BACKGROUND An enterocutaneous fistula (ECF) is an abnormal communication between the small or large bowel and the skin. It is one of the serious complications of gastrointestinal surgery and has a mortality rate of up to 20%. Management involves dealing with malnutrition, sepsis, metabolic derangement and electrolyte imbalance. METHODS This is a combined prospective and retrospective study conducted at SVMC & RC from June 2017 to May 2019. Thirty patients with ECF were enrolled in this study. Patients with biliary, pancreatic and anal fistulas were excluded. Factors influencing spontaneous closure of fistula such as fistula characteristics, organ of origin, sepsis etc. were studied. Initial management for all patients was conservative with restoration of fluid and electrolyte imbalance, and were initially started on parenteral nutrition using dextrose 10%, Astymin, Intralipid, human albumin and total parenteral nutrition (TPN). RESULTS Fistula closed spontaneously in 22 patients. Operative closure was done in 5. Death occurred in 3 (mortality rate-10%). Out of 30 fistulas, 28 were post-operative fistulas. One was due to trauma and one was due to Crohn's disease. Among the former, 83% developed a fistula following emergency surgery. Albumin levels after 3 weeks of treatment, were predictive of both spontaneous closure and mortality. CONCLUSIONS Post-operative causes account for majority of enterocutaneous fistulas. Anatomical origin of fistula, associated factors like sepsis, malnutrition, hypoalbuminemia and abdominal wall defect, influence the spontaneous closure. Total parenteral nutrition increases the spontaneous closure rate of fistulas and decrease mortality rate.

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BACKGROUND Cystic swellings of the scrotum are common clinical entities that surgeons encounter in daily practice. Males of all ages are affected. Today, considerable heterogeneity exists in their treatment. This study sought to identify the prevalence and patterns of presentation of these swellings in adults and evaluate the different modalities of surgical management. MATERIALS AND METHODS A cross-sectional study was undertaken from January 2016 to December 2018. A total of 372 patients fulfilling the inclusion criteria were included. Data was collected using a proforma. All patients were surgically managed. RESULTS Majority of cases (28%) were observed between 41-50 years (mean age 43.9 years). In 71%, mode of presentation was a painless, gradually progressive swelling. Mean duration of symptoms was 17.3 months. Primary vaginal hydrocele was the commonest swelling encountered (in 73.1%). Jaboulay's procedure was undertaken in 75.2% of patients. Lord's plication was associated with a comparatively shorter operative time, lesser postoperative scrotal oedema and a shorter hospital stay. Epididymal cysts accounted for 19.4% and were managed by excision. The most common complication observed irrespective of surgery performed was scrotal oedema (in 36%). Haematoma and infection were less frequently observed. Patients were followed-up for a mean period of 1.8 months. No recurrences were detected during this period. CONCLUSION Cystic swellings of the scrotum are conditions predominantly affecting middle-aged males. Among these, primary hydrocele is the commonest. Although Lord's plication is simpler and gives good results with fewer complications, Jaboulay's procedure remains the gold standard for surgical management of hydrocele.

BACKGROUND About 95% of the leg ulcers are due to vascular aetiology 1 and venous ulcers account for up to 90% of cases. 2,3 Arterial disease accounts for 5% -10%, others are due to neuropathy, usually diabetic or a combination of these diseases. 4 Diabetic ulcers are common on the toe and the heel. 5 Aims and Objectives- To compare and analyse the distribution of age, sex, systemic disease and location of the ulcer among the study group. To study the clinical features of various types of leg ulcers.  To study the usefulness of applied investigations for the effective management.  To study the order of aetiological prevalence of various leg ulcers in India, particularly in Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry. MATERIALS AND METHODS RESULTSAbout 48% of leg and foot ulcers are due to vascular aetiology and arterial ulcers alone account for 32% and venous ulcers 16% in our study. Traumatic ulcer constituted next major category (24%). Diabetic ulcers constituted 18.67% among leg ulcers in our study. CONCLUSIONThis is unlike other studies, about 95% of leg ulcers are due to vascular aetiology and venous ulcers account for upto 90% and 5%-10% arterial ulcers. Diabetic ulcers constituted 18.67%, a relatively higher number as compared to western countries (5%-10%). Gay and Spencer's in 1868 wrote two important books on venous ulcers, which stressed the role of deep vein thrombosis and other lesions of arteries and veins (both superficial and deep) in the aetiology of leg ulcerations. Gay also described perforating ankle veins and suggested use of the term venous ulcerations. 2 Linton drew attention to incompetence of communicating calf veins as potential cause of venous ulcerations. 3 'Financial or Other Competing Interest': None. Submission 24-01-2018, Peer Review 18-02-2018, Acceptance 23-02-2018, Published 05-03-2018. Corresponding Author: Ganesan Vinayagam, 216, Cuddalore Road, Mudaliarpet-605004, Pondicherry. E-mail: ganeshvinayag@gmail.com DOI: 10.14260/jemds/2018 From the 10 th and 18 th centuries various physicians including Halu, Abbas, Avicenna, Falopio and Pare attributed ulceration of the leg to accumulation of black bile and believed that ulcerations of the leg served useful purpose in getting rid of those live substances. 4 The prevalence of leg ulcer is probably between 0.18% and 1% of the population. 5 The site of ulceration is analysed, around 90% of the ulcers were present in the gaiter area, 2% in the foot and 8% in the leg. 6 During the past three decades considerable knowledge has been gained regarding the anatomy, physiology, pathology and management of chronic leg ulcers. Despite all this, the management of leg ulcers is a fertile field for experimentation. Various studies have been conducted and a number of procedures and techniques have evolved with varying degree of success. It is common to see patients with different types of ulcers due to various aetiology and underlying systemic diseases. Moreover, leg and foot ulcers form ...

BACKGROUND Incisional hernia is one of the common complications encountered following abdominal surgery and is an important cause of morbidity. It can be repaired by following anatomical, mesh or laparoscopic methods. The incidence of these hernias is high even with recent advances in surgery, anaesthesiology, antibiotics, and suture materials used. We wanted to study the epidemiology, aetiology, mode of presentations, modalities of treatment and its outcome, of incisional hernia.