Introduction: Delayed presentation of patients with posterior urethral valve (PUV) is common in our country and is usually associated with complications and morbidities. Objective: To determine the pattern of presentation of PUVs and its complications and outcomes in these patients with respect to decrease or resolution of vesico-ureteric reflux (VUR) and/or requirement of additional operative procedures. Materials and Methods: A retrospective study was conducted, and 30 children of PUV were analyzed with respect to the pattern of presentation, duration of symptoms, age at primary fulguration, grade of VUR and its outcome. Results: Patients with early presentation were diagnosed early, had their PUV fulgurated early and had lesser grades and better resolution of their VUR and good outcome. The reverse was seen in those patients who presented late and already had some form of renal impairment such as higher and bilateral grades of VUR and higher serum creatinine levels. Some of them also required additional procedures which added to their morbidity. Discussion: Delayed presentation of PUV is common in our country and is associated with an increased incidence and a higher grade of VUR which does not decrease or resolve on follow-up and usually requires additional operative interventions adding to the morbidity of both the parents and the child. On the other hand, early presentation leads to early diagnosis and early relief of obstruction and is associated with lesser VUR, which resolves over time. Conclusion: With early presentation, diagnosis and treatment, the outcome of patients with PUVs is expected to improve. Efforts at improving awareness and early diagnosis and referral among the health team should be encouraged.

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Background: This study was undertaken with an aim to study the efficacy of trauma scores in predicting the outcome. Developing countries have higher number of automobile accidents due to increasing use of faster automobiles. Prehospital care and transportation victims have its limitations. We hypothesized the existing trauma scores devised in the developed nations will not be useful in the developing countries. Subjects and Methods: This prospective observational study of 1 year was done in the Emergency Department of a Tertiary Care Centre in which 2541 trauma victims were studied. The demographic profile and pattern of injuries with outcome were studied and the data were analyzed on the basis of trauma score-injury severity score (TRISS). Appropriate statistical tests were used for analysis, and P < 0.05 was considered significant. Observations and Results: Young male patients with a mean age of 30.49 years formed the commonest group. Road traffic crashes were the most common cause of trauma which was followed by injuries due to fall from height. Head injury was responsible for the death of the highest number of victims. Spleen was the most common organ injured in abdominal injuries. In our study, 41.1% deaths could not be explained by the TRISS methodology. We had four victims who survived contrary to the predictions of the methodology. TRISS was found to be less reliable in severely injured groups (ISSs >20 and Glasgow Coma Scale ≥12). Conclusion: This study supported the view that pre-hospital care received by the victim at the accident site or during transportation to a tertiary care center should also be considered in predicting the outcome by any ISS. We propose that larger studies are required to devise a newer scoring system for the evaluation of outcome of trauma care.

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Although thyroglossal (TG) cysts are very common in children and young adults, their presentation in the elderly is very rare and often goes unnoticed unless we get the pathology report. This may lead to incomplete excision and recurrence of the cyst, together with the fact that there may be an increased risk of malignancy associated with the cysts in this subset of population. The early identification and complete removal of the cysts is prudent. Here, we endeavor to highlight a series of three cases in the elderly, who presented to us with midline cystic neck mass, which on further evaluation turned out to be a TG cyst.

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Intussusception of the duodenum is a relatively rare event and usually results from the presence of a benign tumor. Duodenojejunal intussusception secondary to duodenal tumors is an uncommon entity. The classic coiled-spring appearance, fairly visible in the jejunum, is not apparent in the duodenum due to its fixed position. We present a case of duodenojejunal intussusception secondary to tubulovillous adenoma in a 37-year-old female. Surgical excision of the polypoidal mass and duodenojejunal intussusception was performed. Pathological examination found the mass to be a tubulovillous adenoma.

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Background: Ampullary tumors have been usually described together with other periampullary tumors. However, they have been found to behave differently in terms of their presentation, management, and perioperative outcomes. In this study, we try to analyze our experience in managing ampullary tumors in the tertiary level university teaching hospital. Materials and Methods: Retrospective review of the patients with ampullary tumors managed surgically over 10 years period (2004 January-2013 December) was carried out. Demographics, preoperative parameters, therapeutic procedures, postoperative morbidity and mortality were reviewed, and overall morbidity and mortality were compared with nonampullary group. Results: A total of 74 patients of ampullary tumors were managed over the study period. Jaundice was present in 65 (92.9%) patients at presentation. Pancreaticoduodenectomy (PD) was performed in 70 (66% of total PDs performed in the same period) cases while 4 patients had palliative bypass. There were no endoscopic resections and transduodenal ampullectomy in our series. On postoperative histology, two patients were found to have benign pathology. Postpancreatectomy fistula (30% vs. 11.1%) and other morbidities such as intra-abdominal collection and surgical site infection were higher in ampullary group. Mortality was comparable in both groups but overall mortality was higher than the published series. Conclusion: In tertiary centers of developing nations like ours, PD is still the main surgical procedure offered to the ampullary tumors. Ampullary tumors have higher perioperative morbidity than the nonampuallry group but have comparable mortality rates.

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An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered a rare cause (1%) of small intestinal obstruction. Paraduodenal hernias are the most common type of congenital hernias. They constitute a protrusion of bowel into an orifice near the third and fourth portion of the duodenum. The lifetime risk of obstruction and bowel strangulation is around 50% with a mortality of 20% and higher. Despite the rarity of the disease, it poses a serious surgical problem. The high risk of obstruction and the associated mortality mandate repair once the diagnosis is established. High index of suspicion and preoperative imaging are essential to make an early diagnosis to improve outcome.

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It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. A 34-year-old Filipino man was treated with chief complaints of anorexia, abdominal pain, and vomiting. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon after exclusion of any malignant lesions found by systemic computed tomography. Surgical complete resection was performed. The prognosis of this disease seems to be worse than that of adenocarcinoma.

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