Key Clinical MessageThe incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. The differential diagnosis is cystic ovarian tumor clinically and radiologically. Peritoneal hydatid disease should be included in differential diagnosis of sonographically diagnosed pelvic cystic lesion.

HighlightsIleosigmoid knotting is a rare but life threatening cause of closed double loop obstruction.Delay in diagnosis can lead to progression of ischemia and subsequent gangrene of large segment of bowel loops.Prompt recognition on basis of clinical and basic radiological findings with immediate surgical intervention, advanced critical care to avoid disastrous complications of Multi organ failure helps to reduce the mortality.

Introduction: The coronavirus pandemic poses a massive challenge for the healthcare system and overburdens the Healthcare Workers (HCWs) in a developing country like India. The coronavirus may survive on various surfaces and/or aerosols for hours to days, making it a necessity to use Personal Protective Equipment (PPE) while treating infected patients. Wearing the PPE is often uncomfortable while working, more so in the summer season, when the temperatures in a tropical country like India are soaring. Aim: To identify, quantify and highlight the difficulties faced by the HCWs while wearing PPEs. Materials and Methods: This descriptive cross-sectional study was conducted in June 2020, by a team of researchers working in a government owned designated Coronavirus Disease- 2019 (COVID-19) hospital in metropolitan city, West India. The questionnaire was prepared for a multicentre survey for 230 HCWs who had used PPE kits during their COVID-19 duties. The online questionnaire responses were recorded in an Microsoft Excel sheet and the results were analysed using Statistical Package for the Social Sciences (SPSS) software version 19.0. Results: Total 230 responses were received out of which 74% were doctors, 21.7% nurses and 4.3% paramedical staff. The mean duration of work was 6.24 hours and per duty one, PPE was used by almost all of the respondents. The most common difficulty faced by the responders while on duty was excessive sweating (96%/n-221), itching of the nose (56%/n-129) and face (50.9%/n-117). While after the duty 61.7% of respondents reported being dehydrated and 68.2% complained of de novo headache. In a subset with a history of migraine, almost all reported worsening of migraine with increased frequency and severity of attacks. Many (40%) reported occasionally lowering the masks or face shield due to unbearable heat, risking self- contamination. Conclusion: The PPEs in current use and in the hot and humid conditions of summer months in tropical countries poses a unique challenge for the HCWs. Customisation of PPEs and working conditions is essential in the mitigation of the problems faced by the HCWs.

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumour of gastro-intestinal tract. Annual incidence of GIST in United States is approximately 3000-4000. Clinical presentation of GIST varies with location and size of tumour but GIST presenting with palpable abdominal mass is rare. We report a case of 38 years old male who presented with large abdominal lump. Computed tomography (CT) scan showed a large solid-cystic lesion encasing second part of duodenum and distal common bile duct. On CT differential diagnosis of Leiomyoma, Leiomyosarcoma and GIST were made. The diagnosis of GIST was confirmed by immune-histochemical study of the biopsy material. Patient underwent pancreaticodudenectomy. Post-operative course was uneventful. Patient was started on Imatinib therapy post-operatively. No recurrence noted at six months follow up.

Aims and Objectives:To re-evaluate role of Wagner's classification in the Study and Management of diabetic Foot in patient admitted to tertiary care hospital. Materials and Methods: This hospital based observational study was conducted in the department of General Surgery at tertiary care hospital from July 2017 to August 2018. This study included 47 cases of Diabetic foot patients in which management protocol according to Wagner's Classification was studied. Data was collected from hospital records which includes history, physical examination, investigations, treatment and follow up at discharge was collected. Results: The most common age of presentation in patients with diabetic foot lesion was between 41-60 yrs. In this study, out of 47 patients, 32 patients (68.1%) were male and 15 patients (31.9%) were female. The most common site was foot in 29 patients (61.7%). Out of 47 cases studied, 28 cases were having history of trauma, which account for 59.6% of the total cases. Amputation was the most common treatment modality. In this study of 47 patients, 11 patient required local debridement after initial surgery. Out of 47 cases; 42 patients ulcers were healed, 5 patients ulcer were not healed (4%). Conclusion: Diabetic patients have always suffered from complication affecting the lower limbs. Foot infection and subsequent amputation of lower extremities are the most common cause of hospitalization among diabetic foot patients. Prevention strategy including patient's education in foot care, prophylactic skin and nail care, and footwear reduces the risk of foot ulceration and lower limb amputation by 25%.