Left-sided acute appendicitis (LSAA) is a rare cause of acute pain in the abdomen and is associated with developmental anomalies such as situs inversus (viscus) totalis (SIT) and midgut malrotation (MM). Due to the rarity along with the atypical presentation, diagnosis of LSAA is difficult, and if it is not managed timely, complications of appendicitis such as perforation can result. Imaging including contrast-enhanced CT scans and ultrasound aids in establishing the diagnosis. In case of a diagnostic dilemma, a diagnostic laparoscopy is an optimal option that offers diagnostic as well as therapeutic benefits. Operative intervention, preferably laparoscopic, is the standard treatment of LSAA. We report a case of appendicitis in a 36-year-old man with SIT detected radiologically who presented with pain in the left side of the lower abdomen for two days. Minimal tenderness was noted on the left iliac fossa during per abdominal examination. Abdominal ultrasonography was showing probe tenderness in the left iliac fossa, and contrast CT of the abdomen was suggestive of appendicitis with SIT. The patient was managed by laparoscopic appendicectomy. Therefore, we conclude that LSAA should be listed in the differentials of the various causes of left-sided pain in patients with SIT or MM. Clinical diagnosis is often difficult, and CT scan is crucial to establish the diagnosis as well as confirm rotational anomalies. Surgery, preferably laparoscopic, represents the appropriate treatment of LSAA.

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Background:Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.Methods: To reduce the rate of negative appendicectomies by the combined use of diagnostic modalities in a prospective study from July 2011 to December 2012 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Medical College and Hospital, Jaipur, India.Results:The results of the diagnostic aids were reported in combination using the ‟or” rule and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p value for the association between the variables of studied. The mean age was 26±11.25 years (10-59 years) and there were 70 males and 30 females in the study. Histopathological examination confirmed appendicitis in 90 patients with 10 negative appendicectomies. A negative appendicectomy rate of 5.71% in men and 20% in women was observed.Conclusions:Alvarado score in combination with ultrasonography is a valuable tool for diagnosing acute appendicitis inspite of sophisticated investigations like CT, thus reducing the cost of treatment and preventing negative appendicectomy rate.

Background: Small intestine perforation and gastrointestinal haemorrhage are the most common and dreadful complications of enteric fever. There are different operative procedures available for enteric perforation repair. In the present study attempts should be made to find out which operative procedure (either single layer or double layer closure) should be planned in enteric perforation by comparing these, in terms of morbidity, mortality and cost effectiveness.Methods: This study was carried out on 50 patients of either sex. They were divided in two groups Group- A     (conventional double layer repair in 25 patients) and Group- B (single layer interrupted sutures in 25 patients). After analysing the result of this study, it can be concluded that single layer repair for enteric perforation can be constructed in less time and with less complication rate compared with the conventional two layer repair technique, it also recovers the patient early and causing earlier bowel activity than two layer repair.Results: 50 patients were studied in the present study and results were in favour of single layer group as time taken for perforation repair and overall surgical time was less in this group. Moreover, single layer repair also helps early bowel activity and early recovery to the patient than double layer technique.Conclusions: Double layer closure of enteric perforation offers no definitive advantage over single layer repair in terms of faecal fistula formation, operative time, returns of bowel movements and other complications like wound abscess formation, wound dehiscence, respiratory complications etc. Less operative time and other factors in favour of single layer repair makes it the choice of procedure for most of the surgeons.

Introduction: The use of locking compression plate in fractures of distal femur in our study seems to be associated with a good functional outcome and early recovery. The DF-LCP is a good implant to use for fractures of the distal femur particularly intra-articular type and osteoporotic fractures. Recent advances in technology for treatment of fractures distal end femur with locking compression plate become popular and has clear biomechanical advantages when compared with conventional plating and other method of fixation. When combined with minimally invasive surgical techniques, locking compression plate may cause substantially less iatrogenic tissue damage when compared with conventional plating. Locking compression plates offers multiple points of fixed-angle contact between the plate and screws, theoretically reducing the tendency for varus collapse that is seen with traditional lateral plates. The commonly observed complications of fracture distal end of femur are knee stiffness, implant failure and loss of reduction are minimal with it. Surgical exposure for plate placement requires significantly less periosteal stripping and soft tissue exposure than that of normal plates. Materials and Methods: This prospective study was conducted which included 30 patients with fracture distal end of femur (Extra & intra articular type A and C based on AO classification) treated with open reduction and internal fixation with distal femoral locking compression plate (DF-LCP) between November 2011 to October 2013 at in the department of orthopaedics, Govt. Medical college & associated MBS hospital, Kota and followed-up for a minimum period of 6 months. The patient's ages ranged from 18 to 78 with a mean of 42 years. The duration of follow up ranged from 6 months to 21 months. The clinical assessment was conducted at least 6 months post-operatively using the Schatzker & Lambert scoring system. Results: Result showed that 9 patients had excellent results, 17 good, 2 fair and 2 failures. Conclusion: The use of locking compression plate in fractures of distal femur in our study seems to be associated with a good functional outcome and early recovery and is a good implant to use for fractures of the distal femur particularly intra-articular type and osteoporotic fractures.