Gastro pleural fistula is an infrequently seen lesion. Here, a case of stab injury to the chest that led to the formation of a gastro pleural fistula has been presented. An intercostal drainage (ICD) tube was inserted after haemothorax was identified on this chest X-ray. The patient noticed the presence of ingested food particles at the site of ICD tube twelve days following the stab injury. The diagnosis of gastro pleural fistula was subsequently confirmed after a contrast enhanced computed tomography (CECT) of the chest and abdomen. Intraoperatively, a defect in the left hemi diaphragm with a fistulous tract between stomach and the left pleural cavity was identified. Closure of the gastric fundal perforation, excision of the fistulous tract and repair of the diaphragmatic defect was done.

A 73-year-old male patient presented to the casualty with history of pain abdomen since 3 days, abdominal distension, inability to pass flatus and vomiting since 2 days and fever since 1 day. Patient had history of surgery 6 years ago. He had undergone a laparotomy for drainage of appendicular abscess. However, patient was unsure whether an appendectomy was done and there were no records of previous surgery. No other significant history could be elicited. On examination, patient was tachycardic, tachypnoeic and mildly dehydrated. Patient's abdomen was distended and there was a right paramedian and drain scar in the right iliac fossa. His bowel sounds were exaggerated. Ryle's tube was inserted and aspirate had feculent material. Patient was resuscitated with intravenous fluids and routine investigations were sent. Patient's erect abdominal X-ray had multiple air-fluid levels and features were suggestive of small bowel obstruction [Table/ Fig-1]. Ultrasound of the abdomen showed dilated small bowel loops with to and fro motion and appendix could not be visualized. With a preoperative diagnosis of small bowel obstruction secondary to postoperative adhesions, patient was posted for an exploratory laparotomy after taking an informed and written consent. Intraoperatively, no significant adhesions were found but the appendix was inflamed and had curled around the terminal ileum. The appendix was acting as a tourniquet around the terminal ileum about 8-10 cm from the ileocaecal junction and was causing the obstruction [Table / Fig-2,3]. Appendectomy and a mid-ileal enterotomy to empty the small bowel content were performed. Postoperatively, the patient recovered well and was sent home six days after surgery.Histopathological examination of the specimen revealed confluent mucosal ulceration and replacement of the mucosal layer by purulent debris. There was a transmural inflammation noted consisting of neutrophils and occasional eosinophils. These microscopic findings confirmed the intraoperative finding of acute appendicitis. Intestinal obstruction is one of the common surgical emergencies seen in daily practice. Postoperative adhesions are notorious for being the most common cause for intestinal obstruction. Occasionally, laparotomy findings do come as a surprise to surgeons. Here one such case is discussed. A patient was operated on with suspicion of intestinal obstruction secondary to postoperative adhesions. However, laparotomy revealed the appendix to be inflamed, curled around the terminal ileum and acting as a tourniquet. Surgery Section

No abstract

Background:Gastric carcinoma is a malignant epithelial tumour of the gastric mucosa with glandular differentiation. It applies to tumours arising in the distal stomach, body stomach and tumours arising in the proximal 5 cm, but not crossing the esophago-gastric junction. It is the fourth most common cancer and the second leading cause of cancer death. Its incidence is increasing and is especially prevalent in Asia. Its prevalence is four times higher in South India than North India. The objective of this study was to study the aetiology, clinical features, evaluation of carcinoma stomach, surgical management and post-operative complications of carcinoma stomach.Methods: This was a prospective study of patients with gastric carcinoma who were surgically managed at Victoria Hospital, Bangalore, India between September 2013 and April 2016.Results:The age group with the maximum incidence of gastric carcinoma was between the ages of 51-60. 61.54% of the patients followed a mixed diet and the rest were vegetarians. 50% of the patients were smokers only, 19.23% gave history of only alcohol consumption and 15.38% of the patients had history of both alcohol consumption and smoking. 55.77% of the patients presented with T3 disease and 19.23% of the patients had M1 disease. 42.31% of the patients had N1 disease, 34.62% of the patients had N2 disease, 19.23% of the patients had N3 disease and the rest had N0 disease. 75% of the patients underwent resection with a curative intent and the rest 25% had palliative procedures. On follow-up, 19.51% of the patients who underwent a curative resection expired and 80.48% are surviving. 81.48% of the patients who underwent a palliative procedure expired and 18.51% are surviving.Conclusions:Diet plays an important role in carcinoma of the stomach. A high index of suspicion is important in the diagnosis. Surgery is the only potentially curative form of treatment and the prognosis after curative surgery for early gastric cancer has been excellent. There is a need for early diagnosis so that the disease can be treated adequately which directly translates into an improved survival.