Background: Intestinal anastomosis dates to ancient eras and hand sewn intestinal anastomosis is the most used technique worldwide. Various complications following bowel anastomoses are anastomotic leak resulting into peritonitis, abscess, fistula, necrosis, stricture. Various factors contribute to these complications including suturing technique. Leakage from the bowel anastomoses complication and accounts for about 1.3 to 7.7%, that is often associated with increased morbidity and mortality and prolonged stay. This comparative study endeavours to compare outcome of extra-mucosal interrupted single layer versus continuous all layers intestinal anastomosis in small and large bowel in terms of duration required to perform intestinal anastomosis, post-operative complications like anastomotic leak, duration of hospital stay in each group Aim of the present study was to compare time required to perform anastomosis and to compare the rate of postoperative complications and hospital duration. Methods: Based on detailed history, clinical examination and radiological investigations; patients were allotted in either group A or B. Group A: Bowel Anastomosis done by single layer (20 Patients) and Group B: Bowel anastomosis done by double layer (20 Patients). Time required to perform anastomosis and post op complications was assessed and compared. Results:  In this prospective study of 40 patients, it was found that Group A required an average of 17 minutes and Group B required 24 minutes for anastomosis. The rate of postoperative complications were found to be similar in both groups. The mean hospital stay was also found to be similar. Conclusions: Thus, from this prospective comparative study, we conclude that both extra mucosal interrupted single layer and continuous all layer anastomosis have operative technical challenges and similar postoperative outcomes.

Gastrointestinal perforation is a common cause of acute abdomen due to peritonitis. The etiology and pathophysiology of gastrointestinal perforations is varied and can range from a small prepyloric perforation that is relatively clean to transection of small or large bowel with spillage of contents in peritoneum with gross contamination. Some of these are more common than others. Here we present 6 cases of rare perforations presenting to us in the casualty, their management and postoperative course in hospital. Methods: We will be assessing the cases of patients, their history, clinical presentation, radiological imaging who presented with acute abdomen secondary to bowel perforation and were intraoperatively diagnosed to have a rare pathology and assess the management and postoperative outcomes. Results: In this case series, 5 rare cases of GI perforations are highlighted including rare cases of posterior gastric perforation, DJ transection, jejunal transection, jejunal perforation, large mesenteric tear and sigmoid colon perforation. All these cases required a different approach in managing intraoperatively. Conclusion: Gastrointestinal perforation is a common cause of acute abdomen and requires emergency surgical intervention. CT imaging has become a fundamental part of the preoperative evaluation and can determine site and cause of perforation.Gastrointestinal tract perforations can occur due to various causes, and most of these perforations are emergency conditions that require early recognition and timely surgical treatment the mainstay of treatment for bowel perforation is surgery. Atypical presentation of perforation can be a challenge to surgeons andshould be prepared to deal with it.

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Thymomas are rare neoplasm of Anterior Mediastinum originating within the epithelial cells of the thymus and it is exceedingly uncommon in children and young adults, rises in incidence in middle age, and peaks in the seventh decade of life. One third to one half of patients present with an asymptomatic anterior mediastinal mass on chest radiograph, one third present with local symptoms (cough, chest pain, superior vena cava syndrome, and/or dysphagia), and one third of cases are detected during the evaluation of myasthenia gravis. Myasthenia gravis is a disease of the neuromuscular junction which causes progressive weakness of muscles. Indication of thymectomy for all cases of myasthenia gravis has been a topic of debate but thymectomy is indicated in all cases with thymomas no matter the stage of myasthenia gravis. We present a rare case of Thymoma as 70/Female patient presented with a painful lateral neck swelling on left side with Myasthenia Gravis and Dysphagia. We couldnt find any similar cases in literature. USG Neck was done which showed a 5.3x5.3x4.3cm multilobulated mass in left supraclavicular region inferior to left lobe of thyroid with calcification suspicious of malignancy which possible origin from Thyroid and Parathyroid Gland. On CECT scan there was 4.1x3.4x3.8 cm isodense mass which seems to be arising from lower pole of left thyroid lobe and extending in surrounding structures. FNAC was s/o Thymoma type A. Patient underwent Sternotomy- entire tumor along with thymus was dissected, however posteriorly it was densely adhered to Left Vagus Nerve Giving Suspicion of Neurofibroma. Specimen Sent for Frozen Section which confirmed it to be Type A thymoma. Histopathology Report concluded the diagnosis- Type A Thymoma. Post Operative was Uneventful. Thus, we conclude a rare case of Neck Swelling with series of event to reach to a Final Diagnosis of Thymoma.