Case report- acute pre-operative gall bladder perforation (Type-1) with generalized biliary peritonitis in younger age group without any comorbid illness.

Gall bladder related disease is now one of the commonest indications for elective and emergency surgery and laparoscopic cholecystectomy is the mainstay treatment in patients with gall bladder stones, however some patient delay their surgical intervention for some period of time which might lead to life threatening complications in later stages such as GBP which is rarest but when it occurs along with other predisposing risk factors (hypoalbuminemia and SIRS) might increase the morbidity and mortality rate. Here we report a case of pre-operative Type-I GBP with generalized biliary peritonitis with sepsis with hypoalbuminemia in younger age group. Acute cholecystitis patient of younger age group without any comorbid illness, needs prompt surgical intervention (cholecystectomy).

Case report--mechanical bowel obstruction with appendicitis without strangulation and leukocytosis.

Intestinal obstruction is a common surgical emergency caused by varied conditions. Acute appendicitis is considered as one of the unusual cause of intestinal obstruction especially functional and very few cases of mechanical obstruction. Here we report a Case of 62-years-old male who presented here with a clinical picture of small bowel obstruction. On laparotomy, there was a dilated gut with long appendix having inflamed tip buried into adjoining mesentery and then appendectomy was done and obstruction was relieved. Also, bowel was found to be viable hence simple appendectomy was found to be sufficient treatment. Histopathological findings was suggestive of chronic fibrosing appendicitis. Hence, in cases of bowel obstruction in an elderly patients with clinical examination which was not typical for appendicitis can be managed with laparotomy and simple appendectomy when early intervention is made to avoid the risk of ischemia and gangrenous changes in intestinal mesentery which may require resection in later stages.

Bowel ischemia and gangrene-primary true enterolith.

Enterolithiasis, or presence of stone concretions in the gastrointestinal tract, is an important but relatively uncommon clinical condition that has recently gained significant attention with advances in the gastrointestinal field. Here, we present a case of an old male having features of bowel Ischemia and gangrene formation. Patient underwent exploratory laparotomy and there was a presence of inflamed Gut with a perforation just one and half feet away from IC junction and an obstruction was also identified by following the dilated bowel loops distally, palpation revealed a hard stone and enterotomy incision at the site delivered a stone. Following it, resection of thickened mesentery was done and loop ileostomy was made. The most important prognostic factor in such cases relies on time interval between onset of symptoms and definitive treatment. By improving the awareness and early recognition of mesenteric ischemia will lead to improved survival in the condition.

Role of Automated Therapeutic Red Cell Exchange in the Setting of Acute Methemoglobinemia: Our Experience.

Methemoglobinemia, an altered state of hemoglobin resulting in impaired oxygen delivery to the tissues can be congenital or following exposure/ingestion of various oxidant drugs or toxins. One of the earliest signs of methemoglobinemia is generalized cyanosis not improved on oxygen supplementation and presence of normal PO2 on acid blood-gas analysis. Here, we report two cases of acquired methemoglobinemia following poisoning and our experience of managing them with automated therapeutic red cell exchange.