INTRODUCTIONHollow viscus perforation leading to peritonitis is one of the commonest emergency surgeries conducted in a surgical practice for a case of acute abdomen.1 It is the second most common cause for acute abdomen following appendicitis. Perforation as a cause of acute abdomen accounts for 30-40% of the total cases of acute abdomen presenting to a surgical emergency.2 Among the cases of hollow viscus perforation duodenal and gastric perforations are the commonest accounting to almost 60-80 % in some series, followed by ileal, appendicular and large bowel. ABSTRACT Background:The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforationa cause of obscure peritonitis. Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention. Methods: A prospective study was conducted in Victoria Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute over a period of 5 years from June 2011 to May 2015. A total of 136 patients presented in this period with hollow viscus perforation and out of these 64 patients had Ileal perforation alone on exploratory laparotomy. Ileal perforations account for about 20 percent of all cases of hollow viscus perforation. Emergency exploratory laparotomy was done and perforation was identified, edge biopsy was taken in all cases and the perforation was closed in two layers and resection anastomosis was done in stricture with perforation. Histopathological report was reviewed following surgery. Results: A total of 64 patients with Ileal perforation were included in the study of which 52 were males and 12 were females accounting for 81.25 percent and 18.75 percent respectively. The causes for perforation were enteric fever (82.81%), nonspecific inflammation (9.38%), and tuberculosis (7.81%). Simple closure of the perforation (74.58%) and the remaining primary resection and anastomosis were the mainstay of the surgical management. Conclusions: The common pathology of Ileal perforation is Typhoid or Enteric fever, Non-specific ulcer, Tuberculosis and others. Intestinal complications of typhoid fever are quite common in developing countries. Nonspecific inflammation of the terminal ileum was other predominant cause operative findings were similar to that of typhoid fever but no laboratory evidence of the disease was found. Intestinal tuberculosis can mimic many conditions.

Lumbar drain catheter insertion for prolonged periods of time is necessary in a myriad of neurosurgical patients which entails its tunneling. We describe a safe and simple technique of catheter insertion and tunneling using two Tuohy needles instead of one, which prevents unintentional catheter damage during the procedure.

BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns) that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital,

Background: Pelviureteric junction obstruction commonly present with antenatal hydronephrosis. The aim was to report and analyze the clinical spectrum of infantile pelviureteric junction obstruction.Methods: Retrospective descriptive study of infants operated for pelviureteric junction obstruction (PUJO) during 2013- 2016. Clinical presentations, management and follow up were analyzed.Results: There were 44 infants involving 48 PUJO renal units of who were nine girls. The sex distribution was 1:3.8. Mean age of the presentation was three months. PUJO was bilateral in four patients. Two patients had unilateral PUJO of lower moiety of duplex system. Median of anteroposterior diameter (APD) and differential function of kidney on EC was 2.5cms and 28% respectively. Three patients had poorly functioning kidneys (PFK) (<10%).Conclusions: Good antenatal counselling and appropriate postnatal evaluation detects PUJO early. Early infantile pyeloplasty is safe and effective. Routine micturating cystourethrography is debatable in pelviureteric junction obstruction.

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