A 60 year old male presented with Gall Bladder perforation in a case of calculous cholecystitis with perforation at the tip of the fundus. The perforation lead to collection of bile under the liver capsule. This case is unusual as clinically suggestive of liver abscess and the perforation didn't lead to biliary peritonitis. Gall Bladder perforation is life threatening event associated with increased morbidity and mortality. Cholecystectomy with peritoneal lavage is the treatment of choice.

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Chronic pancreatitis and tropical pancreatitis lead to frequent abdominal pain. To reduce this pain, lateral pancreaticojejunostomy (LPJ) is the most common surgical procedure. Despite the evidence available for the effectiveness of surgical therapy, the decision for indication, type, and timing of surgical intervention is always been debated. In this case series we make an attempt to define the possible timing of the procedure and the category of patients who might benefit from it. The 14 out of 65 patients who were evaluated from July 2018 to December 2021 were included in this study. All patients were observed with pain in the abdomen, weight loss, steatorrhea, and malabsorption while none of the patients had pancreatic head mass as per cross-sectional imaging. Fourteen patients with confirmed chronic atrophic pancreatitis with severe symptoms and dilatation of the pancreatic duct were operated upon. Three of these were considered failures since they continued to have no weight gain and either pain or malabsorption. The failures were mainly due to impaired pancreas due to chronic disease and not due to failure of the procedure. Chronic pancreatitis cases, with a short duration of illness, have a better chance of success in surgery. We conclude that one can resort to LPJ in cases that do not respond to medical therapy, continue to suffer from pain, malabsorption, and weight loss. It is a relatively safe procedure that provides good pain relief with low postoperative morbidity, further preventing exacerbations and maintaining appropriate pancreatic exocrine and endocrine functions.

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Background: With better imaging technologies, the frequency of detecting GB polyps has increased, however, their effective management remains a clinical dilemma. Aims: This study was aimed to assess the true outcome of lesions suspected or diagnosed as gallbladder (GB) ‘polyp’ on ultrasound. Patients and Methods: Computerised hospital-based medical records between June 2008 and June 2014 at a medical sciences institute in Kerala were accessed to identify and review the follow-up of all cases identified as GB polyp on ultrasound. Results: Ultrasound examination was performed in 108 cases. Of these 46% had symptoms suggestive of gall bladder disease, 20% had nonspecific abdominal symptoms and for the remaining 34% it was part of routine health check-up. The mean polyp size was 4.7 mm. During follow-up, 20 (18.5%) patients underwent cholecystectomy and none of them came as true polyps on histopathology, 25 (23%) patients were lost to follow-up after primary ultrasonography and 10 (9.25%) patients died due to reasons unrelated to GB disease. Conclusion: Radiologists tend to over diagnose GB polyps due to the risk of malignant transformation of GB polyps and increased usage of imaging modalities. It is observed in this study that higher imaging modalities do not add significant specificity in the diagnosis of the true polyp. However, there is a need for a large cohort study to confirm the outcome.