Gastrointestinal stromal tumor (GIST) is a rare stromal neoplasm, which represents the most common mesenchymal tumor of the gastrointestinal tract. It is characterized by indolent clinical symptoms, although it can present as a life-threatening emergency. Here in, we present a case of primary small bowel GIST treated at our department. A 58-year-old male patient presented to our emergency department with a diffuse abdominal pain of acute onset. Patient presented with symptoms and signs of acute intestinal obstruction. Imaging studies revealed a mass at mid ileum, with multiple air fluid levels. Intra-operatively, a mass of 12×9 cm was found at mid ileum on antimesenteric border with 3600 volvulus of adjacent ileum. En bloc resection was performed. Histopathology report was suggestive of gastrointestinal stromal tumor.

AIMS:Study the efficacy of stapled haemorrhoidectomy using circular stapler in terms of benefits as duration of surgery, length of hospital stay, postoperative pain, time to return to normal daily or social activity and usefulness as for patient satisfaction. MATERIAL AND METHODS: Prospective study using circular stapler for grade II, grade III and grade IV haemorrhoids between age group 20 to 70 years was done over a period of Jun 2011 to Nov 2013. OBSERVATION AND RESULTS: Study enrolled 30 symptomatic patients. 21(70%) were males and 9(30%) females. Most common complaint was bleeding per rectum in 29 (96.66%) patients followed by itching 11 (36.66%) patients & constipation 8 (26.66%) patients. 19(63.33%) patients were grade III haemorrhoids, 6 (20%) were grade II and rest 5 (16.66%) grade IV. Mean operative time was 31.76 minutes for our team with same surgeon operating all cases. Postoperative pain recorded using VAS score was max 24 hours after the surgery with mean VAS 2.31 + 0.46(VAS -1 no pain). During stay 28(93.33%) patients required Step 1 pain analgesics (NSAIDS) while only 2(6.66%) were put on Step 2(opioids). Mean hospital stay of patients was 34.96 hours (1.45 days). 28(93.33%) patients were able to return to social activity by day 8 post operatively. 28(93.33%) were complication free while others had minor problems dealt accordingly. No recurrences in 6months follow up in all patients with 28(93.33%) patients reporting satisfaction for their treatment through the procedure. CONCLUSION: Haemorrhoids is a socially embarrassing disorder and this new procedure of stapler haemorrhoidectomy delivers a smile and dignity especially to Indian patients. Hence it should practiced and promoted for patients benefit.

INTRODUCTIONSalivary gland tumors are uncommon and comprise only 1-4% of head-face-neck tumors. Majority of the salivary gland tumors affect parotid gland with more than 70% of the cases. Several studies have been conducted on the tumors of the parotid and minor salivary glands, but very few reports in the literature have focused on submandibular gland tumors as they are rare and are usually grouped with other salivary glands. Submandibular gland is affected in 5-10% of the cases with pleomorphic adenoma being the most common tumor. 1The most frequent neoplasms in the submandibular glands are: pleomorphic adenoma (36%), adenoid cystic ABSTRACT Background: The salivary glands tumour are relatively rare, yet they represent a wide variety of both benign and malignant histologic subtypes. Several studies have been conducted on the tumors of the parotid and minor salivary glands, but very few reports in the literature have focused on submandibular gland tumors as they are rare and are usually grouped with other salivary glands. Approximately 70% of the salivary gland tumors affect parotid gland with the submandibular gland being affected in 5-10% of the cases, sublingual gland in 1% and minor glands in 5-15% of the cases. So, author describe a series of 50 patients of pleomorphic adenoma affecting submandibular gland. Methods: The prospective study was conducted at Department of General Surgery, Indira Gandhi Government Medical College, Nagpur between January 2008 to December 2017. Results: Out of the 50 patients, 10 were male and 40 were female. Thus, male to female ratio is 1:4. Most of the 42 (84%) patients presented with painless swelling in submandibular region. Clinically the tumour has the texture of cartilage and has an irregular and bosselated surface observed in all the patients. The size of tumour was 3 to 6 cm in 32 (64%) patients observed in the present study. Fine needle aspiration cytology was performed in all the patients. All patients were managed by surgical excision. Recurrence occurred in a single patient who was managed with radical excision including a neck dissection with postoperative radiotherapy. Conclusions: Submandibular gland pleomorphic adenoma being common benign tumor, occurring commonly between the 3 rd and 5 th decade of life and presenting as slow growing asymptomatic swelling with female preponderance. The precise surgical excision along with whole submandibular salivary gland and postoperative radical radiotherapy required for recurrence as the accepted mode of management. However, further long-term studies involving submandibular gland have to be carried out to know the pattern of tumor recurrence.

A 55 years old male patient came to the casualty of a medical college and hospital with alleged history of assault with firearm injury on his back. Patient was conscious with GCS 15/15, his pulse rate was 133 beats per min, blood pressure was 100/60 mmHg, SpO2 was 95% and pallor was present. On local examination there was single entry wound at lower back on left side of size 1 cm X 1 cm with no exit wound. Generalized abdominal tenderness and guarding was present. Patient was immediately resuscitated. Blood grouping, cross match were sent immediately. Abdominal radiograph did not show any gas under the diaphragm but a foreign body (a bullet) was seen. Ultrasonography and computerized tomography scan of the abdomen was suggestive of hemoperitonium and a foreign body bullet in abdomen. Exploratory laparotomy showed moderate hemoperitonium of about 1000 ml which was sucked out completely. Evidence of retroperitoneal rent of size approximately 1 cm X 1 cm seen with oozing through it which was closed in layers. A bullet was seen in the anterior abdominal wall but skin was intact. Five jejunal perforations distal to 20 cm from the duodenojejunal flexure were seen and the bullet was removed from the anterior abdominal wall.  Resection of the jejunal segment with jejuno-jejunal anastomosis was done. Jejunal mesenteric rents were closed. Abdominal wall closed in layers. Post-operative recovery was uneventful. Patient was discharged on the 10th post-operative day. Early diagnosis and treatment in the golden hours can save the life of the patients. A mass education on the dangers of these guns and the harm they can cause as well as legal regulations for their restricted use seem to be necessary.

Actinomycosis of colon is an uncommon disease. It is a chronic granulomatous disease caused by Actinomyces species. The ileo-cecal region is most commonly affected, while the left side of the colon is more rarely involved. Presentation may vary from nonspecific symptoms and signs to an acute abdomen. It may mimic colonic malignancy, obstruction or perforated viscera. Preoperative diagnosis is rare and is established only in less than 10% of cases. We report a very rare case of cecal actinomycosis presenting as acute abdomen with a vague lump in right iliac fossa which was found to be appendicular perforation with cecal mass during emergency laparotomy. The final diagnosis was only found post-operatively on histopathology.