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 the most common surgical emergency presenting as an acute abdomen. It refers to the clinical condition in which an acute change in the condition of intra-abdominal organ which is usually associated with inflammation and infection, demands immediate and accurate diagnosis and management.Pathogenesis of acute perforation begins from its etiology progressing to perforative peritonitis, multiple organ dysfunction syndrome (MODS) and death being the endpoint without timely management.Diagnosing a gastrointestinal perforation is not a herculean task except cases complicated with a small sealed perforation and overlapped with a picture of ileus or obstruction.Recent advances show endoscopic, laparoscopic and laparoscopic-assisted procedures are now being increasingly performed instead of conventional laparotomy.

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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