Background: Fistula in ano (FIA) is a chronic complex condition of ano-rectal sepsis characterized by cylical-pain and intermittent chronic purulent discharge. The management of fistula is challenging. In spite of all the advances in the management of FIA, no single method is univresally applicable to all types of FIA due to incontinence and recurrences associated with the individual procedures.Methods: Aims of this study were to compare the outcomes between ligation of intersphincteric fistula tract (LIFT) and conventional fistulectomy (CF) with 60 patients randomized into 2 groups, 30 in each group.Results: Mean age in LIFT was 44.17 years and in CF was 41.1 years. Successful primary healing was observed in 86.7% of LIFT and 100% of CF. Mean pain scores were lower in LIFT compared to CF when checked on Postoperative days 1, 3 and 7 significantly. Anal incontinence was seen in 10% of CF and none in LIFT and recurrence was seen at same site in LIFT in 6.66% of LIFT and none in CF both being not statistically significant.Conclusions: LIFT is a promising and sphincter saving technique which is simple and easy to learn with faster healing rates and better patient contentment but with risk of failure and recurrence. Modifications of LIFT have to be probed for minimizing the failures.

Abdominal vascular injuries are amongst the most lethal injuries encountered by modern day trauma and vascular surgeons. Penetrating injuries to aorta have a wide spectrum of presentation mortality being 50-70%. 38-year-old male presented to emergency department with stab injury to abdomen with a knife stuck in-situ. Patient was conscious with herniating bowel loops from stab site. Bilateral limbs had good pulsations and no neurological deficit. Patient was taken for emergency laparotomy and found to have complete jejunal transection with near transection of aorta with knife stuck in the vertebra. Primary repair of aorta was done with prolene 5-0 along with jejuno-jejunal anastomosis. Patient was transfused with 12 units of blood and 8 units of FFP. Postoperatively patient recovered well and was discharged on post-operative day (POD) 14 with good recovery and follow up was uneventful. Spectrum of penetrating aortic injuries varies from stable patients to severely exsanguinated in vicious cycle of shock, acidosis, coagulopathy and arrhythmias causing high mortality and morbidity. Our case had contained retroperitoneal hematoma with stable vitals and good general condition and due to early diagnosis and timely institution of surgery the patient survived and recovered uneventfully. All abdominal stab injuries are to be taken as having vascular injuries. Surgery has to be taken up as an integral part of resuscitation with quickest and most effective diagnostics along with lifesaving procedures to have lesser morbidity and mortality.

Gall bladder perforation (GBP) is a rare life-threatening complication with a high mortality due to atypical clinical presentation and delay in diagnosis due to atypical clinical presentation. Case report 1, 70-year-old female presented with complaints of pain abdomen, vomiting and blackish pigmentation over abdomen since a week. She was in shock on presentation, with necrotic patch over abdomen and abscess collection at umbilicus. Ultrasound revealed GBP at fundus with thick collection in gastrohepatic recess with overlying abdominal wall cellulitis. CECT was not possible and the patient could not be taken for surgery due to unstable vitals and expired the next day. Case report 2, a 68-year-old male presented with complaints of pain abdomen over right side with vomiting. Abdomen was tender diffusely with guarding in right hypochondrium. Ultrasound showed distended gall bladder (GB) with multiple calculi. Magnetic resonance cholangiopancreatography (MRCP) showed a GBP at fundus with pericholecystic collection extending into hepatogastric recess. He underwent total cholecystectomy and post-operative period was uneventful. Acute cholecystitis has a perforation rate of 2-11% due to cystic duct obstruction, ischemia and necrosis. Our first patient had type-III GBP and was in shock and did not survive due to bad condition on arrival whereas the second patient had type-I GBP and underwent cholecystectomy without any complications. Type-I and type-II GBP as proposed by Niemeier have better outcomes compared to type-III. Rapid diagnosis and surgical intervention are very much necessary for reducing mortality as they rarely present with typical signs and symptoms of perforation.