Background: One of the most common intra-abdominal problems faced by general surgeons in their practice remains bowel obstruction. It is important to identify and analyse the clinical presentation and etiology of patients with acute intestinal obstruction. With its multiple etiologies, intestinal obstruction of either the small or large bowel continues to be a major cause of morbidity and mortality.Methods: An observational study was carried out at Narayana Hrudayalaya Hospital, Bangalore between July 2016 and June 2019 involving 190 patients, after approval from Institutional ethics Committee. Predicted mortality rates were calculated using the APACHE II scoring system by linear analysis method. It was then compared with the actual outcomes. Univariate and multivariate analysis was carried to analyze the collected data.Results: The commonest cause in this study was postoperative adhesions [82 patients (43.2%)]. Frequency of mortality in our study was 7.9%. ROC curve analysis to predict the mortality using APACHE score showed sensitivity (80%), specificity (81.14%) and AUROC=0.796. P value was <0.001 which is highly significant. A positive correlation was found between deaths and complications with higher APACHE scores.Conclusions: Successful treatment of acute intestinal obstruction depends upon early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself. The APACHE II score allows for direct comparison between the observed and expected adverse outcome rates. They can also be used to determine prognosis and help family members make informed decisions about the aggressiveness of care.

Pneumoperitoneum is most commonly caused by hollow viscus perforation which requires an emergency surgical intervention. However, this is not always the case. Pneumoperitoneum which is not due to hollow viscus perforation is called Spontaneous or “non-surgical” pneumoperitoneum. Rarely, it can present with peritonitis but non-surgical pneumoperitoneum usually follows a benign course and can be managed conservatively. A case of 53-year-old male, non-smoker, non-alcoholic, hypertensive known to have decompensated chronic liver disease, since one year with portal hypertension and ascites was presented. The patient underwent uneventful laparoscopic cholecystectomy for acute calculous cholecystitis and developed spontaneous pneumoperitoneum due to intra-abdominal drain one week postprocedure. Pneumoperitoneum was successfully managed conservatively. A thorough history, physical examination and imaging are crucial in identifying patients with non-surgical pneumoperitoneum and to prevent unnecessary laparotomies. In present case, pneumoperitoneum was due to intra-abdominal drain which resolved after removing the drain. So, it is of utmost importance to rule out non-surgical causes of pnemoperitoneum, especially in surgeries where drain are kept in-situ.