Highlights As per the available literature this is the first case of COVID 19 positive patient with gunshot injury with successful outcome. Effective peri-operative and post-operative care in a COVID 19 positive patients results in better outcome. Delay in emergency surgeries should be avoided in view of awaited COVID report. Universal precaution and multidisciplinary approach have pivotal role in surgical care during COVID -era.

Highlights The haemodynamically stable grade III pancreatic injury may be managed conservatively. Assault with punching leading to isolated grade III pancreatic injury in an adult is extremely rare to occur. The decision of operation is mainly based on the clinical conditions of patients.

Retroperitoneal sarcomas represent a group of rare malignant neoplasms with complex clinical management and often a poor prognosis. An elderly male presented with a slowly progressive, right-sided abdominal lump for four months associated with loss of appetite and abdominal discomfort. Abdominal examination revealed an apparent retroperitoneal lump in the right lumbar and umbilical region, which was well-defined, and firm in consistency with the bosselated surface. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed a heterogenous lobulated malignant appearing retroperitoneal lesion arising from the right anterior perirenal space with a differential of retroperitoneal sarcoma. Wide local excision of the tumor was done. Histopathology of the lesion revealed a smooth muscle tumor of uncertain malignant potential (STUMP). The patient is asymptomatic and recurrence-free after 24 months of followup.

Background Fistula in ano is always a troublesome condition for the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient times. There is no gold standard treatment modality to date documented in the literature for complex fistula in ano. Material and methods We enrolled 60 consecutive adult patients attending the surgical outpatient department of a tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in the Ligation of intersphincteric fistula tract (LIFT), Fistulectomy andKsharsutra(Special medicated seton) group were respectively recruited randomly. A prospective observational study was conducted. The primary outcomes were postoperative recurrence and morbidity. Post-operative morbidity is measured in terms of postoperative pain, postoperative bleeding, pus discharge and post-operative incontinence. The result of the study were analysed after 6 months of follow-up by clinical examination at outpatient department and at 18 months follow up done telephonically. Results At 6 months of follow-up, 2 patients (10%) had a recurrence in the Ligation of intersphincteric fistula tract procedure group, 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however 3(15%), 4(20%) and 9(45%) patients developed recurrence in Ligation of Intersphincteric fistula tract, Fistulectomy and Ksharsutra group respectively at 18 month of follow-up. The differences in the recurrence were not statistically significant.The mean Visual analogue score for postoperative pain after 24 h as well as after 48 h were statistically significant in Ligation of intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score for post–operative pain was also significant in the Ligation of the intersphincteric fistula tract versus the Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of intersphincteric fistula tract procedure. Postoperative morbidity was statistically significant between the Ligation of intersphincteric fistula tract versus the Ksharsutra and the Ligation of intersphincteric fistula tract versus Fistulectomy. Conclusion Ligation of intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure; although recurrence was less compared to other methods it was statistically not significant.

Background Fistula in ano is always a troublesome condition for both the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient time. There is no gold standard treatment modality till date documented in the literature for complex fistula in ano. Material and methods We enrolled 60 consecutive adult patients attending surgical out patient department of tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in Ligation of Intersphincteric fistula tract, fistulectomy and Ksharsutra group were respectively recruited. The main outcomes were post-operative recurrence and morbidity measured in terms of postoperative pain, postoperative bleeding and pus discharge and post operative incontinence. Results The result of the study were analysed after 6 months of follow-up, 2 patients (10%) had a recurrence in Ligation of Intersphincteric fistula tract procedure group and 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however, the differences in the recurrence were not statistically significant, the mean Visual analogue score for pain after 24 hours as well as after 48 hours were statistically significant in Ligation of Intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score was also significant in the Ligation of Intersphincteric fistula tract versus Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of Intersphincteric fistula tract procedure. Post operative morbidity was statistically significant between Ligation of Intersphincteric fistula tract versus Ksharsutra and Ligation of Intersphincteric fistula tract versus Fistulectomy. Conclusion Ligation of Intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure, although recurrence was less compared to other procedures it was statistically not significant.