Acute appendicitis is the most common surgical emergency that we encounter. Adynamic Intestinal obstruction due to appendicitis or its complication may be seen time and often. Mechanical obstruction because of appendicitis is uncommon and even rarer for a closed loop obstruction to occur. Although it was described as early as 1901, very few cases have been reported. We report the case of a 20 years male who presented with generalized colicky pain abdomen, abdominal distension, vomiting and obstipation for three to four days. Vital signs were stable. His abdomen was distended and peritonitic, especially in the right iliac fossa. Rest of the physical examination was unremarkable. Blood tests were normal except for leucocytosis with neutrophilia. An abdominal X-ray finding was indicating a small bowel obstruction. A midline laparotomy was performed. On intraoperative examination, distended loops of small bowel from the jejunum to the distal ileum was observed, and a constricting ring around the terminal ileum created by a phlegmonous appendicitis with its tip adherent to the root of mesentery was found, obstructing an edematous loop of small bowel without signs of ischemia. As the bowel was viable simple appendectomy was done. Postoperatively, he had an uneventful recovery and was discharged after 3 d.

Extra-gastrointestinal stromal tumors (E-GIST) are group of soft tissue neoplasm, which originates from outside the gastrointestinal tract and comprises less than 5% of the total GIST. Most commonly, they originate from the omentum, mesentery, retroperitoneum or the solid organs like liver and the pancreas. E-GIST arising from the sac of the jejunal mesentery, and mimicking preoperatively as a colonic neoplasm is very rare. Here we report an interesting case of a 55-year-old male, who presented with pain abdomen for 4 months duration. Contrast enhanced computed tomography was suggestive of right colonic neoplasm. Intraoperatively, to our surprise, the tumor was seen arising from the mesentery of the jejunum and was resected.

Caroli’s disease is a rare congenital hepatobiliary disease characterized by multifocal segmental dilatation of intrahepatic bile ducts affecting all or parts of the liver. It predisposes to biliary stasis and consequent lithiasis, cholangitis, abscesses, and septicemia. Sometimes it is difficult to diagnose and differentiate it from other similar disease conditions. 60-year-old female presented with features of recurrent cholangitis with hepatolithiasis and multiple cyst in liver, cholelithiasis was planned for cholecystectomy and drainage procedure. Patient underwent open cholecystectomy with common bile duct (CBD) exploration with T-tube placement due to intraoperative instability. Post-operative T tube cholangiogram was done. Post-operative T tube cholangiogram showed bilobar major duct cystic dilatation with predominant left lobe involvement, with few cysts containing calculi. Patient was planned for left hepatectomy with bile duct excision but patient refused to undergo aforementioned surgery. Therefore ERCP and sphincterotomy was done in view of poor performance status.Caroli’s disease being a rare disease is sometimes difficult to diagnose and treat in an old age patient with bilobar involvement and poor general conditions.

Introduction Choledochal cysts (CCs) are uncommon biliary lesions. Considering the evolution of imaging, we describe our experience with the presentation and management of choledochal cysts. Methods A review of the records of all patients with choledochal cyst managed in our institute were retrospectively analyzed. The study analyzed clinical presentation, diagnosis, treatment and postoperative outcomes. Results Between 2015 and 2019, 30 CCs (male/female: 7/23) were operated. We observed more adults compared to children (17 vs. 13). The median age at surgery was 18.5 years (4-67 years). The presentation included abdominal pain (90%), pancreatitis (17%0, cholangitis (13%), and incidental diagnosis in (7%). Anomalous union of the bile duct and the pancreatic duct was seen in 17%. Two patients had synchronous cholangiocarcinoma. The cysts were classified (Todani’s): I: 26; IV:3; and V: 1. The patients underwent complete excision of the cyst and Roux-en-Y hepaticojejunostomy - 27; pancreaticoduodenectomy - 1; hepaticoduodenostomy - 1; and cholecystectomy with T-tube drainage - 1 patient. The operative complications were observed in 10 (33.3%) patients: biliary leaks (four), superficial surgical site infections (four), and cholangitis (three). Only one patient developed a major complication; required re-operation for bile leak peritonitis. There was no operative mortality. One patient with cholangiocarcinoma died with the disease at three months of surgery. The remaining 29 patients are doing well at a mean follow-up of 29.5 months (12-56). Conclusion Adults CCs now far outnumber children at the time of presentation. The majority were symptomatic Todani’s type I cyst. Complete cyst excision and bilio-digestive anastomosis is the best treatment for type I and IV CCs, thus eliminating the risk of malignancy with an excellent operative outcome.

Hepatic hemangioma is mostly asymptomatic and incidental finding on imaging. Fever of unknown origin as a sole presentation is rare. We present an interesting case report of a 49-year-old female, who presented with fever for three months. Extensive blood investigations and infectious workup failed to reveal the cause. Contrast computed tomography of abdomen revealed a giant (15 × 11 cm) hemangioma arising from left lateral segment of liver, and was attributed as a cause for fever. Surgical excision of hemangioma completely ameliorated the fever.