Emergency Perineal Rectosigmoidectomy for Gangrenous Rectal Prolapse: a Single-Centre Experience with Review of Literature.

Recurrent and chronic rectal prolapse might lead to irreducibility and ultimately gangrene of the rectum if neglected. Gangrenous rectal prolapse is a surgical emergency and needs urgent surgical management. In view of irreducibility and gangrenous bowel, it is not advisable to attempt manual reduction of rectal prolapse. The only safe option that remains is perineal rectosigmoidectomy (Altemeier's operation). Here, we present our experience of five such cases operated in our institute from 2000 to 2015 with available literature review.

Risk Stratification in Off-Pump Coronary Artery Bypass (OPCAB) Surgery­Role of EuroSCORE II.

OBJECTIVES: To evaluate the EuroSCORE II for risk stratification in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. DESIGN: A retrospective observational study. SETTING: Two tertiary care hospitals. PARTICIPANTS: Participants were 1,211 patients undergoing OPCAB surgery. INTERVENTIONS: No interventions were implemented. MEASUREMENTS AND MAIN RESULTS: The EuroSCORE II estimated the operative risk for each patient. The calibration of the scoring system was assessed using the Hosmer Lemeshow test, and the discriminative capacity was estimated with area under receiver operating characteristic curves. The incidence, patient characteristics, causes of intraoperative conversion to on-pump coronary artery bypass (ONCAB), and outcome were studied. The all-cause in-hospital mortality was 2.39%. Predicted mortality with the EuroSCORE II was 2.03±1.63. Using the Hosmer Lemeshow test, a C statistic of 8.066 (p = 0.472) was obtained, indicating satisfactory model fit. The calculated area under the receiver operating characteristic curve was 0.706 (p = 0.0002), indicating good discriminatory power. Emergency intraoperative conversion to ONCAB occurred in 6.53% of patients. The mortality in the ONCAB group was significantly higher compared with patients who underwent successful OPCAB surgery (15.18% v 1.5%, p<0.0001). On multiple regression analysis with conversion to ONCAB as the endpoint, associated factors were patients with a higher EuroSCORE II (odds ratio = 1.13, confidence interval = 1.03-1.27) and more-than-trivial mitral regurgitation (odds ratio = 1.84, confidence interval = 1.07-3.06). Net reclassification improvement of 0.714 (p<0.0001) was obtained when on-pump conversion was added to the EuroSCORE II. CONCLUSIONS: The EuroSCORE II has satisfactory calibration and discrimination power to predict mortality after OPCAB surgery. Intraoperative conversion to ONCAB is a major complication of OPCAB surgery. A higher EuroSCORE II also predicts higher probability of conversion to ONCAB.

Gastrointestinal Stromal Tumor-Single-Center Experience with Review of the Literature.

GIST or gastrointestinal stromal tumors are the most common mesenchymal tumors of the GI tract showing mostly positive c-kit (CD-117) in immuno-histochemical staining. Most of the times, early diagnosis is missed. Usually, patients present with anemia. Sometimes, the patient can present in emergency with massive GI bleed or intestinal obstruction. The aim of this paper was to make the clinicians aware about the varied presentations of GIST. Presenting herewith is our single-center experience of management of patients of GIST with review of the available literature.

Primary Omental Torsion Is a Diagnostic Challenge in Acute Abdomen-a Case Report and Literature Review.

Torsion of greater omentum is a rare cause of acute abdominal pain. It can be primary or secondary. Secondary omental torsions are associated with a number of preexisting conditions like inguinal hernia (most common), tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting along its long axis resulting in impaired blood supply. This condition is rare and predominant in males. Most patients are middle-aged adults. It clinically mimics acute appendicitis. If evaluated properly and diagnosed in time, good results can be achieved. We are presenting herewith a case of primary greater omental torsion and review of available literature.

Gallbladder cancer revealed by an endobiliary tumor thrombus.

Common bile duct neoplastic thrombosis is rare and can cause jaundice in case of gallbladder cancer (GBC). We report the case of a 45-year-old man with GBC located in the fundus associated with a malignant endobiliary thrombus. A surgical procedure has been performed, including segmentectomy 4b+5 with common bile duct resection with Roux-en-Y hepaticojejunostomy. Postoperative courses were uneventful and the patient is alive at 15 months.

Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis: A case report and review of literature.

Situs nversus totalis is a rare condition which presents difficulty in clinical diagnosis as well as laparoscopic surgery for cholelithiasis. The mirror image anatomy makes the laparoscopic intervention difficult even for an experienced surgeon. Presenting here is a case report and review of literature.

Thoracoscopic retrieval of intra-parenchyamal foreign body of lung.

Thoracoscopy is an innovative procedure. We have retrieved intraparynchymal lung foreign body by thoracoscopy. Intraoperative imaging by 'C' arm facilitated the procedure. Thoracoscopy is a therapeutic option of choice for projectile thoracic injuries, provided patient is hemodynamically stable.

Jejunal diverticula - a rare cause of intestinal perforation.

Jejunal diverticuli is a extremely rare entity. We report a case of jejunal diverticulum as a cause of perforation peritonitis, which has been managed by resection anastomosis. This study is important from the perspective that clear cut guidelines for managment of jejunal perforation are not available in litreture.