Background: Abdominal pain is a very common symptom in pediatric age group. Not all patients presenting with acute pain abdomen require surgical intervention. Hence, an accurate diagnosis based on appropriate investigations is absolutely necessary. Methods: One hundred admitted patients with acute abdominal pain were analyzed, and Alvarado score was calculated for each of them. Conservative or operative management was done depending on the diagnosis thus obtained from these investigations as per the set departmental protocols. Alvarado score was correlated with diagnosis in these children. Results: The mean age of presentation was 70.4 months; range of age being 4 months and 144 months. They were 69 males and 31 females. The most common presenting symptoms besides abdominal pain were vomiting (83), anorexia (73), and nausea (36). The most common diagnoses were intussusception (26), mesenteric lymphadenitis (21), acute appendicitis (13), and appendicular perforation (7). Operative intervention was required in 38 patients out of which 23 were emergency explorations. There were 78 patients in Alvarado score of 5–6; 15 patients in Alvarado score 7–8; and 7 patients in Alvarado score 9 or more. The diagnosis of patients with lower Alvarado Score was mostly intussusception and mesenteric lymphadenopathy whereas as the score increased, the diagnosis of acute appendicitis and appendicular perforation became more common. There was no mortality and all patients are doing well on follow-up. Conclusion: Though most of the patients of acute pain abdomen present with symptoms mimicking acute appendicitis, the most common definitive diagnosis in the pediatric age group with lower Alvarado score are intussusception and mesenteric lymphadenitis which can be managed conservatively most of the times.

Objective: To compare the safety, benefits and incidence of postoperative complications among patients having early oral feeding versus traditional delayed feeding in postoperative period following elective intestinal anastomosis. Methods: This prospective study was conducted in the department of surgery IGMC Shimla. A total of 40 patients undergoing elective routine intestinal anastomosis were included in this studyIn study group patients were fed early within 8 hrs after surgery starting with liquids, semisolids. In control groups patients were started oral feeding after appearance of bowel sounds, passage of flatus and stool. Patients were matched according to age, sex, indication of surgery, nutritional status. Analysis was done using student t-test regarding timing of appearance of bowel sounds, nausea and vomiting, passage of flatus and stool, postoperative complications, duration of stay. Results: Five patients in study and four patients in control group developed postoperative nausea and vomiting (P>0.05). Average time for appearance of bowel sounds was 0.95 ± 0.39 day in study group and 1.85 ± 0.67 days in control group (P<0.05). In study group mean time to pass flatus was 1.3 ± 0.8 days and 2.7 ± 0.92 days in control group (P<0.05). Mean time for passage of stool was 3.5 ± 1.05 days in study group compared to 4.8 ± 1.79 days in control group (P>0.05). In our study mean time for resumption of normal feeds was 6.05 ± 2.31 days in study group and 8.25 ± 2.75 days in control group (P<0.05). In our study 2 (10%) patients had wound infection in study group while it is 3 (15%) in control group. In control group there was 1 case of anastomotic leak. Patient was explored and transverse loop colostomy was done. Average hospital stay in study group was 7.25 ± 3.57 days while it was 10.9 ± 6.88 days in control group (P>0.05). Conclusions: Early oral feeding after elective intestinal anastomosis is well tolerated. It helps in resolution of ileus, decreased wound infection and improved wound and anastomotic healing leading to shorter hospital stay.

Castleman's disease (CD), or angiofollicular lymph node hyperplasia, is a relatively rare disorder characterized by the benign proliferation of lymphoid tissue. Two clinical entities have been described: A unicentric presentation with the disease confined to a single anatomic lymph node and a multicentric presentation characterized by generalized lymphadenopathy and a more aggressive clinical course. In addition, three histopathological subtypes have been described: Hyaline-vascular (80–90%), plasma cell (10–20%), and a mixed variant. Preoperative diagnosis of CD is difficult, and the definitive result is based on postoperative pathological findings. The gold standard therapy for unicentric type is the complete surgical excision. Overall prognosis is good, particularly in the unicentric variety of disease. We report a case of 22-year-old female presenting with a large subpectoral mass on left side chest wall below clavicle. It was painless and gradually increasing since 6 months.

Metastases in medullary carcinoma thyroid are not an uncommon phenomenon; however, metastases to the breast are extremely rare. Authors are reporting a rare case of medullary carcinoma thyroid metastases to breast in a 42-year-old female. Biopsy was performed to distinguish between primary duct carcinoma and metastatic medullary carcinoma thyroid. Further investigations revealed multiple involvements of cervical as well as axillary lymph nodes, bones, lungs, and dermis. Though survival of isolated metastases of medullary carcinoma thyroid to the breast may be better compared to other solid tumors of the breast, with wide spread dissemination survival is poor. Breast metastases on presentation seem to be a manifestation of wide spread disease.

Cecal volvulus as an uncommon cause of acute intestinal obstruction is due to axial twist of the cecum and terminal ileum around their mesentery. Cecal volvulus is a surgical emergency requiring urgent laparotomy. Resection and anastomosis is the proposed choice of the operation depending on the general condition of the patient. In addition, to its rarity, lack of familiarity causes diagnostic doubt and consequently delays in treatment. In this paper, we report a case of cecal volvulus seen in a 31-year-old Saudi male presented with vomiting, abdominal pain, and distension.

Maydl's hernia is a very rare type of a hernia and at times presents as a deceptive condition in a strangulated hernia. There is a paucity of reference to this condition in the literature though it is mentioned in few standard textbooks with little detail. It is also known by other names – “Hernia in W,” “double loop hernia” and “retrograde strangulation.” The Maydl's hernia appears to describe the only three-dimensional spatial anatomical relation of gut loops without reflection of etiology whether a hernia is sliding or not. This arrangement may be present in all types of inguinal hernias as and when hernia ring offers passage of sufficient length of gut through it. This happens when there is an alternate double entry and double exit of gut loops into the hernia sac from a peritoneal cavity that is Entry, Exit-Entry, Exit that may be remembered as a 4E sequence of gut loops. Though, all the gut loops of “W” may be strangulated, but intra-peritoneal loops are first to strangulate.

Background: Hepatic arterial pseudoaneurysm with hemobilia occurs less frequently as a complication of open cholecystectomy than laparoscopic cholecystectomy; however, given its severe nature, it needs to be managed promptly. Patient should be evaluated with high index of suspicion, presenting with post cholecystectomy pain with jaundice. They should be treated with angiographic coil embolization of hepatic arteries as a first line management, which is successful in the majority of bleedings: in a minority of cases, even a laparotomy is needed. However, proper use of electrocautery may decrease the occurane of psedoaneurysm. Case Presentation: Here we present a case history of a 50 years old female presenting with massive hematochezia & jaundice with hemodynamic instability, 3 months following open cholecystectomy due to leaking pseudoanurysm from right hepatic artert & treated successfully with angiographic coil embolisation.

Iatrogenic embedding of foreign body (FB) in the hypopharynx during retrieval process is not uncommon, and its management can be quite challenging. Left in situ, it may lead to serious complications including retropharyngeal, neck abscesses, and mediastinitis. We present an unusual case of a 75-year-old female who presented late with a chicken bone impacted in the hypopharynx and had a fragment iatrogenic embedded that was not noted by the surgeon. It was complicated by a recurrent retropharyngeal abscess. Attempts to remove it endoscopically and surgically failed, prompting us to treat it with long-term systemic antibiotics. More than 6 months later, the patient had no further complaints. Follow-up computed tomography scan showed no change in FB position. However, there was a decrease in its thickness. We suggest long-term systemic antibiotics as a first line of management for embedded bone fragments in the pharynx with expected surgical retrieval difficulties, once diagnosed early before the onset of complications.