Various complications of distal end of the ventriculoperitoneal (VP) shunt have been described in the literature. We present, here, an extremely rare and potentially severe complication of vesical calculi formation on the slit valves of distal end of VP shunt which erosively migrated into the urinary bladder. Suprapubic cystolithotomy performed, peritoneal end of the tube found to be eroding and entering into the bladder with two calculi firmly stuck to slit valves in the distal end of the tubing were removed. Shunt was functional, therefore, it was pulled out and repositioned on the superior aspect of the liver; the urinary bladder was repaired. Patient did well postoperatively. This complication was revealed 1.5 years after the shunt was implanted. Although there were symptoms of dysuria and dribbling of urine of short duration, the patient did not show obvious peritoneal signs; suggesting that, penetration of a VP shunt into the urinary bladder can remain asymptomatic for a long period of time, disclosed late and can lead to considerable morbidity. Careful follow-up is important and management should be individualized.

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Introduction: Cholecystectomy remains the most effective treatment for gallbladder disease when symptomatic. Since the introduction of laparoscopic cholecystectomy, this approach has replaced the traditional open cholecystectomy. Laparoscopic Cholecystectomy was rst reported in Germany (1985) and France (1987). Although not immediately universally adopted, laparoscopic cholecystectomy has revolutionized minimally invasive surgery. Now Laparoscopic cholecystectomy has rapidly become the procedure of choice for gallbladder disease patients and is currently the most commonly performed major abdominal procedure worldwide. Aims: The aim of this study is to assess the preoperative and intraoperative predictors of difcult laparoscopic cholecystectomy. Materials and method: This Study was conducted for one and a half year at Department of General Surgery, AIMSR, Bathinda. 100 patients were included in this study. Result: The study showed that, most of the patients had no Conversion to open [93 (93.0%)] it was statistically signicant (p< .00001.). (Z=12.1622) and we also found that, higher number of patients had POD2 Drain removal [60 (60.0%)] it was statistically signicant (p< .00001.). (Z=5.0064). Conclusion: In this study, most of the patients had E Lap cholecystectomy. However, D Lap cholecystectomy followed by VD Lap cholecystectomy and lower number of patients had Conversion to open which was statistically signicant

To correlate the acute appendicitis between clinically diagnosed, radiological evaluation and histopathologically examined specimen and the role of total count, differential count and CRP in early diagnosis of acute appendicitis in patients admitted in AIMSR. An observational study is conducted in the patients visiting AIMSR OPD and emergency over the period of one and half year as the diagnosed case of appendicitis. And the data is collected from the onset of the symptoms till the discharge of the patient for any intra operative or postoperative complication. The diagnostic criteria used in all the cases is USG along with Alvarado score. The Alvarado scoring system combined with ultrasound can be used as a cheap and inexpensive way of conrming acute appendicitis and also reducing negative appendicectomy rate. Ultrasonography increases the diagnostic accuracy in patients with suspected acute appendicitis to the tune of 90-95%.

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