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Background: Perianal fistulas remain a surgical treatment challenge in colorectal practice due to high recurrence rates and the risk of postoperative wound infection and incontinence. Anal fistula represents one of the most frequent anorectal diseases.Methods: This is a randomized comparative prospective study of 30 cases of fistula-in-ano presenting at the surgical OPD of Almeen Medical College and Research Institute from 1 September 2017 to 31 june 2018.Results: In our study the age of the patient varied from 25-60 years, patient’s wound healed in 3-4 weeks in those who underwent open fistulectomy, whereas in the primary closure method the wounds healed in 1-2 weeks. Recurrence of fistula occurred in 5 patients.Conclusions: The primary closure method of fistulectomy is a safe and feasible method and more effective in the management of fistula-in-ano.

Highlights • Sweat gland carcinoma is very rare with a reported incidence of less than 0.005% of all tumour specimens resected surgically. Due to limited availability of literature, the diagnosis as well as management of these tumours is quite difficult. • Presented to us with a solitary swelling over the left chest wall since two month. We managed the case with wide excision of the swelling with segmental excision of the involved segments of the ribs with pleura followed by a Delto-Pectoral fasciocutaneous flap with insertion of an intercostal drain. • Histopathology report confirmed an eccrine carcinoma with involvement of the ribs. The tumour cells immunohistochemical study showed that tumour cells were positive for pancytokeratin/CK7/Calretinin with focal luminal immunoreactivity for CEA., Introductions Sweat gland carcinoma is very rare with a reported incidence of less than 0.005% of all tumour specimens resected surgically (Tulenko and Conway, 1965) [1]. Case report A sixty year old male patient presented to us with a solitary swelling over the left chest wall since two months. Discussion Cutaneous apocrine gland carcinoma, a subtype of sweat gland carcinoma, is a very rare malignant neoplasm arising in areas of high apocrine sweat gland density. The variability of the histological features even in the same tumour, and its rarity, have contributed to some confusion regarding the classification of sweat gland carcinoma. Conclusions Sweat gland carcinomas are a rare group of tumours with potential for local destruction as well as distant metastasis. Wide surgical excision along with regional lymph node dissection in the presence of clinically positive nodes is the recommended treatment. However, a frequent follow up is essential to detect early recurrence as well as distant metastasis.

Ruptured uterus is an obstetric and surgical emergency that can lead to maternal or fetal death. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. The incidence of ruptured uterus is 0.3 to 1.7% in women with scarred uterus, and 0.03 to 0.08% among women with unscarred uterus. We report a rare case of spontaneous uterine rupture at 30 weeks of gestation with missing fetal limb. Later on, after doing emergency laparotomy the missing limb was found in the abdominal cavity of the patient who had an unscarred uterus. Uterine rupture occurring in an unscarred uterus is sometimes an unpredictable event. Abdominal pain occurring on a pregnant woman should be seriously managed. Ultrasound scan and external electronic fetal monitoring should be carried out rapidly so as to diagnose the uterine rupture at the earliest.