BACKGROUND Small bowel obstruction is defined as failure in forward propulsion of the contents in the intestine either due to dynamic or adynamic cause. It is a common surgical emergency requiring early diagnosis and corrective surgery. It presents a challenge to the surgeon. Studies in the west have shown that bowel obstruction accounts for at least 20% of all admissions to the surgical service. Aim: In view of varying aetiologies, intense study and clinical evaluation regarding trends and patterns of small bowel obstruction is worthwhile. MATERIALS AND METHODS The case series was conducted on 82 patients admitted in the Department of Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from October 2013 to September 2015. Study was done through questionnaires and clinical examination, biochemical investigations including renal function tests, liver function tests, serum electrolytes, CT scan and CRP levels. Treatment modality was planned once the definitive diagnosis of bowel obstruction was made and data analysed using SPSS version 21. RESULTS 63 (76.82%) cases were male, while 19 (23.17%) were female giving a ratio of 3.3: 1. The mean age was 37.50 years ranging from 13-94 years. Mechanical obstruction was the commonest type 92.68% followed by paralytic ileus in 6.1% cases. Abdominal distension was the commonest finding in 73%, abdominal tenderness in 68.5% and elevated bowel sounds in 59.2%. Previous abdominal scars were found in 32.4%, while reduced bowel sounds were recorded in 26.1%. Overall, adhesions and bands were the commonest cause of obstruction found in 56 (68.29%) patients followed by strangulated hernias in 13 (15.85%) patients and ileocaecal TB peritonitis in 8 (9.76%) patients was the main cause of paralytic ileus. 45.12% patients had hyponatraemia, 13 (15.85%) patients had hypokalaemia and 10 (12.20%) patients had hyperkalaemia. CONCLUSION 21-40 years' age group accounted for more than half of the patients, the most common cause being adhesions from previous abdominal surgeries followed by strangulated hernias. Plain abdominal x-rays were diagnostic in more than 60% of cases. Operative management was the mainstay of treatment in more than 2/3 rd of cases.

Background: Penetrating cardiac injuries are rare and considered the most lethal of all trauma patients. Managing cardiac injuries is a great challenge for the trauma surgeons and the outcome of the treatment of such critical condition depends on the mechanism of injury, haemodynamic status of the patients at the time of presentation, heart chamber involved and other associated injuries. Materials and Methods: This is a prospective observational study of consecutive six patients with penetrating cardiac injuries from January 2015 to December 2019 treated in Regional Institute of Medical Sciences, Imphal, India. eFAST and CT scan of the chest were the main imaging methods used for diagnosis. All patients underwent tube thoracostomy for associated haemothorax in the emergency ward. Results: All the patients had penetrating cardiac injuries due to stabbing. Five (63.3%) patients presented with features of cardiac tamponade or with severe hypotension (systolic BP less than 80 mmHg) and one (16.7%) patient who was haemodynamically stable at the time of presentation had developed features of cardiac tamponade after 24 hours. Four patients had undergone emergency left anterolateral thoracotomy, one patient had undergone median sternotomy, and one patient underwent left anterolateral thoracotomy on the second day after admission. Conclusion: A high index of suspicion for cardiac trauma is extremely important in patients presented with penetrating thoracic injuries or upper abdominal injuries. Computed tomography of the chest can show the haemopericardium giving detailed information of associated pulmonary injury and hemothorax. Prompt diagnosis and early surgical intervention play a vital role to save these critically injured patients.

Background: Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide with the potential to cause a dreaded pulmonary embolism (PE). Disease and patient-specific considerations are preferably incorporated into therapeutic options for effective management. Materials and methods: Sixty-eight cases of acute deep vein thrombosis were treated within a period of 3 years from January 2016. All the cases were subjected to routine investigations with the Doppler study of the affected limb. Low molecular weight heparin (dalteparin) was administered in all the cases for a period of 15 days and the Doppler study was repeated at the end of the drug therapy. After the course of low molecular weight heparin, the patients were given acenocoumarol 2mg daily. Estimation of partial thromboplastin time and prothrombin time were performed before starting and during the treatment of the low molecular weight heparin and acenocoumarol regularly. A venogram was done only when the repeated Doppler study revealed unsatisfactory response to low molecular weight heparin therapy. Eight cases underwent thrombectomy and the postoperative period was uneventful. Results: Age group of 21-30 years was most affected (80.8%) with right lower limb being the commonest affected site of injection and associated lesions. Conclusion: DVT in the young population remains a challenge to the evaluating clinician. A variety of disease states can alter the anticoagulant factors. Urgent diagnosis and appropriate intervention carry paramount importance.

BACKGROUND Blunt chest injury is the most common thoracic injury. Although majority of the blunt chest injuries are benign, it can also result in many intrathoracic complications which requires prompt diagnosis and appropriate treatment. Injuries to the thoracic cavity or its contents require urgent intervention as a life-saving measure. METHODS This is a prospective observational study of 324 patients with blunt chest injuries from January 2015 to December 2018 in Regional Institute of Medical Sciences, Imphal. All patients with blunt chest injuries admitted in the Surgery ward and Orthopaedic ward with or without associated injuries were included in this study. Patients with penetrating chest injuries and patients with rib fracture who were not admitted in the ward were excluded from this study. Chest drain output of more than 1000 ml (at the initial drain), persistent air leak, and diaphragmatic rupture were considered as an indication for thoracotomy. Patients with minimal haemothorax or pneumothorax were managed conservatively with closed monitoring of vitals and follow up CT scan of the chest during the hospital stay. RESULTS A total of 324 patients (M=271, F=53) with blunt chest injuries were prospectively analysed. Mean age was 29 years (range 18-82 years). Majority of the patients were in the age group of 21 to 40 years comprising 177 (54.6%) patients (Table I). Road traffic accident (RTA) was the most common cause of blunt chest injuries comprising 88.9%. Rib fracture with or without associated haemothorax or pneumothorax was the most common injury (87.1%). This was followed by haemothorax (60.2%) and haemopneumothorax (5.9%). 11 (3.4%) patients presented with flail chest with varying amount of bilateral haemothorax. Traumatic asphyxia was the least common injury in patients with blunt chest injuries. CONCLUSIONS Blunt chest injuries carry a high morbidity and mortality risk if not managed with appropriate and urgent treatment. Tube thoracostomy is the main procedure performed in any chest injury. High index of suspicion is required for any intrathoracic organ involvement in management of chest injuries due to blunt trauma. Early decisions to perform surgical intervention can improve outcomes for patients with severe thoracic injury unnecessary.

A 26-year-old lady presented with a palpable mass of one and half year's duration, on the left side of her abdomen. It was painless but mild dragging sense was present. She had no history of fever, vomiting or any other complaint. She noticed the mass for the first time during her second trimester of third pregnancy. She had no history of previous surgery. Her bladder and bowel habits were normal. On general examination, patient was afebrile, vitals were stable. Mild pallor was present. Abdominal examination revealed a fairly globular non-tender mass measuring 20 cms across, occupying left flank and umbilicus. It was soft to firm in consistency and immobile. FNAC reported as benign spindle cell tumour. A contrastenhanced computed tomography (CT) scan revealed a large heterogeneously enhancing well defined soft tissue intraabdominal mass in left flank and left retroperitoneum with invasion of left flank muscles suggestive of benign soft tissue tumour with minimal ascites [Figure 1]. At exploratory laparotomy, a mass of around 30 cm x 25 cm was present extending from anterolateral abdominal wall into the retroperitoneum with multiple feeding vessels present, without any solid organ adherence [Figure 2]. The mass was excised completely. Gross examination of the cut section reveals firm whorled mass located within surrounded by skeletal muscle [Figure 3]. Histopathological examination revealed an intrabdominal fibromatosis with densely collagenised stroma and dilated vessels with myxoid change [Figure 4]. Microscopic picture of the tissue showed fish in a stream pattern and stellate cells [Figure 5]. There were no intraoperative or postoperative complications. Patient was discharged on 8 th postoperative day. Follow up till 2 years bears no evidence of recurrence. Fibromatosis is an uncommon neoplasm that occurs sporadically or as part of an inherited syndrome like familial adenomatous polyposis (FAP) and Gardner syndrome. Abdominal wall fibromatosis has a slight female predominance. It accounts for 0.03% of all neoplasms and 3% of all soft tissue tumours.