HighlightsIt is a rare anomaly of abnormal testicular migration.It was seen in a 24 year old with associated left inguinal hernia.He underwent left sided meshplasty and orchidectomy.It is usually discovered on surgical exploration.It’s important due to risk of malignant transformation of the ectopic testis.

Acute appendicitis is a common and serious surgical illness with protean manifestations

Background: Acute appendicitis is one of the most common surgical emergencies. Despite being a common problem, it remains a difficult diagnosis to establish, particularly among the young, the elderly and females of reproductive age. The study aimed to compare the efficacy of RIPASA score in the diagnosis of acute appendicitis.Methods: In this cross sectional comparative study, 100 cases of pain in the right iliac fossa were admitted and evaluated clinically. RIPASA score was calculated for all. Ultrasound (USG) of abdomen and pelvis was done. A positive RIPASA score or USG finding was the criteria for open appendicectomy. The postoperative histopathological reports were compared with the RIPASA scores.Results: RIPASA score was positive in 90% cases. Histopathologically, appendicitis was present in 99% cases. One case of normal appendix histopathologically had a lower RIPASA score. This indicated that RIPASA score could correctly diagnose acute appendicitis in 90% cases.Conclusions: RIPASA score is an efficient score in the diagnosis of acute appendicitis. As compared with ultrasonography of abdomen and pelvis, the RIPASA score is more diagnostic in cases of acute appendicitis. Negative findings of acute appendicitis on ultrasonography of abdomen and pelvis are not the diagnostic test to rule out appendicitis.

Background: The study aimed to compare the management of Grade III hemorrhoids by conventional Milligan Morgan versus Harmonic scalpel hemorrhoidectomy with respect to the intraoperative time, intra operative blood loss, length of hospital stays, postoperative outcome based on immediate and late complications and activity resumption, recurrence and cost.Methods: In this prospective study, a total of 60 patients, 30 patients undergoing Harmonic Scalpel hemorrhoidectomy and 30 patients undergoing Milligan Morgan hemorrhoidectomy, were studied. Operated patients were monitored for bleeding, pain, retention of urine, fecal incontinence ambulatory time and recurrence.Results: Symptoms such as pain during defecation, bleeding PR were significantly reduced at follow up in patients undergoing Harmonic scalpel hemorrhoidectomy over Milligan Morgan technique. Fecal incontinence was present in 8 cases following Milligan Morgan method over 3 months follow up. Recurrence was highest in (26.08%) in Milligan Morgan group while lowest in (4.34%) in Harmonic Scalpel group. No of days absent from work is more Milligan Morgan group and significantly less in Harmonic Scalpel group.Conclusions: This study showed significant difference in operative time, blood loss during surgery and pain score on postoperative days 15, 1 month, 3 months and 6 months and postoperative analgesic requirement for Harmonic scalpel assisted hemorrhoidectomy as compared to conventional Milligan Morgan, which were statistically significant. Harmonic scalpel hemorrhoidectomy is a newer, safer, more effective, faster and bloodless operative technique with minimal tissue damage and further larger sample studies and required to establish its complete efficacy and benefit over other modalities of hemorrhoidectomy.

Testicular torsion is a serious scrotal emergency having a negative impact on fertility and in its most severe presentation, there is potential loss of the testicle if not diagnosed early. The condition needs to be diagnosed promptly with immediate surgical intervention. Intermittent testicular torsion (ITT) is a forerunner or a red flag for an impending frank testicular torsion. ITT is characterized by sudden onset of testicular pain which may resolve spontaneously before further investigation and treatment. Testicular torsion in adults is usually intravaginal in location and can be diagnosed clinically if the patient presents early with typical clinical signs. A case of ITT who presented with frank unilateral testicular torsion diagnosed clinically and surgically treated with salvage of the affected testes is presented to highlight the importance of history of ITT and typical clinical features. The anatomical aspects and pathophysiology of testicular torsion including the aftermath is discussed. ITT is a forerunner to frank testicular torsion. If offered prophylactic orchidopexy then a frank episode of testicular torsion with all its sequelae can be averted.