Background: Perforated peptic ulcer is the most common cause among all causes of gastrointestinal tract perforation which is an emergency condition of the abdomen that requires early recognition and timely surgical management. Peptic ulcer perforation is associated significant morbidity and mortality. The aim of study is to evaluate the incidence, clinical presentation, management and outcomes of the patient with peptic ulcer perforation undergoing emergency laparotomy.Methods: This retrospective study includes 45 patients who were operated for perforated peptic ulcer peritonitis at Bundelkhand Medical College and Associated Hospital, Sagar from March 2015 to April 2017. Paediatric patients of age less than 14 years, patients presenting as recurrent perforation were excluded from the study. A detailed history, clinical presentation and routine investigations were done in all cases.Results: In the present study, most of the patients were male. Most of these patients presents with clinical signs of peritonitis between 24-48 hours after onset of the pain. Among the patients of peptic ulcer perforation, duodenal perforation (93.3%) is more common and which is the most common cause of perforation peritonitis. The diagnosis is made clinically and confirmed by presence of gas under diaphragm on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch was done in all cases. The most common post-operative complication was wound infection (57.5%). The overall mortality was 11.1%.Conclusions: Late presentation of peptic ulcer perforation is common with high morbidity and mortality. Surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.

Background: Fistula in ano is an abnormal connection between the epithelized surface of anal canal and usually the perianal skin. It is a benign treatable lesion of rectum and anal canal. Crypto glandular infection accounts for about ninety percent of the cases. The estimated prevalence of an anal fistula is 12 to 28/1000000 of the population per year with male to female ratio 1.8:1. Ligation of intersphincteric fistula tract is a new sphincter saving method with good result in the management of anal fistula. The aim of study was to evaluate the effectiveness and functional outcomes of the ligation of intersphinteric fistula tract (LIFT).Methods: This prospective study includes sixteen patients who were operated for fistulas in ano at Bundelkhand Medical College and Associated Hospital, Sagar from January 2015 to June 2017. Patients above the age of 20 years, proved cases of fistulas in ano without co-morbid conditions and no previous surgical intervention were included in the study. Patients presenting with fistulas from another source such as crohn’s disease, tuberculosis, anal cancer and recurrent fistulas were excluded. A detailed history, clinical presentation, digital rectal examination, anal ultrasound and routine investigations were done in all cases.Results: In the present study most of the patients were male and presents with perianal discharge. The diagnosis is made by clinical history, per rectal examination and anal ultrasonography. All the sixteen patients with fistula in ano underwent ligation of intersphincteric fistula tract (LIFT). The patients were followed for a period of three months. Most of the cases (87.5%) healed within 4-6 weeks. The recurrence of fistula occurs in four cases (25%). Recurrence is due to infection and technical error in the procedures. There were no deaths in the study.Conclusions: The LIFT technique proved to be safe and effective in the treatment of fistula in ano.

Background: Haemorrhoids are one of the common surgical conditions affecting anorectal region with prevalence of 4% of the population. It is usually defined as increase in size as well as downward disruption of normal functional architecture known as anal cushions. Injection sclerotherapy is time honoured outpatient’s procedure that is widely practised globally to treat first and second-degree haemorrhoids.Methods: This prospective study includes 52 patients who were underwent injection sclerotherapy at Bundelkhand Medical College and Associated Hospital Sagar from August 2015 to September 2016. Patients above the age of 18 years of both sexes with Ist and IInd degree hemorrhoids were included in the study. Pregnant patients, patients with diabetes mellitus and with third and fourth degree hemorrhoids were excluded from the study. A detailed history, clinical presentation, digital rectal examination, proctoscopy and routine investigation were done in all cases.Results: In the present study most of the patients were male. Patients with age group ranging from 20-40 year were found of high incidence of haemorrhoids (86.53%). In present study after three doses of injection 94.23% had satisfactory result. After the first dose injection 71.15% patients had satisfactory results rest 15 patients were given second dose of injection of which 60% patients had satisfactory results. Third dose of injection given to the remaining 06 patients proved satisfactory results in only 03 cases. After three doses of injection 03 cases (5.76%) failed to show any response.Conclusions: Sclerotherapy as a safe, easy, cheap and effective method of treatment of 1st and 2nd degree haemorrhoid devoid of any significant complication.

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