Background: Acute intestinal obstruction is one of common abdominal emergency and is associated with significant morbidity and mortality, especially if it progresses to bowel ischemia. The aims of this study was to analyse various modes of presentation of acute intestinal obstruction in both children and adult age group, etiopathogenesis, various therapeutic modalities of treatment and to accomplish operative management and anticipate the post operative complications.Methods: 50 consecutive patients of all age groups presenting with acute intestinal obstruction were admitted were taken randomly and managed between October 2013 to September 2015.Out of these 50 cases, 36 were male, 14 were female, patients with subacute intestinal obstruction and patients with paralytic ileus were excluded in this study. Plain X-ray erect abdomen was done in all cases. Ultrasonography was done only in those patients whose X-ray finding was inconclusive. CT as a modality also included for work up.Results: Mean age distribution was 35.4years and the standard deviation measured 24.57. Incidence in male (36) was more as compared to female population (14). Pain abdomen was found in 45(90%) patients, vomiting in 35(70%) patients, distension abdomen in 34 (68%) patients and constipation in 30 (60%) patients were noted as many patients had coincidence of symptoms. Commonest cause of acute intestinal obstruction noted was postoperative adhesions.Conclusions: Postoperative adhesions were the commonest cause of obstruction. Earlier the presentation, the better the outcome was found.

It is a comparative study between open appendicectomy and laparoscopic appendicectomy. MATERIALS AND METHODS The study subjects of this dissertation consist of 126 Patients who have undergone Appendicectomy; 60 Patients had undergone Appendicectomy by the conventional open method and the remaining 66 patients underwent surgery by the laparoscopic method with abdominal pain and with clinical features simulating acute appendicitis. RESULTS In most of the patients (95%) of the open Appendicectomy group and the entire laparoscopic group, the position of the appendix was retrocaecal. It also shows that the blood loss was below 50 mL in 93% of the patients who underwent open Appendicectomy and 98% among those who underwent laparoscopic (P=0.2). There was no instance of adjacent organ injury in the open Appendicectomy procedure and in the laparoscopic group one had injury. The duration of laparoscopic procedure was 73 mins. as compared to 64 mins. for the open procedure. The difference was not statistically significant (P=0.07). Laparoscopic Appendicectomy was of longer duration 73+26 mins. than open Appendicectomy which took 64+30 mins. Even though this did not turn out to be statistically significant, when theatre charges are levied by the hour and may be in future by the minute. Negative appendicectomy was similar in both the groups to the mild increase in the laparoscopy group. This difference was not statistically significant. There was a significant difference (P=0.02) in the wound infection rate which was around 8 %in the open group while none of the patients in the laparoscopic group. CONCLUSION It can be concluded that laparoscopic appendicectomy was better than open appendicectomy with respect to pain, wound infection, tackling co-existing pathology, duration of hospital stay, earlier return to normal activity, excellent cosmetic end result, lesser use of antibiotics, and earlier resumption of oral feeds.

To assess prognosis in patients of peritonitis using Mannheim's Peritonitis Index. MATERIALS AND METHODS This is a prospective study which consisted of a total of 60 cases studied in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar between November 2013 to September 2015. The patients studied were between age of 13 and 83 years and both males and females were included in the study. The patients taken into the study were those who had clinical symptoms and signs like pain abdomen, distension, vomiting, fever, tenderness, guarding, rigidity, absent bowel sounds and obliteration of liver dullness. INCLUSION CRITERIA Only cases of secondary peritonitis were taken into study. EXCLUSION CRITERIA Peritonitis due to other causes like Primary peritonitis, Post-operative peritonitis, Pancreatitis were excluded from study. RESULTS In present study, mean MPI score of survivors was 21.27, mean score of non-survivors was 31.96. Mean age of all patients was 37.25 years, mean age of survivors was 32.17, mean age of non-survivors was 53.16 years. 97.5 was observed in mortality <50 years and 100 in mortality >50 years. Mortality in male and female was 0% and 10%. Mortality% with organ failure was 1.6 and mortality% without organ failure was 98.4. Mortality% with malignancy was 0 and mortality% without malignancy was 98.4. Mortality% if >24 hours was 2.2 and mortality% if <24 hours was 0. Mortality% with colonic origin was 0 and mortality% without colonic origin was 0. The nature of peritoneal contamination fluid is an important determinant of the index. Our results are as follows: Clear fluid in 3 cases, Purulent in 57 cases, Faeculent in 0 cases. CONCLUSION The Mannheim Peritonitis Index is a specific, simple, reliable and accurate index in assessment of prognosis in patients of peritonitis.