INTRODUCTIONThe incidence of esophageal cancer in India is 4.1% (men -5.7%, women -2.7%).1 It is the sixth common cancer in men and eighth common cancer in women in India. 2 Majority of patients with esophageal cancer are diagnosed at a late stage and only palliation is possible.3 . Patients with esophageal cancer have a five year survival rate of 5-10%. 4 Dysphagia is the main symptom of esophageal cancer, causing weight loss and poor quality of life. Palliative treatment of dysphagia with selfexpandable metal stent (SEMS) insertion is an effective and safe procedure.5,6 SEMS insertion is associated with complications like perforation, bleeding, stent migration, tumor ingrowth and stent occlusion. In majority of previous studies, endoscopic SEMS insertion was done under fluoroscopic guidance. 8,9 However few studies have demonstrated that SEMS can be safely inserted under endoscopic guidance alone without fluoroscopy. [10][11][12][13][14][15] This method of SEMS insertion is important in centers where fluoroscopy is not available. ABSTRACTBackground: Esophageal self-expanding metal stent (SEMS) placement is traditionally done under fluoroscopic guidance. But few authors have shown that esophageal SEMS can be placed without fluoroscopy. The study aimed to assess the safety and success of SEMS placement in patients with carcinoma esophagus under endoscopic guidance without fluoroscopy. Methods: All patients who underwent esophageal stenting for palliation of malignant dysphagia over a 4 year period were reviewed retrospectively. Consecutive patients were identified from the endoscopy report books and inpatient admission files of medical gastroenterology department, Victoria hospital. In one hundred and ten patients with inoperable carcinoma esophagus, SEMS was placed. The procedure consisted of proximal release SEMS insertion under endoscopic guidance without the use of fluoroscopy. They were followed at one week and one month after deployment. All the complications related to the procedure were recorded. Results: 110 patients underwent endoscopic esophageal SEMS insertion for palliation of malignant dysphagia. Stent was successfully placed in all the patients. The mean age of patients was 57.38±21.21 years (range: 31 to 84 years). Dilatation of stricture before SEMS placement was needed in 33 patients (30%). No patient had esophageal perforation or stent migration. Conclusions: Esophageal stent insertion in carcinoma esophagus under endoscopic guidance without fluoroscopy is successful, safe and effective for palliation of dysphagia.

Introduction: Emphysematous pyelonephritis (EPN) may be defined as a severe infection of the kidney that leads to necrosis and the presence of gas in the renal parenchyma, surrounding tissue, and the pelvi-calyceal system. EPN occurs almost exclusively in diabetics, but may occasionally complicate obstructive uropathy in nondiabetic patients. Case Report: We present the case of a 45 year old male with uncontrolled diabetes mellitus who presented with acute abdominal pain and free intraperitoneal air on abdominal radiograph, initially suggestive of hollow viscus perforation. He was found to have EPN that had ruptured into the peritoneal cavity. Conclusion: Acute abdominal emergencies presenting with a pneumoperitoneum are not an uncommon occurrence in emergency centres throughout the world. However, rarely, patients present with the source of the pneumoperitoneum being an organ other than bowel. These patients need to be identified as soon as possible to prevent further morbidity and mortality arising from a delay in diagnosis.Introduction: La pye´lone´phrite emphyse´mateuse (PNE) peut se de´finir comme une infection grave du rein, entrainant une ne´crose et la pre´sence de gaz dans le parenchyme re´nal, les tissus pe´rire´naux et le syste`me pelvis-calices re´naux. La PNE survient presque exclusivement chez les personnes diabe´tiques, mais peut parfois entrainer une complication de l'uropathie obstructive chez les patients non diabe´tiques. É tude de cas: Nous pre´sentons dans cet article le cas d'un homme de 45 ans souffrant de diabe`te sucre´non controˆle´consultant pour des douleurs abdominales aigue¨s et la pre´sence d'air libre intra-pe´ritone´al apparaissant a`la radiographie abdominale, sugge´rant dans un premier temps une perforation des visce`res creux. Il souffrait en re´alite´d'une PNE avec rupture dans la cavite´pe´ritone´ale. Conclusion: Les urgences abdominales aigue¨s associe´es a`un pneumope´ritoine ne constituent pas un cas rare dans les centres d'urgences du monde entier. Cependant, il est rare que la source du pneumope´ritoine soit un organe autre que l'intestin chez les patients se pre´sentant. Ces patients doivent eˆtre identifie´s le plus rapidement possible afin d'e´viter une morbidite´et une mortalite´supple´mentaires associe´es a`un retard de diagnostic. African relevanceEmphysematous pyelonephritis is a very rare and late presentation of a common disease. It presents late due to lack of access to healthcare and poor patient education. It is more common in immunocompromised and diabetic patients with greater mortality and morbidity.

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Background: Pancreatic pseudocysts can occur as a complication of acute or chronic pancreatitis. Understanding of pseudocysts has changed with times due to advancement in radiology and introduction of new treatment modalities. This study was done to access clinical features etiology and various managements for pseudocyst in a tertiary care hospital.Methods: It is a prospective study of 40 adult patients admitted in Victoria and Bowring and Lady Curzon Hospital, attached to Bangalore Medical College and Research Institute, Karnataka, India from January 2015 to December 2016.Results: Pseudocysts are more common in males. The commonest etiology associated was alcohol. Ultrasound was the basic radiological investigation done in all patients followed by CECT abdomen. Complications associated with pseudocyst were Gastric outlet obstruction and ascites. Internal drainage was done in most of the patients. Post drainage complications included infection which was managed by antibiotics and endoscopic drainage in case of recollection. Pain was most important post-operative complication. Endoscopic drainage is being preferred as it is less invasive, has a high long term success rate, has shorter duration of hospital stay and more patient comfort.Conclusions: Pseudocyst of pancreas is most commonly seen in males probably because of alcoholism. Clinical presentation can be varied, with pain abdomen being the most common complaint followed by, nausea vomiting. Initial management consists of supportive care and if the symptoms persist and complications develop surgical drainage was the most common management modality. Newer modalities of treatments like endoscopic intervention have an added advantage of lesser pain, shorter duration of hospital stay and recurrence.

Authors reported four cases which were idiopathic in origin with rapid progression and high morbidity. Both fulminant and overwhelming were the words used by Fournier to describe the disease which was also identified ABSTRACT Background: Fournier's gangrene is a rapidly progressive synergistic infection involving the perineal region and the scrotum and/or the penis. This study was conducted to know about the etiology and mode of presentation of Fournier's gangrene and the impact of early and aggressive multimodality treatment in reduction in morbidity and mortality associated with this condition which is still considered to be significantly high. Methods: The medical records of 30 patients of Fournier's gangrene who presented to the hospital between May 2014 to June 2017 were retrospectively reviewed to analyze the presentation, progression and the outcome of the disease. Results: The study included a total of 30 male patients. The mean age was 57 years (range 38-72 years). The most common etiology was secondary to anorectal pathology (40%). The most common predisposing factor was noticed to be diabetes mellitus (73.34%). Pain and tenderness in the perineal region was present in most of the patients and scrotal involvement was seen in 66.67% of the patients. Fever was the most common prodromal condition seen in 93.33% all of which in turn were associated with tachycardia. Hyperleukocytosis was seen in 93.33% of patients except for one patient who was diagnosed to be retropositive on admission. The microbiological profile yielded polymicrobial culture report in 80% of the patients and monomicrobial in the rest with Escherichia coli being the most common organism isolated from 80% of the patients. All patients underwent adequate resuscitation, primary emergency debridement with parenteral antibiotic therapy. All the patients recovered after a mean hospital stay of 16.93 days (range 9-30 days). The mortality rate in present study was found to be 6.67%. Conclusions: In spite of the advancements in the field of medicine Fournier's gangrene still remains a disease with questionable degree of morbidity and mortality and early detection and treatment with aggressive debridement seems to be the only way of obtaining a good prognosis in these patients.