Aims:We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with perforation peritonitis.Materials and Methods:A prospective study involving 100 subjects operated for perforation peritonitis over the period of 2 years was designed. Postevaluation of predesigned performa, MPI score was calculated and analyzed for each patient with death being the main outcome measure. The MPI scores were divided into three categories; scores <15 (category 1), 16-25 (category 2), and >25 (category 3).Results:Our study consisted of 82 males and 18 females (male:female ratio 4.56:1), with the mean patients age of 37.96 ± 17.49 years. 47, 26, and 27 cases belonged to MPI score categories 1, 2, and 3, respectively. The most common origin of sepsis was ileal with small intestine dominating the source of perforation. When the individual parameters of MPI score were assessed against the mortality only, age >50 years (P = 0.015), organ failure (P = 0.0001), noncolonic origin of sepsis (P = 0.002), and generalized peritonitis (P = 0.0001) significantly associated with mortality. The sensitivity of MPI was 92% with a specificity of 78% in receiver operating characteristic curves.Conclusion:MPI is an effective tool for prediction of mortality in cases of perforation peritonitis.

BACKGROUND Tuberculous lymphadenitis is the commonest form of extra pulmonary tuberculosis and most commonly cervical lymph nodes are affected. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis which is known to mimic numerous pathological conditions. Availability of molecular technology has improved the ease of diagnosis. We wanted to study the clinical profile, diagnostic dilemmas and management of tubercular lymphadenitis METHODS This descriptive study was conducted in the Department of General surgery at Sri Aurobindo Medical College and Post Graduate Institute between September 2015 to February 2017. The work was started after the review & approval of protocol of study by Institutional Ethics and Research committees. We included all patients with provisional diagnosis of tubercular lymphadenitis and 52 patients were made part of this study. A detail clinical history was taken. Thorough local & systemic examination was done. After clinical diagnosis, further investigated to confirm the diagnosis. Appropriate treatment was instituted & follow up done. RESULTS Total 52 Patients, 29 Female and 23 Male, in 20-60 years age group were included in study with a confirmed diagnosis of tubercular lymphadenitis. 39 (75%) patients belonged to low socioeconomic status. 24 (46%) patients presented to hospital between 1-3 months of symptoms. 36 (69.2%) patients were diagnosed with tuberculosis for the first time (primary tuberculosis of lymph mode) 17 (33%) patients presented with constitutional symptoms like, fever, cough, loss of weight & loss of appetite. 32 (63%) patients had multiple nodes affected. 44 (85%) patients had positive tuberculin test. FNAC was positive in 42 (81%) cases CBNAAT was performed in 10 cases who were negative on FNAC. All cases with primary tuberculosis were started on DOTs CAT I & patients who had previous history of tuberculosis were started on DOTs CAT II regimen.

Introduction :Surgical team always tries to provide consistently low incidence of major complications for patient undergoing any operation. Clavien-Dindo (CD) classification is the simplest way of reporting all complications. The main aim of this study was to test the usefulness of Clavien-Dindo classification in patients undergoing the abdominal surgery. In this study Clavien-Dindo classification has been used for assessment of postsurgical complications after major abdominal surgery. Material and method: It was an observational study of all perforation peritonitis patients admitted in sri aurobindo medical college and post graduate institute between november 2017 to may 2019 (1 and 1/2 Year) on the basis of Clavien-Dindo classification. Results :This was an observational prospective study was carried out in Department of General Surgery, Sri Aurobindo Medical College and P.G. Institute, Indore, which includes total 60 patients of perforation peritonitis admitted and treated in the department, During the period of November 2017 to May 2019. In our study Most common symptoms in patients presenting with perforation is Abdominal pain in 60 (100%) patients. 45(75%) patients had constipation & obstipation, 41 (68.33%) patients had vomiting ,33(55%) of patients had fever 17 (28.33%) patients had abdominal distensions the other common symptoms. Out of 60 patients, all 60(100%) patients had abdominal tenderness and guarding, 47 (78.33%) patients had absent bowel sounds, 42(70%) patients had tachycardia, 26 (43.33%) patients had hypotension, 23 (38.33%) patients had tachypnoea and 21 (35%) patients had low urinary output. In 16 (26.6%) patients comorbid conditions were present. In 10 (16.66%) patients multiple perforations were found out of which only 01 (10%) patient is haemodynamically stable and 09 (90%) patients were unstable. Complication occurred in 09(90%) patients and no complication were only in 01 (10%) patients. In this group 04(40%) patients got discharged and 6(60%) patient expired. P Value was 0.001 which is significant. In our study most common site of perforation was gastric perforation 30(49.18%) Complication according to clavien -dindo classification 14 out of 60 (23.33%) patients had no complications, 4 (6.66%) had grade I complication, 5 (8.33%) had grade II complications, 12 (20%) had grade III complications, 11 (18.33%) had grade IV complications, and 14 (23.33%) had grade V complication rates. Conclusion :Perforation peritonitis is a life-threatening condition and requires urgent hospital care, resuscitation and surgery. Early resuscitation and surgery are required to decrease morbidity and mortality. On the basis of risk stratification in Peritonitis patients its management requires lots of expensive modalities, skill, monitoring and treatment to provide better care to the patient. For the classification of complications, a new system is proposed by Clavien–Dindo which is very helpful during perforation surgery.Clavien- Dindo classification helps us to distinguish a normal postoperative course and the severity of complications, which allows us to compare postoperative morbidity and evaluate the outcomes. We also recommend a larger study with a bigger sample size for better analysis of clavien-dindo classification of complications and to confirm the findings of our study.

Introduction: Hemorrhoids also called piles. It is vascular structures in the analcanal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed. the unqualified term "hemorrhoid" is often used to refer to the disease. Material and method: The present study was conducted in the Department of Surgery, Sri Aurobindo Medical College & PG Institute Indore M.P over a duration of one and half years (November 2017 to May 2019). The study was a cross-sectional prospective study and it compares results between Milligan Morgan haemorrhoidectomy and Stapler haemorrhoidopexy for the management of grade 2, 3, and 4 hemorrhoids. Results: In this study, most of the cases were between age group 30-50 [50%] years with the mean age being 43 years. Hemorrhoids more common in males 30 [65%], male: female ratio being 3:1. The most common presentation in hemorrhoids was bleeding per rectum in 47% followed by something coming out per rectum in 43 % & painful defecation in 10 % cases respectively. The duration of surgery was significantly low in the stapler group with meantime being 44.25 compared to open group 63 with the mean difference being 19 mins (P < 0.001). In 17of 21 [85%] whereas in grade IV all 09 [100%] patients had open surgery grade III had mixed options 03/07 [30/70 %] stapler & open respectively. Postoperatively the mean duration of hospital stay in stapler group was 4.15± 1.03 as compared to the open group 6.05 ± 1.84 with the mean difference being 2 days (P<0.001). The duration of recovery was significantly faster in stapler group with the mean hospital stay being 7.55 as compared to the open group 12.45 with mean difference being 5 days(P<0.001). Postoperative bleeding was found in both the groups which eventually subsided completely in stapler group on POD - 7 and only 3[7.5%]. Patients had bleeding on POD – 7 in the open group. (P < 0.001). The findings were statistically significant as suggested by P-Value. Urinary Retention was found in both groups i.e. 5% and 7.5% in stapler and open group respectively. (P= 0.632). Conclusion: The results of this study concluded that Stapler hemorrhoidopexy had lesser operating time, lower duration of hospital stays, and quicker recovery with less postoperative pain & bleeding as compared to Open hemorrhoidectomy. Hence it was concluded that stapler hemorrhoidopexy is a better option as compared to open hemorrhoidectomyfor grade II. grade III, & a few selected cases of grade IV hemorrhoids. patients stapler procedure was choice in grade II haemorrhoids.

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