Paraduodenal hernia, a rare congenital anomaly that arises from an error of rotation of the midgut, is the most common type of intra-abdominal hernia. There are two types, right and left paraduodenal hernia, the right being less common. We report the case of a 41-year-old patient with a right paraduodenal hernia who presented with two days history of continuous pain abdomen with multiple episodes of vomiting. Patient was decided to undergo laparotomy in view of increasing abdominal pain and development of peritonitis. In a planned laparotomy, herniation of the small bowel loops through the fossa of Waldeyer, behind the ascending mesocolon was found which was gangrenous with prolapse of a few gangrenous loops into the peritoneal cavity. The gangrenous bowel resected, and an end to end jejunoileostomy performed.

Anemia is a common concern in geriatric age group in developing countries. The purpose of this study was to identify the common causes and types of anemia in elderly patients in educationally backward region with limited access to quality health care. This was an observational study was done in Shri Maharaja Hari Singh (SMHS) Hospital of Government Medical College Srinagar, over a period of two years. 2000 patients above 60 years of age attending the outpatient clinic were screened for anemia based on WHO criteria. A random and non-consecutive selection of 100 anemic patients was done to study the morphological type and cause of anemia. 1160 (58%) patients were males and 840 (42%) were females. Total 812 out of 840 (96.67%) females and 738 out of 1160 (63.62%) males were found to be anemic. Maximum numbers of anemic patients were found in the age group 60-69 years. Mean age was 74.5 years. All the types of anemia based on peripheral smear were evident, normocytic being the commonest constituting 77.5%, followed by microcytic hypochromic 11.1%, macrocytic 7.05% and dimorphic 4.35%. 21% were lost to follow up and almost one fourth of the patients (24%) needed further evaluation before labelling them as having anemia due to old age. The common causes of anemia noted were gastrointestinal malignancy (31%), renal insufficiency (15%) and tuberculosis (9%). The inability to evaluate anemia in elderly individuals can lead to delay in the diagnosis of treatable as well as threatening disease conditions.

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Purpose: To determine role and benefit of fibrin glue over tackers for mesh fixation in laparoscopic inguinal hernia repair. Backgroud: Mesh fixation by tackers may lead to many complications peroperatively like bleeding, increased hospital stay and overall more cost and later on chronic groin pain. Material and Methods: 60 inguinal hernia with age more than 18 years were taken and were divided in two groups; 30 patient group who underwent TAPP and 30 patient group who underwent TEPP. In 15 patients in both groups tackers were used and in other half fibrin glue was used for fixation of mesh using a 3mm catheter (Duplotip: Baxter Healthcare), which fits the Tisseel syringe. Results: The use of fibrin sealent has a distinct advantage in laparoscopic treatment of inguinal hernias compared with use of tackers as a method of mesh fixation. The use of fibrin sealant reduces the risk of post-and intraoperative complications, such as bleeding, seroma, chronic pain, has a lower incidence of postoperative neuralgia and provides an early faster return to social life. The recurrence rates do not vary much, but the operative time is slightly longer if the preparation time of the fibrin sealant is taken into consideration. In our study, we found a marginal difference in the cost of the two groups, fibrin sealant and stapled tackers.