A 40-year-old female presented to the neuro physician with complains of headache, giddiness, vomiting and loose stools and altered sensorium since past one day. On examination, deviation of angle of mouth towards right, weakness of left upper and lower limbs, GCS 8/15 and an extensor plantar reflex was seen.CT scan showed bilateral diffuse cerebral oedema. Suspecting a cerebrovascular stroke and increasing intracranial tension, the patient was intubated and started on Inj. Mannitol (150 ml i.v. Q4H) and antibiotics. As the patient was intubated, she was sedated using Inj. Midazolam till fifth day of treatment, when she was extubated. Inj. Dexomethasone (8 mg iv QD) and intravenous fluids were also started. The patient was extubated on fifth day and was started on Inj. Enoxaparin 60 mg subcutaneously BD on sixth day.On the eighth day of treatment (day 3 on enoxaparin) patient complained of sudden development of abdominal pain. This was accompanied by tachycardia and sudden fall in blood pressure. The general surgery department was consulted for the above complaints. On examination, the patient was found to have extreme tenderness, and a vague mass was felt in the right iliac fossa, suprapubic region and left iliac fossa with positive Carnett's sign and Fothergill sign. Repeat complete blood count, ultrasonography abdomen and pelvis, and CT scan abdomen and pelvis were advised.Blood count reports showed a drop in haemoglobin level from 14.6 gm% at the time of admission to 7.1 gm% on the fourth day of enoxaparin treatment. Platelet count which was 353,000 cells/cu mm on admission had fallen to 252,000 cells/cu mm on the day of pain and then fell to 183,000 cells/cu mm the next day. The ultrasonography abdomen and pelvis showed a focal thick walled heterogeneous pelvic collection in the infra-umbilical region.CT scan abdomen and pelvis showed a large (15.3 cm 3 x 12.2 cm 3 x 7.4 cm 3 ) collection, approximately 720 ml, heterogeneous hyper dense collection in the right infra-umbilical anterior abdominal wall, proximally limited to the rectus sheath in epigastric region. Inferiorly extended to preperitoneal space of abdominal cavity crossing the mid line and extending to left side. There was extension into suprapubic region posterior to pubic symphisis and in prevesical region. Compression of bowel loops and bladder was also seen. The reports were suggestive of a Grade III rectus sheath haematoma [Table/ Fig-1].Fluid aspiration cytology report from the infra-umbilical region showed few scattered polymorphs with abundant red blood cells in the background with no evidence of malignant cells. Keywords: AbSTRACTRectus sheath haematoma is a well-documented condition with an elusive diagnosis. It is an uncommon complication of anti-coagulation therapy, which can have a mortality of upto 25%. The patient discussed here is a 40-year-old female who was on Inj. Enoxaparin, who developed severe abdominal pain and hypovolemia after three days of treatment. Ultrasonography and CT scan showed a large rectus sheath haematoma on the...

INTRODUCTIONForeign body ingestion is a common medical emergency in both children and adults. Children constitute 80% of total ingestions. In children most of them are true FBs like coins, marbles, toys, safety pins and batteries.1 In adult's food bolus impaction is more common and true foreign body ingestion (non-food objects) occur in those with psychiatric disorders and alcohol intoxication. Most of the ingested foreign bodies pass spontaneously but few of them pose as an endoscopic emergency.2 Upper esophagus is the commonest site followed by middle esophagus, stomach, pharynx, lower esophagus, pharynx and finally duodenum. 3 The aim of the current study is to report our clinical experiences in the endoscopic management of foreign bodies in the upper gastrointestinal tract in both children and adults. METHODSWe evaluated cases of foreign body ingestion admitted to department of general surgery in SN Medical college from January 2015 to December 2016. Data were collected from the department and recorded information was entered into pre-coded proforma which included details of demography, clinical profile, treatment and outcome. The data collected were cross checked by two independent observers. The data were analyzed using SPSS computer software version 15 (SPSS Inc, Chicago 2, USA) and expressed as a number and a percentage for ABSTRACT Background: Foreign body ingestion and food bolus impaction is a common clinical scenario and can present as an endoscopic emergency. Though majority of them pass spontaneously 10-20% require endoscopic intervention. Flexible endoscopy is recommended as therapeutic measure with minimal complications. The aim of our study is to present 2 years' experience in dealing with foreign bodies in the upper gastrointestinal tract. Methods: Cases of foreign body (FB) ingestion admitted to department of general surgery from January 2015 to December 2016 were evaluated. The patients were reviewed with details on age, sex, type of FB, its location in gastrointestinal tract, treatment and outcome. Results: A total of 23 cases were studied. Age range was 2-75 years. Males were predominant (60.87%). Coins were found most commonly (52.17%). Esophagus was the commonest site of FB lodgment (65.22%). Upper esophagus being the most common (39.13%). Upper gastrointestinal flexible endoscopy was useful in retrieving FB in all the 23 cases. There were no complications throughout the study period. Conclusions: Flexible endoscopy should be used as definitive treatment and endoscopic treatment is safe and effective.

INTRODUCTIONAbdomen is like Pandora's Box. Diseases of the abdomen constitute a topic full of curiosity. A meticulous examination of the abdomen is one of the most rewarding diagnostic procedures available to the doctor, especially the surgeon. As it had been said by Bailey, "A correct diagnosis is the hand maiden of successful operation" Despite the advancements in the fields of diagnosis the surprises never caese.1 Acute appendicitis is the most common acute surgical condition of the abdomen. 2 ABSTRACTBackground: Now a day there is a trend to rely more on high-tech investigations rather than taking thorough history and clinical examination of the patients in the diagnosis of acute pain abdomen. Commonest cause of acute abdomen in the surgical practice is appendicitis. Delay in the diagnosis and treatment of acute appendicitis, leads to complications. Objective of this study was to evaluate the accuracy of clinical diagnosis versus sensitivity and specificity of ultrasound examination and histopathological examination of the resected specimen of appendix. This study also assesses the incidence of negative appendectomies in a medical college hospital of North Karnataka. Methods: This study included one hundred and fifty patients with history of pain abdomen where clinical diagnosis of acute appendicitis was made. The study period was of 18 months between February 2014 to July 2015. Routine blood investigations and abdominal ultrasonography were done in all cases. All ultrasound positive cases were subjected to surgery. Some ultrasound negative cases were also taken to surgery on the high suspicion of diagnosis of acute appendicitis depending upon thorough history taking and clinical examination. The diagnosis made depending on the ultrasound findings were compared with clinical findings, operative findings and histopathological examination reports. Results: Out of 150 patients, 104 were male and 46 were female. The common symptoms were pain in the RIF (100%) and anorexia (80%).The overall sensitivity and specificity of clinical diagnosis was 96.9% and 90.48% respectively. The same for ultrasound was 86.99% and 33.33% respectively. The present study shows negative appendectomy rate 6.66% in females and 7.33% in males. Conclusions: The diagnostic accuracy of ultrasound was 84.87% whereas clinical diagnosis was 96%. Thus, detailed history taking, and thorough clinical examination still holds good in the diagnosis of acute appendicitis and should be stressed in the clinical teaching.

Background: Fissure in Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF).Methods: Prospective comparative study conducted on 90 patients randomly divided into two groups Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA) respectively. The primary outcome variables studied were postoperative pain, hospital stay, and cost effectiveness.Results: A total of 90 patients randomly divided into 45 patients in each group. There was no statistically difference in the pain at surgery, but post-operative pain was significantly less in LA group at 5th hour, 24 hours after surgery. Hospital stay in LA group is significantly less when compared to SA group (1.92, 3.75 respectively).Conclusions: LAS can be comfortably performed under LA with added advantages.

Background: Mortality is an inevitable component of hospital practice and patient outcomes. The age and cause of death and sex mortality pattern and the audit give a myriad of information. This helps to identify the trend of mortality. Hence, this study was done to identify age and sex patterns of mortality of the patients admitted to Hangal Sri Kumareshwar Hospital and Research Centre, Navanagar, Bagalkot, Karnataka, India.Methods: A retrospective study of all deaths that occurred in the year 2018 in Hangal Sri Kumareshwar hospital and Research Centre, Navanagar, Bagalkot, Karnataka was done by analysing the records from medical records department after institutional review board clearance. Data regarding age, sex, area of residence, ward of admission and cause of death was noted and analysed using percentages and chi square test.Results: Out of 411 deaths during 2018 in HSK hospital, 64.96% were males and 35.04% were females. Majority (71.53%) were from rural areas. Maximum number of deaths (27.98%) was observed in those more than 61 years of age followed by those between 41 to 60 years of age. Overall, maximum number of deaths (69.35%) was due to a Non communicable disease. Infectious and parasitic disease contributed to 10.46% of deaths. Cardio vascular disease contributed to 16.30% deaths.Conclusions: Primary prevention of non-communicable diseases by creating awareness in the community and secondary prevention by early identification is needed to prevent premature mortality before the age of 60 years.