INFO software version 7. RESULTS: A total 84 patients with mean age 42.96 +14.34 years with 58 females and 26 males were enrolled. Of them 28 (33.33%) had difficult   laparoscopic cholecystectomies. The conversion rate to open cholecystectomy was 9.52%. Age above 50 years, prior history of acute cholecystitis, thickened gall bladder wall and stone impaction of Hartmann’s pouch were statistically significant pre-operative risk factors. The sensitivity of the preoperative score in identifying difficult cases was 85.7% with the specificity of 96.43%; positive predictive value of 92.31% and the negative predictive value of 93.10% and the accuracy was 92.86%.  CONCLUSION: Pre-operative score and intra-operative findings are helpful in identifying difficult laparoscopic cholecystectomy.

Introduction: Blunt abdominal trauma accounts for the majority of abdominal injuries seen in the Emergency Department. It is responsible for substantial morbidity and mortality. Selecting appropriate approach has been recently a point of conflict in management of abdominal blunt trauma, and criteria for non-operative management are being changed frequently. Objective: With aim to identify some of the determining factors of successful non-operative management. Methods: A 2 year tertiary care teaching hospital based longitudinal study was done. Selection criteria were defined and a prestructured proforma was made to assess and note the findings. Results: 34 patients were studied. 29.4% of patients were in the age group of >20-30 years with the mean age 35.29 ± 15.84 years. 79.4% were male. Road traffic accident was responsible for 79.4% of blunt abdominal trauma cases while majority of the patients presented with abdominal pain (91.2%) and abdominal tenderness (91.2%). Associated extra abdominal injuries were found in 10 cases. The common extra abdominal injuries were head injuries (14.7%). 9 patients underwent exploratory laparotomy. 25 were selected for nonoperative management. The most commonly injured organ was spleen (38.9%) followed by liver & stomach. 3 patients died in the present study. The sensitivity and specificity of the Emergency USG findings were 80.9% and 92.3% respectively, and that of the CT findings were 100% and 0% respectively. Conclusion: Non operative management (NOM) was found to be highly successful and safe. Hemodynamic stability along with ultra sound, CT scan and repeated clinical examination were the sheet anchors of NOM