Introduction: Most foreign bodies in the G.I tract are asymptomatic and probably pass spontaneously in stool. Few may cause complications and require interventions. Diagnosis can be a challenge in certain cases. We present a case in which the ingestion of a Neem Twig caused duodenal perforation mimicking Acalculous Cholecystitis. Case report: A 63-year-old lady visited emergency with acute abdominal pain of 2 day history. Computed tomography (CT) showed mildly thickened Gall bladder with loculated pericholecystic fluid collection which is extending into subcapsular region of segment III of liver. A Laparoscopic Cholecystectomy was planned in view of Acalculous cholecystitis. Intraoperative, an Omental phlegmon guarding a Neem (Azadirachta indica) twig which perforated out of duodenum was found. Laparoscopy was converted to an open midline Laparotomy and graham's Omental patch repair of duodenum perforation was done. Conclusion: The patient has been doing well since the operation. She gave history of swallowing the Neem Twig 6 Months prior to this surgery. Many a times open surgical approach would give a satisfactory search rather than Laparoscopy.

Introduction: Emergency laparotomy, though lifesaving, may result in significant morbidity and mortality. In an attempt to clinically evaluate patients undergoing emergency laparotomy and predict their mortality using the worldwide accepted Portsmouth Predictor equation for mortality (P POSSUM), the present study was undertaken in the Surgery department of a tertiary care hospital in eastern India. Material and methods: This observational cross-sectional study included 60 patients aged between 15 to 75 years, undergoing emergency laparotomy during the specified study period of one and half years. Results: It was observed that out of 60 patients, 63.3% were male, and mean age was 40.60 (16.67) years. Peptic perforation was the most common indication for laparotomy. Mean P POSSUM predicted mortality risk was 40.617% (Range-0.8 to 99.7). Twenty-four patients died during hospital stay. ROC curve analysis of P POSSUM scores revealed that if a cut off value of P POSSUM score of 42.45% was selected, mortality could be predicted with a sensitivity of 70.80% and a specificity of 83.30%. Conclusion: Thus, P POSSUM might be a useful tool in predicting risk of short-term mortality following emergency laparotomy.