Introduction: Perforation is defined as an abnormal opening in a hollow organ or viscus. Gastrointestinal perforation is one of the common surgical emergencies in developing countries. The diagnosis is mainly clinical and is aided by radiological investigations. The present study was conducted to highlight the spectrum of hollow viscus perforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgical treatment, postoperative complications, and mortality encountered at SMS Medical College and Hospital, Jaipur, India. Materials and Methods: The study was a hospital-based prospective observational study conducted from April 2012 to October 2013 in the Department of General Surgery. During the study period, a total of 442 patients underwent surgery for secondary peritonitis. The patients included in the study were patients (>12 years) presenting with gastrointestinal perforation and undergoing emergency laparotomy. Results: Out of 442 patients, 91.2% (403) were males, with male-to-female ratio being 10.33:1. The mean age was 39.13 years. About 79.2% of the patients were below 50 years. Free gas under diaphragm on chest X-ray was noted in 86.2% cases. Duodenum was the most common site of perforation in 158 patients. The most common etiology for perforation was acid peptic disease (41.4%). Simple closure was the most common surgical procedure being performed in 63.8%. Overall morbidity and mortality recorded in this study were 42.8% and 14.7%, respectively. Conclusion: Early diagnosis, resuscitation with fluids, and timely surgical intervention are the most important factors deciding the fate of the patient with perforation peritonitis.

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Background: Bariatric surgery is an accepted treatment for obesity. And, only a limited number of studies were concerned with the outcome of significant weight loss following the surgery procedures. Objective: the aim of this systematic review was to evaluate and demonstrate the comprehensive data about the significant loss of body weight of obese patients after appropriate techniques of different bariatric surgery procedures and to determine the impact of bariatric surgery on weight loss. Methodology: MEDLINE and Cochrane databases were searched from 1989 to July 15, 2016. Search terms included bariatric surgery, individual bariatric procedures, and obesity significant body weight loss. Studies were included if they described outcomes of interest, which were significant body weight loss after gastric bypass, gastric band, or sleeve gastrectomy performed on obese patients. Conclusion: Significant body weight loss was achieved in most of the obese patients after undergoing bariatric surgery; most of the studies that were included in this review showed that all current bariatric operations lead to major weight loss.

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Objectives: The aim of this study is to determine the indications of primary total hip arthroplasty (THA) at a tertiary hospital in Jeddah, Saudi Arabia. Methods: The electronic medical records system (Phoenix) of the hospital was searched for all registered patients who had undergone THA between 2001 and 2015. The research team reviewed patients' files, X-rays and collected data, including patients aged at the time of surgery, procedure year, site, and presurgical diagnosis. Results: A total of 107 patients had undergone THA during the study. Gender-specific prevalence was 50.5% in females and 49.5% in males; the average age of the patients was 52 years. Of the 107 patients, only 15% had bilateral surgery, and 46.7% of the 85% who had unilateral THA had surgery on the left side. The main indication of surgery included primary hip osteoarthritis (OA) (43.9%), avascular necrosis (25.2%), posttraumatic arthritis (22.4%), developmental dislocation of the hip (5.6%), hip ankylosis (1.9%), and postinfection arthritis (0.9%). Conclusions: The rate of THA at our institution increased through between 2001 and 2015; approximately, 66.4% of surgeries were performed during the last 7 years. OA was the most common indication of surgery during the study.

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Orbital floor fractures are a common result of facial trauma. They may occur as isolated fractures after localized blunt trauma or as part of massive facial trauma. Common clinical feature of orbital blowout fracture includes diplopia, enophthalmos, and hypoglobus. There have been debates over the type of materials used in the reconstruction of orbital blowout fractures and time of surgery. We report our experience and challenges with the investigation and repair of impure orbital floor fractures, especially in resource-scarce environment.

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Background: Colorectal surgery has always been a challenge for surgeons due to a large number of bacteria present in this area. Some of these bacteria may cause wound infection, anastomotic leak or frank sepsis. Mechanical bowel preparation (MBP) has been one of the many practices which aim to mitigate these complications. However, the use of MBP has been controversial for sometimes. We performed a prospective study to investigate the outcomes of colorectal surgery with or without MBP. Materials and Methods: This prospective study was conducted in the Department of Surgery, IGMC, Shimla from July 1, 2014 to June 30, 2015 included forty patients admitted in an emergency, or for elective open colorectal surgery. All patients who were scheduled to undergo primary resection and anastomosis of the colon and upper rectum were eligible for inclusion in the study. Results: Complications in the form of surgical site infection, wound hematoma, and enterocutaneous fistula were present in both groups. However the value of P = 0.204 in either group indicated that statistically, there was no difference between results of two groups. The average duration of stay in the no bowel preparation group was 13.42 days, and in the MBP group was 11.5 days. Conclusion: This study suggests that MBP is not necessarily essential for safe colorectal surgery.

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Retrocaval ureter is a rare congenital anomaly. We report a 31-year-old woman who presented with dull aching pain in the right flank that was exaggerated in the past few months. Diagnosis was made on intravenous urography, which showed proximal ureteric dilatation and hydronephrosis. Retrograde ureteropyelogram showed typical “S-” shaped or fish hook deformity in the dilated proximal ureteric segment with moderate hydronephrosis. The patient underwent an ureteroureterostomy with anteriorization of ureter.

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Background: Acute appendicitis is the most common surgical non-obstetric pathology during pregnancy. Unnecessary hesitation and hence delay in surgical intervention for acute appendicitis in pregnancy is common. In this background, while attempting early suspicion and surgical intervention (appendectomy) in our patients, we encountered no mortality and no significant morbidity in the in immediate postoperative period. Materials and Methods: This prospective study was carried over a period of 3.5 years from June 2012 to November 2015, in the department of surgery, GMC (Government Medical College) Srinagar. Patients included were only those who had features of acute appendicitis on clinical grounds and/or imaging studies (ultrasound). Objective: Our aim was to study the feasibility of early suspicion and surgical intervention in patients with features of acute appendicitis in pregnancy. Results: The mean age of the patients was 28.84 years, ranging from 21 to 38 years. The mean gestational age of our patient cohort was 17.4 weeks (6-35 weeks). Majority of the patients presented in the 2nd trimester (55.9%) followed by 1st trimester (29.4%). The Alvarado score of the patients ranged from 5 to 9 (mean 6.76). WBC (white blood cell count) of our patients ranged from 5800 to 22400 (average 14150). Neutrophill count ranged from 64.4% to 92.2% (mean 79.20%). USG diagonosed 20 patients as acute appendicitis (58.82%) and 14 patients as negative for appendicitis (41.2%) with a sensitivity of 60.6% and specificity of 71.42 %. Intraoperatively 31 patients (22 inflamed and 9 perforated) had features of acute appendicitis, one had early lump formation, and two had grossly normal appendix. All patients were followed up strictly for 2 months postoperatively and no obstetrical complication was recorded. Conclusion: Diagnosis of acute appendicitis in pregnancy can be difficult; however, surgical intervention should be performed with any suspicion. Fetal morbidity and mortality are high in the presence of perforation and generalized peritonitis. For minimizing the unnecessary delay in diagnosis and surgery, high clinical suspicion can only be supplemented and not replaced by imaging studies. Ultrasound is not only safe in pregnancy but also easily available and affordable. The decision to perform laparotomy should be based on clinical findings and diagnostic imaging. Delays over 24 hours for intervention increase the risk of perforation. We noted no immediate fetal or other major complications in our patients, hence we recommend early surgical intervention in patients with suspicion of acute appendicitis in pregnancy. There is also need for some unequivocal diagnostic scoring system which should be highly predictive of acute appendicitis in pregnancy, early in the course of disease before giving way to complications.

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Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, indolent, low-grade sarcoma recognized as progressive locally infiltrative nature, and it is much less frequent than desmoid tumor. It accounts for <0.1% of all cutaneous malignancies and 6% of all soft-tissue sarcomas. A painless, long-standing, slow-growing cutaneous nodule remains the most common form of presentation of this disease. Patients and Methods: Sixteen patients with DFSP (9 patients; Group A) were recurrent, of them three patients had recurrence of the disease for the 4^th time, and seven patients (Group B) were dealt with for the 1^st time. Results: Nine recurrent tumor patients had operated with 5-cm safety margin and were followed up for more than 2 years after postoperative radiation therapy, none of them had recurrence. Seven nonrecurrent cases were operated with 3 cm safety margin and followed up for 1–3 years after postoperative radiation therapy, none of them had recurrence. Conclusion: Excision of DFSP with enough safety margin followed by radiation therapy decreases the rate of recurrence; however, long-term follow-up and further studies are required.

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My patient, 70-year-old female, presented with adenocarcinoma of third part of duodenum, treated with segmental resection of the third part of the duodenum. This tumor is very rare and generally affects the III and IV duodenal portion. Diagnosis and the exact localization of this tumor are important factors for deciding the type of surgical treatment. Diagnosis is confirmed by endoscopy and biopsy. Pancreaticoduodenectomy and segmental resection of the duodenum are the two options of treatment.

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Gastrointestinal stromal tumors (GISTs) represent rather rare neoplasms. Most GISTs are benign; malignant tumors account for 20%–30% of cases. Advances in the identification of GISTs, its molecular and immunohistochemical basis, and its management have been a watershed in the treatment of gastrointestinal (GI) tumors. They have now come to be understood as rare GI tract tumors with predictable behavior and outcome, replacing the older terminologies such as leiomyoma, schwannoma, or leiomyosarcoma. We present a case of GIST discovered in an elderly female that presented to emergency room with history of hematemesis with severe anemia.

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