Background: Typhoid ileal perforation peritonitis is a potentially life-threatening surgical emergency in developing nations. The severity assessment of a disease condition is useful to prioritize treatment and to reduce morbidity and mortality. Aims: The aim of this study was to use Acute Physiology and Chronic Health Evaluation (APACHE) II score to grade the severity and outcome in patients of typhoid ileal perforation peritonitis. Materials and Methods: A prospective analysis of data was done, which was collected over a period of 3 years for 100 cases of secondary peritonitis following typhoid ileal perforations, irrespective of age, sex, and duration of illness. APACHE II score was used to grade the severity and outcome in these patients. Results: Out of 100 patients included in this study, 87 were male and 13 were females. Age ranges between 14 and 65 years, maximum number of patients were in 2 ^nd and 3 ^rd decade of life. History of fever, abdominal pain, and abdominal distention were present in all cases. After onset of fever perforation occurred in 65% patients in 1 ^st week, there was an increase in mortality with increase in APACHE II score, age >50 years was associated with more mortality. The mean Intensive Care Unit stay in this study was 4.33 days, 5.81 days for survivors, and 3.47 days for nonsurvivors. Mortality in our study was 22%. Conclusion: APACHE II score is an easy and objective tool to grade severity of acute peritonitis and can be used for assessment of outcome. According to this study, patients with higher APACHE II score had highest rate of mortality and vice versa.

Objective: In Saudi Arabia expatriates physicians involved in malpractice litigation process (MLP) risk travel ban, creating immeasurable stress as these procedures are quite lengthy with no insurance company or employer support. A survey study conducted in the city of Taif aimed to demonstrate the outcome of ongoing MLP on overall patient care. Methods: Various grades doctors of both sexes, from different surgical and medical specialties in Ministry of Health Hospitals, Taif city, were surveyed, including mental, pediatric, King Faisal and King Abdul Aziz Specialist Hospitals. The study was conducted between January 25, and May 3, 2015. Saudi nationals and paramedics were excluded from the study. Multichoice questions with space for suggestions were distributed and collected manually. It is a qualitative and cross-section study. Results: A total of 277 responded to the survey, 127/277, (45.84%) were involved in MLP of whom 97/127 (76.4%) were banned from travel. While in Linkert's scale, 96/277 (34.65%) were satisfied with the role of insurance company, 114/127 (89.8%) had little or no support from their employer during MLP, and 218/277 (96.03%) agreed that overall patient medical care will have a negative impact due to the ongoing MLP (P < 0.05). Conclusion: We believe the ongoing MLP is a fertile ground for developing defensive medicine culture. A stress-free environment strategy governed by support and legal protection by employer and insurance company respectively is suggested.

Background: Haemorrhoids is a common condition seen in general surgery practice. Treatment includes many methods ranging from rubber band ligation, infrared photocoagulation, sclerotherapy to stapler hemorrhoidectomy. Our study is done to evaluate the efficacy of both the procedures in a rural setting. Objectives of the study was to study the efficacy of two surgical methods of treatment of hemorrhoids, in terms of (1) operation time; (2) post-operative pain; (3) hospital stay; (4) return to normal activity and return to work. Methods: A comparative study was done between open and stapling methods for the treatment of symptomatic hemorrhoids in Al Azhar Medical College, Thodupuzha, India. Results: There was major statistically significant difference seen among different parameters between the two procedures of haemorrhoidectomy, open versus stapler procedure for prolapsing hemorrhoids (PPH) as evident from the p value. Conclusions: In our study there is a definite difference noted between two surgical methods in terms of hospital stay and return to work. As far as satisfaction of patient is considered in both the groups satisfaction is similar except for the cost of surgery which was the only cause of dissatisfaction.

Aims and Objectives: This study is aimed at determining the frequency and histopathological patterns including grading and staging of bladder tumors as seen in University of Benin Teaching Hospital, Benin City, Nigeria and to compare with similar research works elsewhere. Materials and Methods: A retrospective study of all data of surgical excision and cystoscopic bladder biopsies received over a 10-year period (2003-2012) at the Department of Histopathology, University of Benin Teaching Hospital, Benin City, Nigeria. Histological criteria published by the World Health Organization/International Society of Urological Pathology were used for the diagnosis and grading of these tumors. Results: A total of 75 bladder lesions were received in the Pathology Department. Of these, 64% were males and 36% were females giving a male to female ratio of 1.7:1.0. The peak and mean age incidence of urothelial bladder lesions was 60-69 years and 54.9 years ± 8.6 standard deviation, respectively. Bladder tumors accounted for 74.7% of all bladder lesions. Fifty-one (68%) cases out of 75 lesions were malignant tumors. Transitional cell carcinoma (TCC) was the most commonly encountered histological pattern accounting for 64.7% of bladder cancer. High grade papillary urothelial carcinoma was the most common tumor grade accounting for 51.4%. Only 40.6% cases were urothelial confined carcinoma (PTa) while 29.7% each accounted for lamina propria (PT1) and muscle (PT2) invasive carcinoma. Conclusion: Bladder tumors are more commonly encountered in males with the majority of cases occurring in the 7 ^th decade. Both high-grade TCC in stage (PT2) and low-grade carcinomas stage (PTa) were relatively common patterns seen in this study.

Duodenal duplication cysts are rare congenital abnormalities that are most commonly diagnosed in infancy and childhood. However, in rare cases, the lesion can remain asymptomatic until adulthood. An extremely rare case of a previously healthy young adult patient with recurrent acute pancreatitis, who was diagnosed with a duodenal duplication cyst, is presented. At laparotomy, a duplication cyst measuring 3.8 cm × 2.8 cm was found posteromedial to the 2 ^nd part of duodenum impinging over the head of pancreas. Cyst was excised. The patient is healthy and asymptomatic 1 year after surgery. The present case illustrates the necessity of considering a duodenal duplication cyst in the differential diagnosis of recurrent acute pancreatitis.

Brunner's gland adenoma (BGA) is a very rare benign duodenal lesion, usually asymptomatic. BGA presents with duodenojejunal intussusception (DJI) is a very rare condition; only 2-3 cases have been reported. Here, we present a 45-year-old male, Yamani, presented with a 6-month history of recurrent upper abdominal pain and melena. Computed tomography (CT) with contrast revealed target sign. Laporatomy confirmed DJI with duodenal polyp that acting as a lead point. Histopathology confirmed BGA. To conclude, BGA presents with DJIs is very rare conditions; nonspecific symptoms and less dramatic presentation are possible causes of delay in diagnosis, CT with contrast is usually diagnostic.

Congenital pouch colon (CPC) is a pouch-like dilatation of the colon in cases of high anorectal malformation. It is common in males with male to female ratios ranging from 2.5:1 to 7:1 in various series. In females, CPC is usually associated with cloaca. Only four cases of CPC with rectal atresia (RA) are reported in literature, one being in a female child. We report a 5-day-old female neonate with urogenital sinus and RA who presented with pneumoperitoneum and sepsis. At exploration, she had Type I pouch with two large perforations, absent appendix, a large fistula to the vagina with a bicornuate uterus which was distended with gas and meconium.

Duplication of the lower urinary tract is a very rare congenital anomaly which is diagnosed either at birth or during early childhood. These rare malformations are most of the times accompanied by other concomitant anomalies and are therefore diagnosed immediately after birth. In some even rarer cases, there are no concomitant anomalies and symptoms thus leading to a diagnosis later in childhood. We present a case of incomplete bladder duplication in a male child with no other associated anomalies which misdiagnosed as mesenteric cyst and review the literature pertaining to this rare anomaly.