Background: Acute appendicitis is the most common cause of surgical abdomen. A delay in diagnosis and subsequent delay in intervention may lead to appendicular perforation which leads to peritonitis and further complications including death. In this study, we tried to evaluate – “Estimation of serum bilirubin level as a diagnostic laboratory marker of acute appendicitis and its role in prediction of appendicular perforation.” Aims and Objectives: The objectives of the study are as follows: To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis. To evaluate whether elevated Bilirubin levels have a predictive potential for diagnosis of appendicular perforation. Materials and Methods: Patients clinically diagnosed with acute appendicitis, supported by imaging studies, who gave consent for the study were included in the study. All those patients underwent estimation of serum bilirubin levels along with other investigations. Data collected were compiled and analyzed. Results: In this study, among 408 patients, sensitivity of serum bilirubin in predicting acute appendicitis was 74.59%. Specificity of serum bilirubin in predicting acute appendicitis was 12.38%. Positive predictive value of serum bilirubin in predicting acute appendicitis was 71.06%. Negative predictive value of serum bilirubin in predicting acute appendicitis was 14.44%. Odds ratio was 0.4147. Conclusion: Serum Bilirubin level appears to be a promising marker for diagnosing acute appendicitis and perforation.

Background: Reconstruction of abdominal wall defects following full-thickness excision of large tumors (primary or metastatic) has always been a challenge for the treating surgeon. A number of reconstructive techniques have been described in the literature, including different types of meshes, flaps, and component separation techniques (anterior and amp; posterior), with varying results. We conducted a prospective observational study of our three-layer technique of abdominal wall closure at Medical College Hospital, Kolkata, to assess the long-time success of the procedure, especially in terms of hernia rates. Aims and Objectives: Reconstruction of abdominal wall defects following full-thickness excision of large tumors (primary or metastatic) has challenged surgeons for long, with several reconstructive techniques being described, with varying results. We conducted a prospective observational study of our three-layer technique of abdominal wall closure at Medical College Hospital, Kolkata, to assess the long-time success of our procedure, especially in terms of hernia rates. Materials and Methods: Thirteen patients with abdominal wall primary and isolated metastatic tumors were included from January 2017 to January 2022 with follow-up period from 8 to 60 months. Tumors were dermatofibrosarcoma protuberans, sarcomas, desmoid tumors, and two abdominal wall metastases. All patients in our study underwent computed tomography scan, core needle biopsy, and immunohistochemistry for better surgical planning. Results: Eight patients were male and five were female with mean age of 39 years and mean defect size of 10 cm. Polypropylene mesh was used, size varying from 15×15 to 30×30 cm with average operative time of 210 min. Post-operative superficial wound infection in 2 (15%), partial flap necrosis in 1 (7.6%), and tumor recurrence in one patient (7.6%) were seen. Conclusion: For closure of such large abdominal wall defects, our three-layer reconstructive technique has shown good results in terms of zero hernia rates. We recommend our method of closure, where affordability of biological meshes, availability of expensive meshes, accessibility to plastic and reconstructive surgeons or non-acquaintance with complex closure techniques are present.