Background: Peptic perforation is an emergency and requires urgent surgical treatment. Many modalities of treatment are available ranging from conservative treatment to laparoscopic repair. There is no consensus on treatment of perforated pylorodudenal ulcer which can be treated with conservative treatment, simple closure of ulcer, closure of ulcer with free omentum, closure of perforation with use of pedicled omentum, definitive treatment with truncal vagotomy and drainage procedures or parietal cell vagotomy. However best treatment is still to be decided.Methods: This study was conducted in department of surgery 60 patients presenting with peptic perforation in last three years. All patients with duodenal perforation in first part (D1) were included in the study. Pyloric perforations, multiple perforations, traumatic perforations and severe co-morbid condition were excluded from study. A pedicled omentum was used in the repair of duodenal perforation. Immediate and late postoperative complications were recorded. The patients were followed for three months.Results: Out of 60 cases there were 50 male patients and 10 female patients. The majority of male patients were in the middle age group between 35 to 45 years of age and the female patients were of older age group between 40 to 65 years of age. These patients presented with history of acute pain abdomen in the epigastric region. All the patients underwent modified Graham’s patch repair. In postoperative period, two patients had burst abdomen on fourth postoperative day. Biliary fistula formation occurred in 2 patients. Wound infection occurred in 4 patients and the hospital stay was 5 to 9 days. There was no mortality recorded in this series.Conclusions: In summary, the surgery for perforated peptic ulcer should use modified Graham’s repair using pedicled omentum giving excellent results in terms of healing, morbidity and mortality.

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Background: Epididymal cysts are common in teenagers and young adults. They can present as unilocular or multilocular swelling. These cysts are generally present on one side but can be bilateral. Small epididymal cyst are asymptomatic but are detected on ultrasound examination of scrotum. This study was done with aim of treating epididymal cyst with different modalities based on size of the epididymal cyst. Methods: A total of 124 patients of epididymal cyst were included in this study. Scrotal ultrasonography was done in these patients. The clinical presentations of these patients were asymptomatic detected on ultrasound, orchialgia, scrotal swelling and physical examination. Based on the size of epididymal cyst patients were divided into three groups. The treatment modalities used these were natural involution, aspiration, aspiration and sclerosing agent and surgical excision. Results: The group I consisted of cyst size less than 10mm having 73 patients. The group II consisted of patients with cyst size 11-20mm having 39 patients; and group III patients were with cyst size 21-50mm having 12 patients. Natural involution was most effective treatment modality in group I and group II. Aspiration was the second was most effective. Only a few patients required aspiration and sclerosing agent. Surgical excision was done in majority of group III patients and failed aspiration in group II. Conclusions:The results of present study show that asymptomatic and small epididymal cyst can be cured by natural regression in 77.42%. The cysts 11 to 20mm are amenable to aspiration alone, only a few need repeat aspiration and instillation of a sclerosing agent. These conservative approaches save the cost. Excision should be reserved for very large cysts and in which conservative approach fails.

INTRODUCTIONAccessory breasts can develop in the mammary or milk line. The accessory breast incidence is stated to be 0.4%-0.6% in women.1 This ectopic breast tissue is commonly present in the axilla. The axillary ectopic breast is quite common in women in Asia. The exact incidence is not available in India. The clinical presentation of accessory breast may be asymptomatic or may present with pain in the premenstrual phase due to congestion. Many women are anxious about presence of swelling in the axilla. The breast cancer awareness programs also bring these women to clinician for lump in the axilla. Most of women present for the cosmetic problem. The Indian women wear ethnic dress which covers the axilla, so women are less anxious about this cosmetic deformity. As more women are resorting to sleeveless dress the axillary swelling is a cosmetic problem for them. These accessory breast may be present in either or both the axilla. Occasionally the aberrant breast tissue is seen in axilla, scapula, thigh and labia majora. Axillary accessory breast can present as palpable thickening in the axilla to a pendulous mass. These axillary breasts can become tender and increase in size during premenstrual period. For these symptoms more women are seeking surgeon consultation. These women want investigations to rule out breast carcinoma.3 Reassurance or counseling that the axillary swelling is accessory breast tissue which has enlarged during lactation works only when breast ABSTRACT Background: The axillary accessory breast tissue develops as part of polymastia along the milk line. This is of common occurrence in women. The clinical presentation can be from asymptomatic to cyclical changes. Enlargement of axillary accessory breast tissue is during pregnancy and lactation. The most common reason for seeking surgical consultation is anxiety for development of carcinoma. Small number of women opted for surgery purely for cosmetic reason. Methods: A total of 60 women were included in the study. The age of these women was between 19 to 50 years. Fifty women opted for surgical excision. Results:The most common symptom in these patients was exacerbation during pregnancy and lactation in 30 patients. This enlargement was the also the most common cause anxiety by patients for development of carcinoma. The palpable thickening in 10 patients was another cause of anxiety. Only 6 patients had large pendulous mass and had already made up their mind for removal of this mass. The clinical presentation in rest of the patients represented comparatively small number of patients. Conclusions: The potential of malignancy in accessory axillary breast is more than normal breast, it is essential to investigate these patients. The surgical excision of these accessory breasts is quite safe and is recommended for all the patients having symptoms.