Background: Gastrointestinal perforations account for about 25% of acute abdominal emergencies. Despite advancements in diagnosis, management and critical care of patients due to hollow viscus perforation, the prognosis remains worrisome as the overall mortality rate due to perforation peritonitis is 6 to 27%. The aim of the study was to evaluate the prognostic value of Mannheim peritonitis index scoring system in patients with perforation peritonitis, to assess it as a clinical tool in stratifying these patients according to individual surgical risk.Methods: A prospective study of 58 patients with peritonitis due to non-traumatic hollow viscus perforation who presented to the department of general surgery, Jorhat medical college hospital, Jorhat from June 2020 to May 2021. The structured scoring system of MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. The study patients were divided into three groups according to MPI score. Group 1: MPI score less than 21, group 2 MPI score in between 21-29, and group 3 MPI score more than 29. Data was analysed for predicting the outcome by using IBM statistics SPSS software 21.0 version.Results: MPI scores of <21, 21-29, and >29 had a morbidity of 27.6%, 51.7% and 20.7% respectively. No mortality in patients with MPI less than 21; whereas those patients with MPI score more than 29 had the highest mortality rate of 60%. Patient with MPI score 21 to 29 had mortality rate of 40%. The number of post-operative complications, duration of ICU and hospital stay proportionately increased with the MPI score.Conclusions: MPI is an independent, disease specific, easier to calculate with very minimum basic investigations, simple and effective objective scoring system in predicting the morbidity and mortality.

Background: Appendicitis is one of the most common surgical emergency in general surgical practices. Early and prompt diagnosis is necessary to avoid life-threatening complications associated with it. Hence this study was conducted to evaluate the hyperbilirunemia as predictive marker in acute appendicitis and appendiceal perforation. Methods: Al cases of acute appendicitis and appendicecal perforation fulfilling inclusion and exclusion criteria taken up for this prospective observational single center study which were confirmed histopathologically in per operative setting. Results: Total 100 patients were in the study of which 33 patients had appendicecal perforation of which 23 patients had hyperbilirubinemia (70%) . 67 patients had acute appendicitis of which 42 patients had hyperbilirubinemia , 37%. Hyperbilirubinemia with a cutoff point of 0.9 mg% for appendicitis patients has a sensitivity of 85.3%, a specificity of 77.2%, a positive predictive value of 36%, and a negative predictive value of 91%. Hyperbilirubinemia with a cutoff point of >1.3 mg% for appendiceal perforations has a sensitivity of 75%, a specificity of 81.2%, a positive predictive value of 83%, and a negative predictive value of 88%. Conclusion:Hyperbilinemia is seen in acute appendicitis predominantly in appendiceal perforation hence evaluation of serum bilirubin level preoperatively can predict possibility of appendiceal perforation as it is easily available , cheap and simple laboratory test.

Background: About 15-20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Thus early prediction of severity is utmost important so as to provide better management and decrease mortality. Objective: To explore the efficiency of PANC 3 SCORE in predicting the severity in patients with acute pancreatitis on admission and its relation to clinical outcome. Methods: Patients with Acute pancreatitis were assessed to sex, age, body mass index (BMI), etiology of pancreatitis, Hematocrit and presence or absence of pleural effusion at the time of admission intensive care need, length of hospital stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined on admission and compared to acute pancreatitis grade of the Revised Atlanta classification. Results: Out of 46 patients diagnosed with acute pancreatitis, 46 patients met the inclusion criteria. The PANC 3 score was positive in 4 cases (8.69%), pancreatitis progressed to a severe form in 7 cases (15.2%) and 3 patients (6.5%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 42.85%, specificity of 97.45%, accuracy of 90.17%, positive predictive value of 75% and negative predictive value of 89.13% in prediction of severe acute pancreatitis. Conclusion: The PANC 3 score has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis. It has only 3 parameters which can be easily done in any healthcare system. It does not need much expertise to analyze PANC3 at the time of admission which adds the advantage of this score over other scoring systems.

Aim: To establish the correlation between initial GCS score and its impact on further management and outcome. Materials And Methods: A prospective study was done at department of surgery at Jmch from April 2021 to march 2022 on 30 patients after fulfilling inclusion and exclusion criteria. Data was collected using patient data sheets which were presented in tables and graph. Results: Out of 30 cases,23 males and 7 females were observed out of which maximum incidence observed at the age of 21 to 30 years with RTA being most common mode of injury. 17 patients were observed with gcs>13 of which 13 patients underwent conservative management. At the end of study all patients discharged with good outcome. Conclusions: Study shows incidence of EDH in MF about 2.74: 1.This study examined the factor for surgery from the clinical rather than radiologic perspective of initial EDH, which is not indicated for GCS score can be a factor for deciding the further management of EDH.