Background: Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency in India. The present study was conducted to understand the spectrum of perforation peritonitis in terms of etiology, clinical presentation, site of perforation, surgical treatment, postoperative complications, and mortality encountered at Shyam Shah Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.) India.Methods: The study was a prospective observational study conducted from July 2018 to June 2019 in the Department of General Surgery, S. S. Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.). A total of 280 patients with perforation peritonitis were included in the study and underwent exploratory laparotomy.Results: Out of 280 patients, there were 234 males (83.57%) and 46 females (16.43%). Most common affected age group was 21 to 30 years (19.64%). Doudenal perforation was the most common type (35%), which were mainly due to Acid peptic disease (48.92%) followed by Jejunal and Ileal perforations (34.95%). In our study, a variety of operative procedures were performed depending on the patients general condition, peritoneal contamination, site of perforation, gut viability, and surgeon’s decision. Wound infection was the most common complication (29.64%). Mortality rate was 7.5% (21 patients).Conclusions: Perforation is diagnosed on clinical grounds immediately as patient reaches emergency department, time lost due to delayed hospitalization affects the outcome of standard surgical procedure. Selection of appropriate surgical procedure and postoperative care is helpful in early and uneventful recovery.

Introduction: A volvulus is an abnormal twisting of the bowel on its mesenteric axis greater than 180 degrees, which produces an obstruction of the intestinal lumen and mesenteric vessels. Sigmoid volvulus is a surgical emergency and significant cause of large bowel obstruction with high mortality and morbidity. The disease is more prevalent in India, especially rural population. The patient may present with features of shock, generalized abdominal tenderness and peritonitis pointing towards the presence of an underlying gangrenous segment in sigmoid volvulus. This condition can be life threatening if proper resuscitation and appropriate emergent procedures are not done. This study analyses various management options in our institute which caters mainly to patients from the surrounding rural areas. Methods: The present work consists study of 40 cases, carried out to study the clinical course and manifestations of sigmoid volvulus and to study the various surgical methods of treatment and their outcome. This study was conducted in patients of sigmoid volvulus admitted in Department of General Surgery, Shyam Shah Medical College Rewa during the period of May 2016 to April 2018. Results: Sigmoidopexy was done in 8(20%) patients with 50% recurrence rate. Resection and Primary anastomosis done in 14(35%) patients, of which 2(14.28%) had anastomotic leak and 2(14.28%) patients expired. Resection and Primary anastomosis with diversion colostomy was done in 10(25%) patients, all of them recovered well in postoperative period and underwent colostomy closure after 12 weeks. Hartmann's Procedure was done in 8(20%) patients. Higher mortality rate (37.5%) was observed in this group in comparison to others. Common post-operative complication was found to be wound infection. Overall mortality rate was 12.5%. Conclusions: Although Primary resection anastomosis is considered gold standard treatment for sigmoid volvulus but in developing and resource poor nations Primary resection anastomosis with diversion colostomy is found to be a safer procedure in patients with chronic malnourishment and poor general condition. Hartmann's procedure is suitable only if the bowel is gangrenous and in elderly patients with short life expectancy. Morbidity and mortality can be reduced by early institution of appropriate resuscitative and therapeutic measures.

Background: Cattle horn injuries are common in rural India, where people make their living rearing the livestock for domestic and farming purposes. Methods: A retrospective study of 40 patients with history of Cattle horn injury admitted to department of general surgery in S.S. Medical College, Rewa which is tertiary care hospital in central India. Study period was November 2016 and October 2018. Results: The vast majority of patients were male (70%), with only 12 women (30%). Male: Female ratio was 2.3:1. Maximum no. of patients belong to age group above 50 years of age. The commonest site of injury was in the abdomen followed by the perineum, back and lower limb. Most common type of injuries were Penetrating injuries followed by Blunt injury. Early surgical intervention was done in 72% of cases. Conclusions: Animals as cow, bull and buffalo are normally a docile and easily domesticated animals in rural parts of India. Injuries caused by these animals can be sometimes life threatening. Awareness in health care professionals about the mechanism of these injuries and a management protocol is necessary to avoid morbidity and mortality.