Introduction: Adrenal haemorrhage (AH) is a rare, life-threatening condition that requires prompt diagnosis and management. Case Report: A 61-year-old male presented with sudden-onset central abdominal pain, distended abdomen, and nausea. There was no history of trauma or any other predisposing factor for AH. The blood pressure was raised, while other vitals were normal. The patient was managed with intravenous Diclofenac, Tablet Amlodipine, and Ryle's tube insertion. Initial abdominal ultrasound revealed bilateral adrenal enlargement. However, non-contrast computed tomography of abdomen revealed changes suggestive of bilateral AH. These findings were confirmed on magnetic resonance imaging of abdomen. Though the serum cortisol and adrenocorticotropic hormone levels were normal, and the patients were not symptomatic of adrenal insufficiency, intravenous Methylprednisolone was initiated to prevent deterioration of adrenal function. All the known causes of AH were excluded, and a diagnosis of idiopathic bilateral AH was reached. On Day 7, an abdominal ultrasound revealed a non-progressive size of the bilateral adrenal lesions and the patient was discharged with well-controlled blood pressure. Conclusion: Idiopathic AH, in patients without any predisposing factors, should be included in the differential diagnosis of a patient with vague abdominal pain.

Background/Aim: Laparoscopic cholecystectomy (LC) is the gold standard modality for treating the gallstone disease. However, it is associated with perioperative complications. Moreover, some of the patients with acute cholecystitis (AC) require conversion to open cholecystectomy (OC). Thus, the aim of this study is to assess the safety and feasibility of LC in patients with AC. Methods: This was a single center, prospective, observational study performed, over a period of 18 months (March 2019 to August 2020), in Department of General Surgery of a tertiary care center located in Central India. 96 patients fulfilling Tokyo guidelines (2018 diagnostic criteria for AC) were included. The feasibility was assessed in terms of conversion to OC, while safety was assessed in terms of postoperative complications in the first 30 days. Results: During LC, none of the patients required conversion to OC due to difficulty in dissection or anatomy. On postoperative day 1, the mean VAS score for pain was 2.1 (0.56), meaning of low pain. Mean length of hospital stay was 2.34 (0.61) days, thereby inferring shorter hospital stay. Mortality was not observed. During the follow-up period, 2 patients developed epigastric port-site infection, while other 2 reported port-site bleeding. Moreover, 2 patients had intra-abdominal collection. All the complications were managed conservatively. Conclusion: The study confirms that LC is feasible and safe in patients with AC, among the age group studied. LC can be a method of choice for AC due to decreased conversion rate, short hospital stays, reduced morbidity, and swift transition to routine.

Lipomas are very common benign tumours of mesenchymal origin. Lipomas occur with an estimated prevalence rate of 2.1 per 1000 amongst all tumours that can involve in the human body. There have been only 5 cases of giant lipomas published to date.1-5 This case report describes a unique giant lipoma located in the upper back with 30 x 30 cm in measurement and weighing 3800 grams.

Diaphragmatic hernia (DH) usually occurs in childhood; however, in adult it is uncommon. Most common aetiology of DH in adult is trauma while spontaneous DH is a rare entity accounting for <1%. The management is primarily surgical repair in the form of open or laparoscopic approach; the later has been associated with low morbidity, mortality and excellent long term outcomes with low rate of recurrence. In this case series, confirmation of the diagnosis was done by CT scan and by laparoscopy in all the patients; laparoscopic repair was performed in all the patients along with thoracoscopic aid in two cases. We found that minimal access techniques can be safely done in DH; in conditions when the herniated content are difficult to get reduced laparoscopically alone, a simultaneous thoracoscopy has helped in great deal in reducing the content and completing the procedure entirely by minimal access techniques. This gives all the advantages of minimally invasive approach like less postoperative pain, shorter hospital stay, quicker recovery and low recurrence rate; provided tissue repair is done in tension free manner by an experienced laparoscopic surgeon.

An internal hernia is any protrusion of a solid organ or a hollow viscus through a defect within the abdominal cavity. Paraduodenal hernias are rare, but are the most common variety of internal hernias. We present a rare case of a left sided paraduodenal hernia in a 26 years old otherwise healthy male who presented in emergency department with intermittent colicky upper abdominal pain. Left paraduodenal hernia was diagnosed pre operatively in a computer tomography scan. Hence patient was offered a laparoscopic repair. Our search via online search engines revealed very few case reports of Paraduodenal hernias which were repaired laparoscopically. We believe that in expert hands, paraduodenal hernias should be managed with laparoscopic technique as it significantly reduces morbidity and hospital stay.

Paraesophageal hernias are the results of defects in the diaphragmatic hiatus. Types II to IVhiatal hernias are also known as paraesophageal hernia. These hernias can be associated with life threatening complications such as gastric volvulus leading to necrosis or perforation of the stomach. Due to these potential complications it was thought that all paraesophageal hernia should be repaired upon diagnosis. Recent evidence, however demonstrated that a non surgical approach is a safe option in many cases. Surgical intervention is usually reserved for patients who are exhibiting symptoms secondary to paraesophageal hernia.We report an interesting case of a 72yrs old female who presented at with Type III paraesophageal hernia with organo axial gastric volulus for which successful Laparoscopic reduction of volvulus with Diaphragmatic hernia repair with Nissen's fundoplication was done

Background: Bowel perforation is one of the common emergencies faced by the surgeons in the developing world. It carries a high morbidity and mortality rate even today. In the present era, laparoscopy is being used as a better treatment alternative across the world. Various reports in literature are now available regarding the feasibility of laparoscopic repair of bowel perforation. The purpose of this study was to assess the feasibility of laparoscopic primary suture repair as the initial modality in treating a bowel perforation and to analyze the pattern of bowel perforation in relation to age, sex and etiology in Chhattisgarh state.Methods: This study included the data of relevant patients who got admitted in Ramkrishna Care Hospital Raipur from 1st October 2017 to 31st September 2019 (24 months).Results: Most commonly affected mean age group in this study was 39±15.82 years with male predominance. Statistically significant findings in favour of laparoscopic repair in our study were early return of bowel activity, less incidence of surgical site infection, early return to work (less hospital stay), less post-operative pain as compared to open surgery (p<0.05).Conclusions: In this study it was found that laparoscopy in patients with bowel perforation who are hemodynamically stable and present early (<72 hours) to the hospital is feasible and safe and gives many benefits including reduction in perioperative morbidity and mortality.