forty five patients out of 415 patients with clinical diagnosis of appendicitis underwent operative treatment. The histopathological reports were reviewed and correlated with clinical diagnosis. Results:Out of 345 patients who underwent operative procedure 98% (n= 338) came with chief complaint of pain in the periumbilical region migrating to the right iliac fossa. The mean age of presentation was 42 years. Increased leucocyte count was seen in only 65% cases. Acute appendicitis was more commonly seen in male patients (214 cases, 62%). The most common per operative finding was acutely inflammed appendix (84%) followed by perforated appendix (7.5%), gangrenous appendix (3.5%) and appendicular lump (1.5%). However, histopathological diagnoses were acute appendicitis (91.9%), resolving appendicitis (3.5%), lymphoid hyperplasia (2.6%), mucocele (0.3%) and carcinoid (0.3%). Normal histology was seen in 1.4% cases. Conclusion:Though there are other causes of acute abdomen, acute appendicitis still stands first amongst all the emergencies. Histopathological examination of appendectomy specimen should not be omitted in order to see the incidence negative appendectomy rate and to avoid complications relating to malignant conditions.

Interphalangeal (IP) joint dislocations of the toes are uncommon lesions. We present here a case of closed dorsolateral dislocation of proximal interphalangeal (PIP) joint of the fourth toe. Closed reduction and buddy strapping have been done with middle toe for two weeks under digital block. There was painless full range of movement after 2 weeks. We propose that attempt of closed reduction must be given adequately under anesthesia before proceeding for open reduction.

Post-Operative Pancreatic Fistula(POPF) remains the challenge following Pancreaticoduodenectomy(PD). Recently Post Operatve Pancreatitis(POP) has been defined which has been shown to be independent predictor of POPF in retrospective studies. Method: We Performed a prospective study where Serum Amylase of more than 80U/L on POD0 or POD1 was defined as POP following PD. The end point of the study was to see incidence of POP and its relation with POPF. Result: There were total 23 PDs. Most of the Patients had final diagnosis of ampullary carcinoma(52%). The incidence of POP and POPF was 56.5% and 60.9%. 84.6% patient who had POP developed POPF(P= 0.008). There was total seven Post Pancreatectomy Hemorrhage, two delayed gastric emptying, one chyle leak and four Mortality. However no statistical correlation could be made between POP and other pancreas specific complications and mortality. Conclusion:Though the sample size is less but POP seems to predict POPF in Patient following PDs in our study.

Pancreaticopleural fistula is a diagnostic challenge to physicians. The diagnosis should be suspected if a patient presents with pleural effusion in a setting of chronic pancreatitis. The significantly raised amylase in the pleural fluid offers an important clue to the diagnosis. Computed Tomography (CT), Endoscopic retrograde cholangiopancreatography (ERCP) and Magnetic resonance cholangiopancreatography (MRCP) can reveal the fistulous tract between the pancreas and the pleural space. The therapeutic options include medical, endoscopic, as well as surgical interventions. Here we report a case of pancreaticopleural fistula in a chronic alcoholic that was treated successfully by medical management.

Preoperative prediction of the difficulty of surgery would be useful for surgeons embarking on minimally-invasive distal pancreatectomy(MIDP). A novel difficulty scoring system(DSS) was recently developed in Japan but has not been externally validated. This study aims to externally validate the DSS determine its association with important clinical outcome parameters Method: Retrospective review of 90 patients who underwent MIDP from 2006 to 2018. The patients were stratified into 3 groups (low, intermediate and high difficulty) according to the DSS with some minor modifications. Result: Difficulty of MIDP was classified as low in 45(50%), intermediate in 32(35.5%) and high in 13(14.4%). Comparison between the baseline characteristics across the 3 difficulty groups demonstrated a significant difference in the frequency of malignant tumors, larger tumor size, frequency of extended pancreatectomies and use of robotic assistance. There was statistically significant increase in operation time, blood loss and blood transfusion rate across the 3 groups from low to high difficulty. Conclusion: The DSS correlated significantly with operation time, blood loss and blood transfusion rate. These findings support the validity of the system.