Angiomatoid fibrous histiocytoma (AFH) is one of the spindle cell neoplasms having fibroblast and myofibroblast origin. The perineoscrotal region is an uncommon site for such tumors and never reported in the literature. We present a 31-year-old gentleman presented with a painless, rapidly growing scrotal swelling for 2 months duration. Guided core needle biopsy demonstrated spindle cell neoplasm; regional magnetic resonance imaging (MRI) revealed a large mass extending from the perineum to inter-testicular space within the scrotal sac. After staging evaluation, he underwent en bloc resection of the tumor. Histopathology showed features of AFH which is supported by immunohistostains positivity to smooth muscle actin, clusters differentiation (CD) 68, CD99, and desmin. Despite any adjuvant treatment, he remained disease-free on follow-up MRI for 4 years. AFH can also have an unusual origin from perineoscrotum, and it grows rapidly and has a good prognosis.

Background: Intestinal obstruction is one of the common clinical problems encountered in surgical practice, and the dreadful complication of intestinal obstruction is strangulation, which requires an emergency surgery for management. The main objective of our study was to evaluate patients with clinical suspicious intestinal obstruction and to find out the significant levels of serum C-reactive protein (CRP) and serum lactate in the early detections of strangulation preoperatively. Materials and Methods: A total of 30 patients who aged between 15 and 80 years were included in the study after excluding the patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and lactate were measured pre-operatively and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn, and cut-off values for the diagnosis of strangulation were calculated along the calculation of sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs). Results: Fifteen patients of strangulated bowel obstruction had significantly higher values of serum CRP and lactate when compared with 15 patients of simple bowel obstruction (99 vs. 38.3 mg/L and 35 vs. 9.9 mg/dl, respectively, P < 0.05). Using ROC analysis, the area under the curve of serum CRP and lactate was found to be 0.809 and 0.947, respectively for bowel strangulation. The serum CRP test has the sensitivity of 80.0%, specificity of 66.7%, PPV of 70.6% and NPV of 76.9% to detect the obstruction with strangulation when using a cut-off value of 49 mg/L. The serum lactate test has the sensitivity of 86.7%, specificity of 73.3%, PPV of 76.5% and NPV of 84.6% to detect the obstruction with strangulation when using a cut-off value of 19 mg/dl. Conclusion: The serum CRP and lactate are useful and reasonable diagnostic markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

Background: The surgical impact on the 30-day mortality and morbidity in geriatric patients is a scarcely studied topic. The aims of this study were to identify the 30-day morbidity and mortality in geriatric patients undergoing major gastrointestinal surgery and to identify the risk factors associated with the same. Materials and Methods: A cross-sectional study was conducted on 93 patients at a tertiary care centre. Thirty-day morbidity was broadly grouped into wound, renal, cardiac, respiratory, psychiatric, neurologic complications and others. The complications were also graded into five based on the Clavien–Dindo classification. Data were analysed using appropriate statistical methods. Results: The 30-day mortality in our study was 3.2%. The 30-day overall morbidity was 58.06%. Grade 2 and above Clavien–Dindo complications were encountered in 25/93 patients – 26.9%. There was an increased risk of Grade 2 and above Clavien–Dindo surgical complications in patients who had prior history of falls, who had timed up and go test more than 14 s, who had significant weight loss, who were operated for malignant causes and those who underwent open surgeries. Majority of complications occurred in the 65–69-year age group. Patients operated for non-malignant causes had no post-operative complications in our study. Conclusion: Elective surgery is generally well tolerated by the elderly. Age should not be used as the only criterion when deciding suitability for surgery in this age group. The results of elective surgery in the elderly are in fact reproducibly good, especially in non-malignant causes.

Background: Acute calculous cholecystitis is one of the common conditions. The initial radiological investigation of choice is ultrasonography of the abdomen. Cholecystectomy is the definitive treatment for acute cholecystitis. Laparoscopic cholecystectomy is the procedure of choice for acute cholecystitis. Sometimes there is a need for conversion to open cholecystectomy due to intra-abdominal adhesions which make laparoscopic cholecystectomy difficult. Hence, pre-operative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. In our study, we aimed to analyse the various risk factors and to predict the difficulty and degree of difficulty pre-operative lay by the use of a scoring system. Materials and Methods: All 100 patients were evaluated and their clinical and ultrasound parameters were recorded. They received symptomatic treatment with antibiotics and analgesics preoperatively. Following that, they were subjected to laparoscopic cholecystectomy, time taken, bile spillage, stone spillage, injury to duct, artery and conversion to open cholecystectomy were noted. All patients were operated by similarly experienced surgeons. Postoperatively, cases were followed up for any complications and they were discharged on recovery. Results: Receiver operating characteristic curve analysis of pre-operative with an intraoperative score in our study with area = 0.846, P = 0.0005 <0.01 is highly statistically significant at P < 0.01 level. The sensitivity and specificity of the scoring system at score 0–5 for the prediction of easy laparoscopic cholecystectomy are 89.2% and 80.0%, respectively, and the sensitivity and specificity of the scoring system at score 6–10 for the prediction of difficult laparoscopic cholecystectomy are 80.0% and 89.2%, respectively. Conclusion: Our study concludes that the scoring system evaluated is robust, reliable and useful to predict difficult laparoscopic cholecystectomy.

Introduction: Necrotizing soft-tissue infections are often fatal, characterized by extensive necrosis of the fascia and subcutaneous tissues. To aid the early diagnosis of necrotizing fasciitis (NF), there is a Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system for the early diagnosis of NF. Our study was undertaken to evaluate LRINEC score, based on routine laboratory investigations that are readily available, that could help distinguish NF from other soft-tissue infections. Materials and Methods: The study was conducted on all inpatients, admitted with features of soft-tissue infections suspected to have NF and later underwent wound debridement or amputation in a tertiary care hospital. LRINEC score more than or equal to 6 was considered as case and the score <6 considered as control. Both were treated with intravenous (IV) antibiotics, IV fluids and surgical intervention based on their clinical findings and outcome. The confirmatory diagnosis for NF was done through culture of tissue and other body fluids. Results: The cutoff value of LRINEC for predicting NF was 6 with sensitivity of 85.7% and specificity of 70.7%. The negative predictive value of LRINEC-OC was 87.9% and positive predictive value (PPV) 66.7%. The accuracy was 76.8%. Conclusion: LRINEC scoring system has a better PPV in identifying the onset of NF and risk strategizing of the patients with severe soft-tissue infections. We recommend LRINEC score to be used as a predictor in the diagnosis of NF. Multi-disciplinary team may guide immediate operative and supportive management, thereby improving the clinical outcome of the patient.