Introduction: Acute appendicitis is a very common cause of acute abdomen and the diagnosis is essentially clinical. A decision to operate based on clinical suspicion alone can result in removal of a normal appendix; whereas, if left untreated, appendicitis can result in necrosis and perforation. Therefore, improving the diagnostic accuracy of appendicitis is a need of the hour. This study was conducted to evaluate hyperbilirubinaemia in acute appendicitis to find out its predictive value in complications like perforation. Materials and Methods: This prospective study for diagnostic test evaluation was conducted amongst the inpatients in the Department of General Surgery, KIMSHEALTH Trivandrum, during the period from August 2019 to August 2020. A total number of 100 patients who were admitted with the clinical diagnosis of acute appendicitis were studied, and serum bilirubin and liver function tests were carried out in all of them. Results: Total bilirubin levels when compared with histopathological diagnosis by unpaired samples t-test, the t-value = 0.763, P = 0.447 > 0.05 which shows no statistically significant difference between total bilirubin levels in uncomplicated and complicated acute appendicitis based on histopathological diagnosis. Sensitivity is 81.8%; specificity is 29.2%; positive predictive value (PPV) is 12.5%; negative predictive value (NPV) is 92.9%. Conclusion: Elevated total serum bilirubin levels have a fairly high sensitivity and NPV in predicting complications of acute appendicitis, but the specificity and PPV are quite low, and hence, hyperbilirubinaemia could be used as an aid in diagnosing complicated acute appendicitis along with the clinical findings and ultrasonography findings, but it is not reliable as a standalone diagnostic test. If the total serum bilirubin levels are low, an alternate diagnosis could be suspected, and the chances of complicated appendicitis are quite low, but elevated serum bilirubin values alone cannot confirm the presence of complications. Therefore, our study could not find any correlation between the absolute levels of elevation of total bilirubin values and the presence or absence of complications in acute appendicitis.

Mucormycosis is an uncommon but potentially lethal fungal infection in immunocompromised individuals. The natural history of the disease is vascular invasion followed by thrombosis and necrosis of infected tissues. It can affect any organ system. Gastrointestinal (GI) mucormycosis is quite rare. Here, we report a case of primary invasive gastric mucormycosis in a 45-year-old male with diabetes and ethanol-related chronic liver disease who presented with necrotizing fascitis of the left thigh, groin, and lower abdominal wall. At presentation, he was hemodynamically unstable, anuric, and febrile with a high blood glucose level. He was stabilized with aggressive debridement and critical care management. During hospitalization, he developed sudden episode of upper GI bleed. Gastroscopy revealed extensive ulcerations with thick mucus in the fundus and body of the stomach. Biopsy from the lesions and special stain examination was consistent with invasive gastric mucormycosis. Delayed presentation of our patient and rapid progression to fungemia resulted in mortality.

Background: Acute calculous cholecystitis is one of the common conditions. The initial radiological investigation of choice is ultrasonography of the abdomen. Cholecystectomy is the definitive treatment for acute cholecystitis. Laparoscopic cholecystectomy is the procedure of choice for acute cholecystitis. Sometimes there is a need for conversion to open cholecystectomy due to intra-abdominal adhesions which make laparoscopic cholecystectomy difficult. Hence, pre-operative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. In our study, we aimed to analyse the various risk factors and to predict the difficulty and degree of difficulty pre-operative lay by the use of a scoring system. Materials and Methods: All 100 patients were evaluated and their clinical and ultrasound parameters were recorded. They received symptomatic treatment with antibiotics and analgesics preoperatively. Following that, they were subjected to laparoscopic cholecystectomy, time taken, bile spillage, stone spillage, injury to duct, artery and conversion to open cholecystectomy were noted. All patients were operated by similarly experienced surgeons. Postoperatively, cases were followed up for any complications and they were discharged on recovery. Results: Receiver operating characteristic curve analysis of pre-operative with an intraoperative score in our study with area = 0.846, P = 0.0005 <0.01 is highly statistically significant at P < 0.01 level. The sensitivity and specificity of the scoring system at score 0–5 for the prediction of easy laparoscopic cholecystectomy are 89.2% and 80.0%, respectively, and the sensitivity and specificity of the scoring system at score 6–10 for the prediction of difficult laparoscopic cholecystectomy are 80.0% and 89.2%, respectively. Conclusion: Our study concludes that the scoring system evaluated is robust, reliable and useful to predict difficult laparoscopic cholecystectomy.