BACKGROUND:The common postoperative complications of laparoscopic cholecystectomy (LC) are port site infection, biliary leak, hemorrhage, and pain at the surgical site, as well as at the shoulder tip. The aim of the study was to identify whether the Glisson's capsule (GC) injury during LC responsible for postoperative right shoulder tip pain (RSTP). MATERIAL AND METHODS:This prospective observational cross-sectional study was conducted over 18 months. We enrolled patients aged ≥18 years who underwent LC. Demographic data, preoperative investigations, and intraoperative video recordings were used to evaluate factors for postoperative RSTP. RESULTS:The study included 215 patients with a mean age of 42.65 years. Forty-one participants (19.1%) were male, and 174 (80.9%) were female. Our study showed that the incidence of RSTP after LC was 41.9%. Of 90 patients who had RSTP, 81 (90%) had GC injury. Among the 125 patients without RSTP, 97 (77.6%) also had Glisson's capsule injury. The difference in the presence of Glisson's capsule injury between patients with and without RSTP was statistically significant ( P =0.017). CONCLUSION:Our study demonstrated an association between GC injury and post-LC RSTP.

Gallstones and alcohol consumption are the most common causes of acute pancreatitis. Lung carcinoma typically presents with respiratory symptoms, and in some cases, locoregional or distant metastases. However, acute pancreatitis as the initial manifestation of lung carcinoma is rare. Herein, we report the case of a 75 year-old man who presented with acute pancreatitis and was diagnosed with metastatic lung carcinoma upon evaluation.

Background:The common postoperative complications of laparoscopic cholecystectomy (LC) are port site infection, biliary leak, hemorrhage, and pain at the surgical site, as well as at the shoulder tip. The aim of the study was to identify whether the Glisson's capsule (GC) injury during LC responsible for postoperative right shoulder tip pain (RSTP).Material and Methods:This prospective observational cross-sectional study was conducted over 18 months. We enrolled patients aged >= 18 years who underwent LC. Demographic data, preoperative investigations, and intraoperative video recordings were used to evaluate factors for postoperative RSTP.Results:The study included 215 patients with a mean age of 42.65 years. Forty-one participants (19.1%) were male, and 174 (80.9%) were female. Our study showed that the incidence of RSTP after LC was 41.9%. Of 90 patients who had RSTP, 81 (90%) had GC injury. Among the 125 patients without RSTP, 97 (77.6%) also had Glisson's capsule injury. The difference in the presence of Glisson's capsule injury between patients with and without RSTP was statistically significant (P=0.017).Conclusion:Our study demonstrated an association between GC injury and post-LC RSTP.

Appendiceal mucocele is a rare pathological entity characterized by luminal distension due to mucin accumulation, arising from both benign and malignant etiologies. We report two contrasting cases highlighting the diagnostic and therapeutic challenges of this condition. The first case involved a 37-year-old male with features of acute appendicitis and a dilated appendix on imaging. Surgery revealed a mucocele with localized perforation, and histopathology confirmed eosinophilic appendicitis (EA), a rare variant previously unreported as a cause of mucocele. The second case was a 53-year-old female with chronic abdominal pain and a cystic appendiceal lesion on imaging, later diagnosed intraoperatively as mucinous adenocarcinoma, prompting right hemicolectomy. Despite surgical intervention, the patient succumbed to postoperative sepsis and complications. These cases underscore the broad spectrum of presentations, from benign inflammation to malignancy, and the limitations of preoperative imaging in definitive diagnosis. EA-associated mucocele and perforation is a novel finding. Surgical management remains the cornerstone of treatment, guided by intraoperative and histopathological findings. High clinical suspicion is warranted, especially in older patients with anemia or atypical symptoms, to avoid delayed diagnosis of malignancy. This series emphasizes the need for individualized surgical approaches and highlights underrecognized etiologies such as EA in appendiceal mucocele.

Malnutrition is an under-assessed risk factor for poor surgical outcomes in emergency settings. Emergency laparotomy (EL) for gastrointestinal perforation peritonitis presents a unique challenge due to its acute nature and associated sepsis, which often compromise preoperative nutritional optimization. This study evaluates the impact of preoperative nutritional status on 30-days postoperative morbidity and mortality following EL. In this prospective observational study, 105 adult patients undergoing EL for gastrointestinal perforation peritonitis were assessed for nutritional status using CONUT and MUST scores. Postoperative complications were graded using the Clavien-Dindo Classification (CDC). Patients were stratified into high and low risk based on nutritional score thresholds, and complications were grouped as minor (CDC Grades I–II) or major (CDC Grades III–V). A significant proportion of patients were found to be moderate to severely malnourished (66.67

Abstract Aim To determine the effectiveness of the CORES model in predicting post-operative in-hospital and 30-day mortality in patients undergoing emergency laparotomy. Methods The CORES and APACHE-II scoring were done in 211 patients aged> 18 years undergoing emergency laparotomy, and both scores were compared, with calculating mortality rate being the primary objective. Abdominal trauma, pregnancy and ASA grade V were excluded. CORES was constructed using a regression model based on the presence or absence of Japan coma scale >30, ASA class III, ASA class IV, WBC <2500 cells/ μL, Platelet count <150000 / >300000 cells/ μL and blood urea nitrogen >/= 40mg/dL. Results The CORES in-hospital and 30-day mortality prediction score was marginally less than the APACHE II (Table 1& 2)Table 1:APACHE II versus CORES in-hospital mortality scorePredictorAUROC95% CIpSn%Sp%PPV%NPV%DA%ORAPACHE II0.9010.85-0.94<0.00170937889871.42CORES0.8600.80-0.91<0.00181735391752.35Table 2:APACHE II versus CORES 30-day mortality scorePredictorAUROC95% CIpSn%Sp%PPV%NPV%DA%ORAPACHE II0.8850.834-0.937<0.00170927490861.42CORES0.8670.808-0.926<0.00176876691842.67AUROC: Area under ROC curve; CI: Confidence interval; Sn: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; DA: Diagnostic Accuracy. Conclusion CORES accurately predicting post-operative mortality. However, CORES was less effective than APACHE II in calculating in-hospital mortality but equally effective in predicting 30-day postoperative mortality.

Helicobacter pylori’s type IV secretion system (T4SS) is a key virulence determinant, mediating the delivery of effector proteins such as cytotoxin-associated gene A (CagA) into host epithelial cells. Despite its significance, the molecular architecture and assembly dynamics of the inner membrane core complex within the Cag-T4SS remain inadequately resolved. This study aimed to identify and characterize the direct interaction between CagF, a chaperone protein, and CagV, an inner membrane-associated component of the Cag-T4SS. Immunoprecipitation and pull-down assays confirm the physical interaction between CagF and CagV. Computational docking and molecular dynamics simulations further elucidated the binding interface, revealing a stable interaction mediated by electrostatic complementarity, hydrogen bonding, and salt bridges. Co-expression and pull-down experiments using recombinant proteins validated these findings. Notably, deletion analysis identified the critical role of the N-terminal region (residues 50-100) of CagF in CagV binding, further supporting the computational predictions. Given the essential role of CagV in CagA translocation, we hypothesize that CagF-CagV interaction may facilitate the localization of the CagF-CagA complex near the secretion channel, promoting efficient effector translocation. These findings enhance our understanding of the Cag-secretion system’s structural organization and biogenesis.

Necrotising enterocolitis (NEC) is a life-threatening condition predominantly affecting preterm neonates. In contrast to well-characterised neonatal forms, adult NEC (ANEC) is a rare entity. Early diagnosis is crucial, as NEC carries a high mortality rate if left untreated. This report describes a man in his 80s presenting with acute abdomen subsequently diagnosed as ANEC. This case emphasises diagnostic challenges and highlights the key differences between the neonatal and adult forms of the disease. This case contributes to the limited literature on ANEC, supporting the need for early diagnosis and management of this rare condition in adults.

Introduction Most patients with acute abdominal conditions present with a unique set of problems because of acute physiological derangements, lack of optimization, and associated comorbidities. Emergency laparotomy in such patients is quite a morbid procedure. Predicting the surgical outcome and taking measures in advance to improve patient outcomes following emergency laparotomy is of utmost importance. Simultaneously, it can also help in preoperative counseling and shared decision-making for patient management. This study was designed to investigate the potential use of Emergency Surgery Score (ESS) in predicting outcomes among non-traumatic emergency laparotomy cases. Material and methods This prospective observational study was conducted at the Department of General Surgery at a Tertiary Care Centre in India. All patients above 18 years of age undergoing nontraumatic emergency laparotomy were included in the study. All variables related to the three broad categories of ESS were recorded. Each ESS variable was scored accordingly, except for the variable "White race," which was scored zero by default. Surgical outcome was recorded in terms of length of hospital stay, length of ICU stay, 30-day mortality rate, 30-day postoperative complications, and 30-day readmission. Results A total of 163 patients were included in this study. All the variables related to the ESS and surgical outcomes were recorded and analyzed. ESS correlated positively with the length of hospital and ICU stay among the survivors (rho=0.51 and rho=0.53, respectively). For a one-unit rise in ESS, the length of hospital stay and the length of ICU stay increased by 1.8 days and 0.71 days, respectively. Using Receiver Operating Characteristic (ROC) analysis, the ESS demonstrated a strong correlation with both the 30-day mortality rate and 30-day complications (Area under the Receiver Operating Characteristic Curve (AUROC) values of 0.895 and 0.875, respectively). Conclusion Our study's findings underscore the potential of ESS as a powerful predictor of postoperative outcomes in emergency laparotomies. By providing an objective measure for outcome comparison, ESS can significantly enhance preoperative patient counseling and decision-making.

Background and objectives Hemorrhoidal disease (HD) is a common anorectal condition affecting a large number of adults worldwide. Lack of standardized outcomes limits treatment decisions in HD. Patient-reported outcome measures (PROMs), directly reported by the patients, offer standardized, patient-centric measures, aiding in HD severity assessment and treatment decisions. The Sodergren score is one such PROM that has shown significant predictive ability for surgical decision-making in HD patients. The Aim of this study was to find a Sodergren hemorrhoidal symptom severity cut-off score to predict the need for surgical management in hemorrhoidal disease. Methodology All patients > 18 years of age diagnosed with HD presenting to the outpatient clinics in the Colorectal Unit, who gave their consent to participate, were included in the study. Patients with anal fistula, anal fissure, inflammatory bowel disease (IBD), colorectal malignancy, prior hemorrhoidal surgery, on antiplatelet therapy, and pregnancy were excluded. The sample size calculated was 34. Based on the treatment, the patients were divided into non-surgical (A) and surgical (B) groups (17 in each group). The patients were made to fill out the Sodergren hemorrhoidal symptom severity score questionnaire. The final Sodergren score was recorded for data analysis. Results Sodergren score was evaluated in 34 HD patients; 17 in each treatment group. A significant difference in Sodergren scores was found between the non-surgical group (median: 4; interquartile range (IQR) 0-4 ) and the surgical treatment group (median: 7 (IQR 4-10) (P=0.001). The Sodergren score demonstrated an area under the receiver operating characteristic curve (AUC) of 0.834 (95% CI: 0.702 - 0.966) for predicting surgical decision-making, with an optimal cut-off score of ≥7 (sensitivity:58.8; specificity:88.2). Conclusion Sodergren score demonstrated utility as a patient-reported severity assessment tool to guide treatment outcomes in HD patients. A cut-off score of ≥7 was predictive of surgery.

Internal hernias through mesenteric defects are a rare cause of bowel obstruction. Early recognition and intervention are crucial for preventing bowel ischemia and subsequent complications. We report a case of a 64-year-old female who presented with acute intestinal obstruction secondary to an internal hernia associated with volvulus. She had a previous surgical history of exploratory laparotomy 25 years back. This case illustrates the diagnostic challenges of internal hernias and emphasizes the importance of considering this entity in patients with previous abdominal surgery presenting with bowel obstruction. A CT scan helps in prompt diagnosis, and early surgery is required for the management. The concurrent finding of midgut volvulus adds to the uniqueness of this presentation.

Gastrointestinal perforation peritonitis is a life-threatening surgical emergency with high mortality. Early identification of patients at increased risk of poor outcomes is critical for optimizing care. In this study, we aimed to evaluate the prognostic value of combining serial Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and serial serum lactate levels in predicting 30-day postoperative mortality among patients undergoing emergency laparotomy for gastrointestinal perforation peritonitis. In this prospective cohort study, 120 adult patients diagnosed with gastrointestinal perforation peritonitis and undergoing emergency laparotomy were enrolled after obtaining ethical approval and informed consent. APACHE II scores and serum lactate levels were recorded at three time points: preoperatively (baseline), 6 h postoperatively, and 24 h postoperatively. The primary objective of this study was a combination of serial APACHE II and serial serum lactate level (baseline, 6 h and 24 h post-operatively) and its correlation with post-operative mortality in emergency laparotomy for hollow viscus perforation peritonitis. Data were analysed to compare clinical variables between survivors and non-survivors. Receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were used to assess the predictive performance of individual and combined markers. The 30-day postoperative mortality rate was 35

Background High output enterostomy leads to malnutrition and fluid/electrolyte loss which may be challenging to manage despite dietary modification, anti-motility, anti-secretory drugs, and parenteral nutrition. Distal infusion stomal enteroclysis (DISE) is an alternative to restore nutritional deficit and replace parenteral nutrition in resource-limited settings where treatment cost and availability of trained nurses are limiting factors. Objective To assess the effectiveness and feasibility of DISE in managing postoperative enterostomal output. Methods Consecutive patients who met the inclusion criteria and underwent enterostomy in one year were included. Postoperatively, DISE was started after the return of bowel movement. Stomal effluent was collected, filtered, and reinfused through the distal limb using a Foley catheter. The patients and caregivers were trained to perform under supervision. At discharge, they were encouraged to maintain regular contact and advised to report back when necessary. Results Twenty-five patients received DISE, of which 22 were discharged and successfully continued to manage at home, while 3 expired. The median age was 36 years, the median BMI at admission and discharge was 19 and 17.8kg/m2 respectively (the difference was statistically significant), and the male: female ratio was 2.5: 1. Thirty-day readmission was done for 2 patients to manage minor complications. The average stomal output was 820mL/day initially and 478mL/day at discharge. The median duration of DISE was 12 days. Thirteen patients (52%) needed parenteral nutritional support due to inadequate oral intake. Conclusion DISE is a feasible and effective technique for managing high output enterostomies. It can be easily taught and performed with minimal resources at home.

We aimed to study the association between sleep quality, total sleep duration, and wound healing among adult patients who had good sleep quality at the time of admission to the hospital who underwent laparotomy for various reasons. In this observational study, consecutive adult patients undergoing emergency laparotomy were followed up until the eighth postoperative day. The primary outcome (wound healing) was assessed using the Southampton Wound Grading System. Sleep quality (assessed by the single-item sleep quality scale) was the primary predictor. Pain was assessed using a visual analog pain scale. We studied the effect of postoperative sleep quality on wound healing on postoperative day 8. Secondary analyses assessed the effect of total sleep time, severity of pain, and markers of systemic inflammation on wound healing. In this study 110 participants were included. The average age of participants was 41.7 ± 16.2 years. On postoperative day 8, 34.5

INTRODUCTION:A significant proportion of breast cancer cases are hereditary and are potentially preventable. However, adoption of the preventive measures remains a significant challenge, particularly because of to lack of knowledge and awareness in low- to middle-income countries. METHODS:This prospective study conducted at a high-volume tertiary care cancer center in North India to assess the knowledge, awareness, and attitudes of female breast cancer patients and impact of a brief educational intervention. The study involved three phases: pre-interventional assessment, educational intervention, and post-interventional assessment utilizing a structured questionnaire. RESULTS:The study involved 300 newly diagnosed breast cancer patients; 16.7% were familial. At the outset, 87.0% patients had low knowledge of risk factors, 90.3% about screening, and 32.7% about treatment. Awareness levels were low: 13.7% aware of familial risk and 2.7% of breast cancer genes. Affordability of genetic testing was low (15.2%), and interest in testing for self and family members was limited (32.0% and 26.3%). Following educational intervention, a significant positive percentage change was noticed in knowledge (risk factors: 12.8%, screening: 36.2%, treatment: 82%), awareness (familial risk: 66.7%, BRCA gene: 12.3%), and attitude (testing for self: 17.8%, family: 19.5%). CONCLUSIONS:This study highlights the significant knowledge gaps among breast cancer patients regarding genetics. The educational intervention led to notable improvements in knowledge, awareness, and attitudes, underscoring the importance of tailored patient education in breast cancer care.

A femoral hernia is an uncommon and acquired hernia in the groin. Its incidence in adults is 2%-8% of all abdominal wall hernias, and it has a female-to-male ratio of 1.8:1. It is usually found in elderly patients and is associated with increased morbidity due to delays in diagnosis leading to a high incidence of incarceration and strangulation. Accurate preoperative diagnosis of femoral hernia is challenging, especially in obese patients in whom a small femoral hernia can be hidden under the groin fat. Unlike an inguinal hernia, it rarely reduces on its own and if asymptomatic and small, is often unnoticed by the elderly obese patient. Femoral hernia is often unsuspected and overlooked in males as it is predominant among females. Delay in diagnosis can lead to intestinal gangrene and high morbidity. We present a case of an incarcerated left femoral hernia in an elderly obese male who presented with acute intestinal obstruction. He was managed with resection of the gangrenous segment and double barrel ileostomy. Although uncommon in males, a femoral hernia has a high incidence of strangulation, and therefore should always be ruled out as a cause of acute intestinal obstruction in elderly patients. Therefore, never forget to examine the groin in case of intestinal obstruction.

Background and Aims: Pneumoperitoneum creation for laparoscopic surgery increases the intraabdominal pressure and causes alveolar atelectasis. We investigated the influence of an increase in intra-abdominal pressure (IAP) on ventilatory mechanical power (MP) delivery during pneumoperitoneum creation for laparoscopic cholecystectomy. Material and Methods: In a prospective cohort design, we enrolled 42 patients undergoing laparoscopic cholecystectomy. During pneumoperitoneum creation, the IAP was sequentially raised to three predefined IAP levels (8, 11 and 14 mmHg), keeping identical ventilatory settings (timepoints T1, T2, and T3). After that, positive end-expiratory pressure (PEEP) was sequentially raised from 5 to 8 to 11 cmH 2 O (timepoint T4 and T5). The primary outcome included ventilatory MP delivery at each timepoint. Other variables included respiratory driving pressure (DP), airway resistance (AR), and respiratory compliance (RC). Results: The MP increased linearly with a rise in IAP from T1 to T3 ( r = 0.71, P < 0.001); the MP increased by 0.19 per unit rise in IAP (effect size 0.90, P < 0.001). A similar positive correlation was also observed between DP and IAP from T1 to T3 ( r = 0.73, P < 0.001); the DP increased by 0.72 per unit rise in IAP (effect size 0.89, P < 0.001). The MP increased significantly on increasing PEEP from T3 to T5, while the DP decreased concomitantly ( P < 0.001). The AR increased significantly from T1 to T3, while RC decreased concomitantly; vice-versa was observed at T4 and T5 ( P < 0.001). Conclusions: The ventilatory MP delivery rises linearly with an increase in IAP. Targeting an IAP-guided MP level could be an attractive approach to minimize lung injury.

Laparoscopic cholecystectomy is the established standard of care for addressing symptomatic gallstones, typically representing a straightforward and uncomplicated surgical procedure. However, patients exhibiting variant anatomy or local inflammation can present challenges to the surgeon, potentially leading to complications. In this context, we present the case of a 55-year-old woman who underwent a laparoscopic cholecystectomy for symptomatic gallstone disease at a different medical facility. Postoperatively, she was diagnosed with a case of duodenocolic fistula and cholecystocolonic fistula. Conservative treatment ensued with intravenous antibiotic administration, as well as enteral and parenteral feeding. Diagnosing cholecystocolonic fistula before surgery proves challenging, even with modern diagnostic and imaging tools. Despite its significance, there is limited information in the literature regarding the management of this infrequent finding. The approach to diagnosis and management is elaborated upon in the case report.

A man in his 20s presented with a painless, slow-growing firm swelling in the anterolateral aspect of his left forearm. The swelling had been present for 1 year and measured 10×12 cm. Clinically, a differential diagnosis of soft tissue sarcoma, lipoma, neurofibroma, dermoid cyst and hydatid cyst of the extremity was considered. MRI suggested a primary intramuscular hydatid cyst. However, fine-needle aspiration was inconclusive, and ELISA for immunoglobulin G antibodies to echinococcal antigen in serum was negative. A wide-local complete surgical excision of the lesion was planned. Intraoperatively, a well-defined, tense cystic swelling with surrounding dense adhesions was found within the intramuscular plane. Histopathological examination of the cyst wall revealed cysticercosis. The patient recovered uneventfully. This case highlights that solitary intramuscular cysticercosis, although rare, should be included in the differential diagnosis of an isolated soft tissue mass, particularly in endemic areas.