HighlightsPancreatic hydatid cysts are very rare entities with an incidence ranging from 0.14% to 2%.They can masquerade as pseudocyst or cystic neoplasm of pancreas.Ultrasonography, Computed tomography and Hydatid serology help in diagnosis.Pericystectomy, Partial cystectomy with omentopexy/external drainage, Marsupialization, Cysto-enterostomy are some of the surgical options.Prophylactic preoperative and postoperative anti-helminthics(Albendazole) are recommended.

HighlightsPresacral tumors are rare variety of space occupying lesions which due to their location, etiological heterogeneity and difficult surgical approach, present a challenge to treating physician.Surgical excision remains the treatment of choice for presacral masses.Posterior surgical approach, if applied judicially, in carefully selected cases, remains an attractive option as it provides better surgical exposure, is more direct approach, commodious to adopt, easy to learn with quicker post-operative recovery.

HighlightsSurgical diagnosis of conditions causing acute abdominal pain in situs inversus is complicated by the mirror image anatomy.Chest X-ray and Ultrasonography abdomen can be helpful in diagnosing this condition.Laparoscopic cholecystectomy in situs inversus is problematic for right handed surgeons.We describe a modified 4 port configuration where right handed surgeons can use the left mid-clavicular port for dissection.

Gastrointestinal perforations remain the most common cause of surgical pneumoperitoneum since time immemorial. The aim of this study was to find out the effectiveness of plain radiography in diagnosing hollow viscous perforation. A prospective analysis of a total of 1,723 patients of perforation peritonitis between January 2009 and June 2011, confirmed by exploratory laparotomy, was worked out in the study. All these patients had undergone either an upright chest or erect abdominal or both radiographs before undergoing operative procedure. Pneumoperitoneum was evaluated, and the findings were compared with that of exploratory laparotomy. Out of the 1,723 patients of documented perforation on intraoperative finding, 1,537 patients showed pneumoperitoneum on preoperative plain radiography. The overall positivity rate of plain radiography in detecting pneumoperitoneum was 89.20%. The positivity rate was highest for stomach and duodenal perforation (94.19%) and the least for appendicular perforation (7.69%) with highly significant difference (p value, <0.001). In developing world, where there is limited availability of resources and overburden of patients, imposing a limitation in adapting advanced radiological technique as a first line of investigation, plain radiography may be considered as a valuable screening tool in detecting pneumoperitoneum with high positivity rate.

HighlightsLongest gallbladder (30 cm), documented till date, removed successfully.Mucocele of gallbladder operated without any complications through standard 4 port technique.