Ascariasis is one of the most common helminthic diseases in humans, occurring mostly in countries with low standards of public health and hygiene, thereby making ascariasis highly endemic in developing countries. In endemic areas, 30% of adults and 60–70% of children harbour the adult worm. Biliary ascariasis is a rare cause of obstructive jaundice. Conventional management involves endoscopic extraction of worm. We are reporting a rare case of ascaris which induced extrahepatic biliary obstruction in a young male who presented with acute cholangitis. The ascaris was removed by laparoscopic exploration of the common bile duct. Postoperative period was uneventful.

Introduction Laparoscopic cholecystectomy is now considered the gold standard for the treatment of symptomatic cholelithiasis. The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. Although the rate of conversion to open surgery and the complication rate are low in experienced hands, the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon. Various preoperative factors can help in deciding the difficult gallbladder and conversion to open cholecystectomy. The aim of this study is to predict the difficulty of laparoscopic cholecystectomy and the possibility of conversion to open cholecystectomy before surgery using the clinical and ultrasonographic criteria in our set up. Materials and methods A total of 200 patients presenting with symptomatic gall stone disease between January 2011 and June 2012 were included in the study. Every patient included in the study was subjected to the following assessments which were regarded as risk factors for laparoscopic cholecystectomy: patients' characteristics, complaints, history and clinical examination and laboratory data. Results Amongst the 200 patients admitted for laparoscopic cholecystectomy, 47 (23.5%) were male and 153 (76.5%) female, with an average age of 39 years (range 16-62 years).The body mass index ranged from 16.3 to 42.7 with a mean of 32.8 ± 6.28 kg/m 2. Five patients were considered obese (BMI > 35 kg/m 2). Conclusion Male gender, single large stone, thickwalled gallbladder, previous abdominal surgery and contracted gallbladder are the factors that proved to be significant factors in our study.

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Benign biliary strictures fall into two aetiological groups: traumatic

IntroductionGall bladder perforation is a rare but life threatening complication of acute cholecystitis with or without stones and is associated with increased morbidity and mortality due to late diagnosis. The late diagnosis is attributed to the fact that most of them are present with the same symptoms as in an uncomplicated acute cholecystitis. Most of them are identified and confirmed by laparotomy as preoperative diagnosis is very rare,that is, on computed tomography scan and ultrasound. We are reporting two cases of gall bladder perforation. Case reportThe first case was a 70-year-old man who was presented to the emergency department with complaints of pain in the abdomen for 7 days and obstipation for 3 days. The second case was a 58-year-old man who was presented to the emergency department with complaints of pain in the abdomen for 1 week and obstipation for 2 days. ConclusionGall bladder perforation is a fatal and life threatening complication of acute cholecystitis so early diagnosis is the key, as delay will result in the increase of mortality and morbidity.