HighlightsSpontaneous CBD perforation is one of the rare causes of acute abdomen.Ideally managed with T-tube drainage of the CBD along with cholecystectomy.Bilious peritoneal tap, features of generalized peritonitis and absence of free gas under diaphragm in abdominal x-ray may be considered as clues for suspicion of CBD perforation.

HighlightsGastric Schwannoma is a rare neoplasm of stomach.It mimic clinically and radiologically with Gastric GIST.Immunohistochemical study can differentiate these two tumors.

Background: An enterocutaneous fistula is the abnormal communication between two epithelialized surfaces, one of which is a hallow organ. The discharge of intestinal content into the skin constitutes major nursing challenge. The most important complications include infection and sepsis, electrolyte imbalances and malnutrition, which when not managed properly will lead to grave outcome. Aims: To evaluate the causative factors, the various modes of management and the outcome of such intervention. Methods: Retrospective study of the patients admitted and treated for enterocutaneous fistula due to operative causes were evaluated in Dept of General Surgery S.C.B. Medical College and Hospital, Cuttack from 2014 to 2016. Results: Enterocutaneous fistula frequently follow emergency surgery on gastrointestinal tract, particularly the ileum, duodenum and colon, usually occurring around the 7th postoperative day and most end in spontaneous closure with conservative therapy. Surgery should be restricted to treatment of specially indicated patients like prolonged continuous fistulous discharge, abdominal wound dehiscence and deep seated intra peritoneal abscess. Conclusions: The total management of enterocutaneous fistula involves skilled nutritional support, stoma therapy, elimination of sepsis and finally a carefully timed, well-judged and well carried out surgery which will result in favourable outcome in patients with this dreaded complication.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review

Background: Aim of our study is pre-operative prediction of conversion using clinical, hematological, biochemical and ultra sonographic parameters in laparoscopic cholecystectomy. Methods: 748 patients underwent laparoscopic cholecystectomy in our institute during the period of 2008 to 2011 are included in this study. Clinical parameters are age, sex, BMI, Fever, tenderness, Duration from last attack, total duration of symptoms, diabetic status. Haematological parameters included are total leukocyte count, serum amylase. Ultrasonographic parameters included are gall bladder wall thickness, number of stones, pericholecystic edema, CBD diameter. Patients having jaundice, CBD stones, raised alkaline phosphatise are excluded from the study. All patients were operated by senior laparoscopic surgeons. Before converting, opinion from the other experienced surgeon was taken. Results: Mean patient age was 34.2 years. Conversion rate is 4.02%. The mean age in non-converted cases was not statistically different from the conversion group (p>0.05). The conversion rate in males was also not significantly different from that in females (p>0.05). Logistic univariate analysis showed that age, sex, duration of symptoms are not statistically significant(p>0.05) but body mass index (BMI), fever, number of stones, number of attacks, previous history of acute cholecystitis, obesity, presence of tenderness, gall bladder wall thickness on ultrasonography (USG) and raised total leucocyte counts (TLC) were significant for conversion(p < 0.05). Stepwise logistic regression showed that only number of attacks, obesity, TLC & wall thickness were significant. The predictive scoring system was calculated by β-coefficients of the variables found significant on logistic regression. Increasing scores are associated with significantly increased conversions rate. Evaluating the significance of this scoring system with prediction of conversion, it was noticed that the test was highly significant for prediction of conversion. Conclusion: Pre operative prediction for difficult laparoscopic cholecystectomy is possible, it can help the patient as well as the surgeon prepare better for the intraoperative risk and risk of conversion to open cholecystectomy.