Intraoperative bile duct injuries often are difficult to be identified intraoperatively can lead to a variety of complications and require complex surgical procedures for their definitive treatment. With multiple complicated treatment options, these injuries become a therapeutic challenge. We present a case of a 49-year-old lady diagnosed with symptomatic gallstone disease who underwent open cholecystectomy in an outside hospital, during which she had an iatrogenic bile duct injury which was diagnosed postoperatively. She was promptly referred to a higher centre. After investigations, the patient underwent a Roux-en-Y hepaticojejunostomy with a subhepatic drain. The patient was discharged post-successful recovery on post-op day 7.  Iatrogenic bile duct injury can be missed intraoperatively in a cholecystectomy. The patient provides non-specific symptoms, and a high degree of suspicion can help in early diagnosis. Prompt treatment by an experienced hepatobiliary surgeon is necessary for the successful treatment of the condition.

Gall stones related complications are very common in the world, Bouveret’s syndrome is one of the rare complications (1-3%). Bouveret’s syndrome presents a diagnostic and therapeutic challenge. We present a rare case of an 80-year-old lady diagnosed with gastric outlet obstruction with jejunal impaction of gallstones, because of a gallstone impacted in the jejunum 50 cm from duodenojejunal flexure. The patient was operated on with enterotomy and retrieval of gall stones impacted in the jejunum, with roux en y gastrojejunostomy drainage procedure, the gastro-duodenal fistula was left in situ, because of high risk and unstable general condition of our patient intra-operatively. The patient had multiple pre-existing pre and peri-operative comorbidities, fortunately, our patient recovered and our patient was discharged on 21st postoperative days. Identifying Rigler’s triad symptoms is synonymous with diagnosing Bouveret’s syndrome. However, classical Rigler’s triad is present in only 40% of cases, hence alertness and a high degree of suspicion are required to differentiate Bouveret’s syndrome from other mechanical causes of gastric outlet obstruction. The atypical cases of Bouveret’s syndrome present a challenge to the surgeon for early diagnosis and therapeutic surgical management.

Intra cholecystic papillary neoplasm of the gallbladder is a recently established neoplasm among gallbladder tumours by the world health organization in the year 2010. Since it is recently enlisted and rare type of tumour, not much knowledge is available about it in the public domain, intra cholecystic papillary neoplasm of the gallbladder is more common in women than men, and about half of the cases, are incidentally diagnosed, it could be invasive or non-invasive and is histopathologically diagnosed, determines the prognosis and survival rates of the patients. It is closely related to mucinous cystic neoplasm of the pancreas, as it is newly enlisted no defined guidelines to distinguish gall bladder polypoidal mass from adenocarcinoma/adenoma/papillary neoplasm is available, whether a simple cholecystectomy or an extended cholecystectomy would suffice as in our case is to be debated.

Synchronous breast and kidney carcinomas are extremely rare with only 11 cases have been reported in the literature so far in the world. We present a case of a 40-year-old lady diagnosed with right invasive ductal cell carcinoma. During the workup of the patient, an incidental renal mass was identified. After appropriate investigations, the patient underwent a right modified radical mastectomy with a right partial nephrectomy. The patient recovered successfully and was put on regular follow-up post-discharge. We are reporting a case of synchronous presentation of carcinoma breast with RCC which is rare since in world literature, most of the multiple malignancies reported are metastasis/metachronous breast carcinoma with RCC. The aetiology of synchronous malignancy is complex, some primary tumours may not be symptomatic and detected in the routine metastatic workup, and this poses a challenge for the surgical team. Hence with the histopathological report and with the other clinical and radiological parameters, we made a final diagnosis of carcinoma right breast pT2N0M0 with synchronous renal cell carcinoma (RCC) pT1aN0M0. the patient was planned for adjuvant chemotherapy and advised regular follow-up.