Background: Although acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis is challenging. There may not be classical symptoms and signs of appendicitis always. Accurate diagnosis can be aided by biochemical testings and radiological evaluation and expectant management. These might delay laparotomy and lead to complications of appendicitis and increase the morbidity. Recent research literatures have shown that hyperbilirubinemia is a diagnostic tool for gangrenous/perforation of appendix. This study is designed to evaluate the association between the derangement of liver function test and severity of acute appendicitis and it’s complications like gangrene and perforation of appendix.Methods: This was an observational prospective study on 66 consecutive cases of acute appendicitis done in the department of general surgery, VIMSAR, Burla. After taking informed consent, all patients included in the study were subjected to abdominal ultrasound and blood sample taken for routine blood examination, LFT and after appendicectomy histopathology examination report were collected. A master chat prepared from above data and stastical analysis done.Results: The LFT parameters are deranged in pathological appendix and more specifically the total bilirubin level but the sensitivity, specificity and PPV are specifically high for gangrenous and perforated appendix.Conclusions: LFT can be added as adjunctive test to the investigation of acute appendicitis and its complications and earlier diagnosis of the complications of acute appendicitis and timelier management. It can also help in prevention of negative appendicectomies.

Cystosarcoma phyllodes is a rare, predominantly benign tumor of the female breast, comprising less than 1% of all breast neoplasms. The incidence of malignancy in phyllodes tumor is even less, only 25% which usually does not ulcerate the skin or involve the nipple areola complex. 1, 2 Herein we report a case of 16years old girl with a right sided big malignant phyllodes tumor with nipple areola complex involvement and skin ulceration.

Background: The objective of this study is to study the impact of combined use of Alvarado score and computed tomography (CT) scan on negative appendectomy rate.Methods: This prospective observational study comprising of patients presenting with clinical features of appendicitis admitted to department of general surgery, VIMSAR, Burla from November 2017 to October 2019, where Alvarado score and ultrasonography (USG) findings are mismatching each other. Alvarado scores calculated and categorized in 2 groups as negative (score <4) and positive (score ≥4). These patients were also subjected to USG and categorized as negative (USG -ve) and positive (USG +ve). Those patients having discrepancy in both the findings were subjected to CT scan. On histopathological examination, inflamed appendix in 63 (97%) patients and non-inflamed in 2 (3%). Rest patients were either discharged (both -ve) or operated (both +ve). Results: Total 84 patients showed discrepancy between Alvarado score and USG findings and are subjected to CT scan abdomen and pelvis. CT scan was positive for appendicitis in 65 cases (where appendectomy done) and negative for appendicitis in 19 cases (where the diagnosis is different). patient. Thus, negative appendectomy (NAR) is 3% in this study.Conclusions: Alvarado score and ultrasonography could not be used as absolute tool in doubtful and equivocal cases, where combined use of CT scan with Alvarado score and USG has definitely has an edge by diagnosing the differentials and reducing NAR followed by reduction in cost and length of hospital stay.

Background: Fundus first method is a widely accepted and practiced procedure in open cholecystectomy to deal the difficult cases but laparoscopic surgeons still have reserved opinion regarding use of fundus first approach in difficult laparoscopic cholecystectomy (DLC). As in open cholecystectomy fundus first laparoscopic cholecystectomy (FFC) can have advantages over conventional laparoscopic cholecystectomy (CLC) in DLC. So many preoperative, intraoperative, postoperative information were collected in both CLC and FFC and compared to evaluate whether FFC has any advantage over CLC in difficult laparoscopic cholecystectomy.Methods: A total 73 cases were included in the study that underwent laparoscopic cholecystectomy (LC) for gall stone diseases and intraoperatively found to be difficult cases. They were distributed into 4 classes i.e. Class I, Class II, Class III and Class IV according to the type of difficulty encountered during surgery.Results: Out of the 73 patients 24 were male and 49 were Female. Age of patient ranged from 14 to 70 years with mean age of 42.64 years. Out of 38 cases operated with FFC 6 cases (15.78%) needed conversion to open cholecystectomy as compared to 26 out of 35 (71.14%) cases that underwent CLC where conversion was done. Mean duration of hospital stay is 4.19±3.053. Mean hospital stay in FFC is 2.58±1.869 days and that of CLC is 5.14±3.143 which is clearly much higher and statistically significant (p< 0.001) than mean hospital stay in case of FFC.Conclusions: FFC has advantages over CLC in difficult LC i.e. reduced conversion rate, lesser hospital stay and less duration of antibiotic use.

Background: Acute cholecystitis is a serious surgical emergency for elderly patients. strophe and dittensbaugh (1953) observed that all gall stones were found twice as often in the age group of over 70 years as compared to all groups. Several studies have also found that laparoscopic cholecystectomy (LC) is a safe and efficient treatment approach for acute cholecystitis compared with open cholecystectomy (OC). The role of LC in acute cholecystitis