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Gastrosplenic fistula is an unusual complication of benign as well as malignant gastric and splenic pathologies. This pathology acquires an important clinical significance due to its rare association with life-threatening upper gastrointestinal haemorrhage. The aim of this article is to review the English-language literature in order to gain a better understanding of etiological factors, diagnostic evaluation, and management of gastrosplenic fistula. The systematic search of the literature was performed on PubMed and MEDLINE from January 1950 to September 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We retrieved 44 articles matching our selection criteria from the search. There were 3 case series, 37 case reports, and 4 review of the literature. In our appraisal of articles published in PUBMED, a total of 36 cases of malignant and 10 cases of benign gastrosplenic fistula could be identified. Gastrosplenic fistula is an exceptional complication of malignancies of the gastrointestinal tract. Lymphomas particularly arising from the spleen are the commonest cause. Gastric adenocarcinoma causing GSF is extremely rare. Most cases occur spontaneously, but at times, it can be secondary to tumour necrosis following chemotherapy.

Involvement of esophagus with tuberculous infection is a rare form of extrapulmonary tuberculosis. Secondary esophageal tuberculosis is much more common than primary TB. The most common source of secondary esophageal involvement is tuberculous mediastinal lymphadenitis. Esophageal tuberculosis mimics carcinoma esophagus. Clinical features are same and it is difficult on imaging studies also to differentiate the two pathologies. Misdiagnosis is common. The disease is medically curable; therefore, it is essential to make all efforts to diagnose the pathology with non-surgical diagnostic modalities in suspected cases so as to save patients from the trauma of major surgical resection. Surgical intervention is indicated for failed medical therapy and complications. A total of 133 cases of esophageal TB have been reported till date. The authors encountered 4 cases of esophageal TB between April 2011 and March 2019. The aim of this article is to present our data and to provide comprehensive review of the available literature on this pathology in order to gain a better understanding of diagnostic methods and provide guidelines for the diagnosis and management of esophageal TB.

Congenital diaphragmatic hernia (CDH) is a condition characterized by defect in the diaphragm which leads to protrusion of abdominal contents or viscera into the thoracic cavity interfering with normal development of the lungs. CDH is a developmental defect of diaphragm associated with significant neonatal mortality and morbidity. Incomplete development of diaphragm allows the abdominal content to invade the thoracic cavity resulting in compression of the developing lungs. Most of the CDH diagnosed in the new born or early childhood. Around 1% with CDH have no symptoms and may be detected incidentally. Diaphragmatic hernias can be divided into two broad categories: congenital and acquired. A congenital diaphragmatic hernia (CDH) occurs through embryologic defects in the diaphragm, and most patients present early in life rather than later. However, a subset of adults may present with a smaller CDH that was undetected during childhood. Infants with CDH often present in the neonatal period with severe respiratory distress. Early surgery is mainstay of treatment in newborn as mortality is very high in this condition. Here, we are describing very late presentation of a case of congenital diaphragmatic hernia treated by surgery with good post operative outcome. This case report summarizes how to diagnose and manage a late-presenting congenital diaphragmatic hernia to prevent further complications.

Objective: Penetrating abdominal trauma secondary to bamboo stick injury is a rare entity in the developed world. Most of such kind of trans abdominal penetrating bamboo stick injury is associated with multiple solid and hollow viscus injuries. In developing countries like India, where nearly 70% of the population reside in rural areas, it is not that uncommon. Aim of this report is to recognition of risk factors and explain optimum surgical management in trans-abdominal bamboo stick injury. Case Presentation: Here we describe a case of penetrating trans abdominal bamboo stick injury resulting due to fall over a branch of bamboo stick with multiorgan damage, which was successfully managed by early surgical exploration in our institute. Conclusion: There are many factors which can prognosticate the penetrating trauma cases. The most important factors include a long interval between injury and surgical exploration, presence or absence of shock, and other associated organ injuries at the time of admission. Early recognition of the severity of injury with surgical management is utmost necessary. These patients have high morbidity and mortality rates due to multiorgan damage and post-operative infection.

Objective: The aim of this study was to compare the post-operative effects of closed incision negative pressure wound therapy with conventional dressing in emergency laparotomy. Methods: This study was conducted from 1st November 2018 to 31st March 2020 in ABVIMS & Dr. R.M.L. Hospital, New Delhi. The potential candidates for the study were patients of 18 years and above who were admitted in surgical emergency and underwent emergency laparotomy by a midline incision. Fifty random patients were alternatively allotted to group A (25 patients) and group B (25 patients). In the patients of group A, closed incision negative pressure wound therapy (ciNPWT) was applied on midline closed wound after an exploratory laparotomy procedure. The patients in group B, standard dry gauze dressing was done. Results: The mean age of patients in group A and group B were 46.76±12.20 and 41.96±8.33 years, respectively (p-value-0.11). The wound infection was present in 12% of cases in group A and 32% in group B, but when we calculate the p-value, it was found to be statistically non-significant (p-value-0.08). Similarly, seroma formation and wound dehiscence were found less in group A as compared to group B but not reached up to a statistically significant limit (p-value 0.55 and 0.38 respectively). The frequency of dressing change was 1-2 per week in 92% of cases in group A while it was 3-4 per week in 68% of cases in group B. The mean time of the frequency of dressing change was 1.24±0.72 per week and 4.28±1.90 per week in both the groups respectively (p-value 0.05) difference in the duration of hospital stay between group A (mean hospital stay 8.20±2.34 days) and group B (mean hospital stay 8.21±3.37 days). Conclusion: Closed incision negative pressure wound therapy has no advantages over conventional dressing in terms of post-operative complications and hospital stay. However, it reduces the frequency of dressing change significantly, which reduces the mental stress of the patient and the burden of changing daily dressing.

Tuberculosis of the stomach is an extremely rare manifestation of Mycobacterium tuberculosis infection and mimics gastric carcinoma in its presentation. Most of our knowledge about this rare disease comes from case reports and there are only a few case series published on this disease and thus the majority of the part remains uncovered. Diagnosis is made commonly only after a major surgery. Endoscopy and guided biopsy are the diagnostic modality of choice. Surgery is indicated in cases which present with complications. Patients respond well to antituberculous therapy. The authors encountered 4 cases of gastric tuberculosis over 5 years. This study summarises the available literature and gives comprehensive update on this rare disease.

Self-gripping mesh can be difficult to handle during spread to the inguinal floor because it can stick or adhere to the undesired structures because of micro-grips available on its underneath surface. This article aims to describe a new technique; we named it a four-fold technique to spread the self-gripping mesh to avoid this problem. The present study was a prospective comparative study between self-gripping mesh (polyester mesh with polylactic acid grips) and sutured mesh (polypropylene) in open inguinal hernioplasty under spinal anesthesia. This study was conducted from 1 November 2018 to 31 March 2020 in ABVIMS & Dr. R.M.L. Hospital, New Delhi. The potential candidates for the study were patients of 18 years age and above, presenting with a unilateral uncomplicated inguinal hernia that underwent open inguinal hernioplasty under spinal anesthesia. Sixty patients were alternatively allotted to group A (30 patients) and group B (30 patients) for comparison between self-gripping and sutured mesh. We used a 14 × 9-cm-size self-gripping mesh, which has semi-resorbable surface on one side and resorbable micro-grips on the other side to provide immediate fixation. Mesh was folded four times in a specific sequence before placing it, thus hiding the majority of the absorbable micro-grips. In this way, only the lower medial half of the mesh has the micro-grips exposed, and the mesh can now be fixed to the inguinal ligament without fixation to unintended tissues and structures underneath. Once the mesh is placed over the pubic tubercle and medial part of the inguinal ligament, it can be unfolded in the reverse order. The four-fold technique is an excellent method to spread the self-gripping mesh in inguinal hernia surgery to avoid sticking with undesired tissues.

Rectal tuberculosis is an uncommon entity. It has unique epidemiological features, specific medical treatment and surgery is rarely indicated. The first case of rectal tuberculosis was reported in 1957. Delayed diagnosis is common. Patients who develop rectal tuberculosis have been reported to have some risk factors or associated comorbid conditions or pathologies with some form of abnormal host-defence mechanism such as acquired immunodeficiency syndrome, complement deficiency. Rectal tuberculosis has been reported to be more common in females as compared to males. Haematochezia is the most common presenting symptom. The definite diagnosis requires demonstration of Mycobacterium tuberculosis bacillus on histopathologic examination. Once a correct diagnosis has been made, rectal tuberculosis is curable with antituberculous treatment. Surgery is indicated for diagnostic dilemmas, non-responsive disease and complications. The authors encountered 3 cases in the last 10 years. The aim of this study is to provide our data on this rare disease and to review the reported literature comprehensively so as to provide guidelines for diagnosis and management.

Coexistence of carcinoma colon and tuberculosis is rare. The aim of this study is to present our 12-year experience on colonic carcinoma with coexisting colonic TB. Histopathology and imaging records of 189 patients of colonic carcinoma patients who underwent treatment in surgical unit 6 in our institute between January 2006 and December 2017 were reviewed. In 7 patients, histopathology and/or imaging studies were suggestive of coexistence of colonic carcinoma and tuberculosis. Fifteen cases of colonic tuberculosis were also reviewed. Descriptive statistics were used to summarize the data. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The duration of symptoms spanned between 2 and 7 weeks. Anorexia and weight loss were the predominant symptoms. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The morbidity was low and there was no surgery associated mortality. Clinical awareness and advancement in diagnostic studies and improvement in management strategies may guide and lead to early diagnosis, optimum therapeutic guidelines and thus improved outcome.

The tuberculous infection of major salivary glands is rare because they are relatively resistant to tubercle bacilli. The aim of this study is to present our 13 year experience on major salivary gland tuberculosis. The clinical, histopathological, microbiological and imaging records of 9 cases of major salivary gland tuberculosis were reviewed retrospectively. The cases diagnosed with either microbiological culture and/or polymerase chain reaction assay and/or Histopathological examination were included in the study. Descriptive statistics were used to summarize the data. There were 9 cases with tuberculous involvement of major salivary glands; parotid (n = 5), submandibular (n = 3), sublingual (n = 1). The most common local symptom was painless swelling present in 8 cases and constitutional symptoms were present in all the cases. The previous history of TB was present in 5 out of 9 cases. Surgical intervention was done in 2 cases of parotid TB for diagnostic purpose and therapeutic intervention was required in 1 patient. Patients responded well to medical therapy. Two patients with disseminated disease died. The major salivary gland is rare in both immunocompetent and immunocompromised patients. Diagnosis is difficult and requires high degree of suspicion especially in isolated cases. Medical management yields satisfactory results.

Submandibular salivary gland is an uncommon and unusual site for tuberculosis. It is a rare extrapulmonary manifestation of a common infection caused by Mycobacterium tubercle bacillus. Submandibular gland TB can be due to primary or secondary infection. The clinical features are non-specific and depend on its manifestations. A delay in diagnosis is common because of the rarity of disease. Direct histological examination is the best method of diagnosis. As the disease is curable with antituberculous drugs; treatment should not be withheld in suspected cases until the diagnosis is confirmed. Surgery is indicated for non-responsive disease and complications. Till date, only 15 cases have been reported in the literature. First case was reported in the year 1990. The authors encountered three cases in last 10 years. The aims of this study are to review clinical presentation, epidemiological features, diagnostic methods and to provide our data and guidelines for optimum management of this rare pathology.

Thyroid tuberculosis is a rare disease. Its incidence is low even in countries where prevalence of pulmonary tuberculosis is high (0.1-0.4%). In literature, there are only a few cases which were diagnosed as thyroid tuberculosis. It can be explained by a high resistance of the thyroid gland to infectious processes. However, the prevalence of tuberculosis has increased worldwide and thyroid involvement can be a primary manifestation of the disease. The incidence of extrapulmonary tuberculosis has been showing a progressive increase in the recent years(Barnes and Weatherstone, 1979). The most frequent clinical presentation is a solitary thyroid nodule that may present as a cystic nodule. It may also present as thyroid abscess with pain, fever and other non-specific signs and symptoms. ATT results in complete cure therefore it is important to differentiate it from other form of thyroiditis. Patients are usually euthyroid, but cases of hypothyroidism and hyperthyroidism are described. For accurate diagnosis of thyroid tuberculosis, clinical and radiological features are nonspecific and histological examination is required for confirmation of diagnosis. PCR may help in diagnosis. The authors encounter 3 cases of thyroid tuberculosis in last 5 year which are described in this article. The aim of this study is to review all the cases published in literature to describe clinical presentation, appropriate diagnostic method and possible treatment options of the disease.

Background: Midline ventral hernia is a common complication of abdominal surgeries. Laparoscopic mesh hernioplasty is novel method of hernia repair but has many complications. Venous thromboembolic complications are one of them.Methods: A prospective observational study in patients with midline ventral hernia was carried out. Based on the size of defect patients were divided into two groups (consisting 60 patients each). Group A with hernia defect size of less than 6cm and group B with more than 6 cm. Group A patients underwent intraperitoneal onlay mesh plus repair and group B patients underwent endoscopic components separation technique with intraperitoneal onlay mesh repair. Each patient was followed up at day 5 and day 30 postoperatively and Well’s score was calculated. The patients with ‘Likely’ score were taken for Doppler ultrasonography. The patients with ‘Unlikely’ score were further evaluated with D-Dimer study. Patients with raised value of D-Dimer were taken for Doppler ultrasonography.Results: Well’s score on post-operative day 1 and 5 did not show any statistical significance between both groups (p

The rare case is reported of advanced hepatocellular carcinoma (HCC) in a 50-year-old male with type 1 neurofibromatosis (NF 1). The patient presented in the surgical outpatient department with a 4-year history of multiple neurofibromas over the trunk and complaints of pain in the right upper abdomen for 4 months, progressive weight loss and loss of appetite. Investigation for both the abdominal complaints and the multiple neurofibromas led to the diagnosis of advanced HCC (according to the Barcelona Clinic Liver Cancer Sstaging and Treatment Strategy) with NF 1, and the patient is being managed on oral Sorafenib as palliative treatment. NF 1 occurs due to mutation in the NF 1 gene located on 17q, which codes for the protein neurofibromin, which has a tumor suppressor function. NF1 presents rarely with malignancy, in which case tumors of the central nervous system are the most common type. To the best of our knowledge this is only the second documented case of NF 1 presenting with HCC.

Aim/objective India accounts for the highest tuberculosis burden in the world, and abdominal tuberculosis has been an endemic surgical and gastroenterological problem. Aim of this study is to present our two decades experience on abdominal (gastrointestinal) tuberculosis. Method 756 patients, who received standard antituberculous treatment with or without surgical treatment with the diagnosis of abdominal tuberculosis from January 1996 and May 2014, were reviewed retrospectively. On the basis of clinical presentation, four groups of clinical presentation were identified and various diagnostic measures used in different groups were studied. Numeric values were determined as percent or mean ± standard deviation. Kruskal–Wallis test was used for quantitative results and chi-square test was used for qualitative results between groups. p value of less than 0.05 was considered to indicate the statistical significance. Results The duration of symptoms was variable in this study. Out of 756 patients, 64 patients gave definite past history of tuberculosis. Most of the patients in the acute pain abdomen group required surgery while most patients in chronic pain group responded well to medical management. There was significant difference in mortality among the four groups ( p = 0.025). Conclusion Prognosis seems significantly related to the severity of disease, with graver prognosis and less symptomatic improvement in more seriously ill presentations.

Aim/Objectives This prospective study aims to assess the efficacy of hyperbaric oxygen therapy in diabetic foot ulcers in relation to standard wound care.

Aim/Objectives This study aims to evaluate the role of laparoscopy in patients presenting with chronic non-specific abdominal pain and also correlate the laparoscopic findings with clinical and radiographic findings in all such patients.

Perforation peritonitis is one of the most common surgical emergencies encountered by general surgeons in India. The spectrum of aetiology of perforation differs from its western counterpart. This prospective study conducted at a tertiary healthcare centre was designed to highlight the spectrum of perforation in terms of aetiology, presentation site of perforation, surgical treatment and postoperative complications so as to improve its outcome in our region. This was a single-centre prospective cohort study conducted by the department of surgery from January 2001 to December 2014. In total, 1908 consecutive cases of perforation peritonitis admitted to surgical unit 6 were recruited in the study. Continuous variables are presented as mean ± SD, and categorical variables are presented as absolute numbers and percentages. The mean age of the patients was 34.42 years (range 18 to 60 years) and the standard deviation was ± 11.10. The majority of patients were male (77.6%). Perforated duodenal ulcer due to acid-peptic disease and small bowel perforation due to typhoid were the most common causes of perforation peritonitis, followed by small bowel tubercular perforations. Postoperative complications included wound infection 18.4%, wound dehiscence 3.9%, respiratory complications 10.5%, septicaemia 5.2%, and abdominal collection 3.9%. Perforation peritonitis is still a dreadful disease. Malignancy is a rare cause in our region. Resuscitation before surgery improves outcome. The formation of only a stoma in bowel perforations and omentopexy in the stomach and duodenum perforations rather than extensive emergency surgery contribute to low mortality.

Aims/Objectives This study aims at comparing the value of BISAP, APACHE II, and CTSI scoring in predicting the outcome of acute pancreatitis and categorization of patients based on these scoring systems.

Tuberculosis of the pancreas is extremely rare and in most of the cases mimics pancreatic carcinoma. There are a number of case reports on pancreatic tuberculosis with various different presentations, but only a few case series have been published, and most of our knowledge about this disease comes from individual case reports. Patients of pancreatic tuberculosis may remain asymptomatic initially and manifest as an abscess or a mass involving local lymph nodes and usually present with non-specific features. Pancreatic tuberculosis may present with a wide range of imaging findings. It is difficult to diagnose tuberculosis of pancreas on imaging studies as they may present with masses, cystic lesions or abscesses and mass lesions in most of the cases mimic pancreatic carcinoma. As it is a rare entity, it cannot be recommended but suggested that pancreatic tuberculosis should be considered in cases with a large space occupying lesions associated with necrotic peripancreatic lymph nodes and constitutional symptoms. Ultrasonography/computed tomography/endosonography-guided biopsy is the recommended diagnostic technique. Most patients achieve complete cure with standard antituberculous therapy. The aims of this study are to review clinical presentation, diagnostic studies, and management of pancreatic tuberculosis and to present our experience of 5 cases of pancreatic tuberculosis.

Injury to the extrahepatic biliary tract occurs frequently due to damage inflicted during upper abdominal operations, cholecystectomy being the commonest situation followed by other upper abdominal surgeries, and less often due to blunt or penetrating abdominal injury. Most traumatic extrahepatic biliary tract injuries are caused by penetrating trauma and are usually discovered during laparotomy. Diagnosis is made by noting the accumulation of bile in the upper quadrant. The gallbladder is the most commonly injured structure. Regardless of the type of biliary injury and/or management, wide and adequate drainage is essential. Any upper abdominal operation can result in biliary tract injuries. Cholecystectomy is the procedure most implicated in biliary tract injuries because it is one of the most common elective surgeries performed worldwide. If not managed properly, bile duct injuries can lead to life-threatening complications. Identification and management of biliary tract injuries demand precise judgement, expertise, timely and appropriate intervention and prevention of complications. This study aims to present detailed information and an update on biliary tract injuries.

Introduction : Periappendicitis is defined as appendiceal serosal inflammation without mucosal involvement. It is a rare benign pathology, diagnosis is difficult and carries high morbidity. A detailed literature and large series are still lacking on periappendicitis. Aim of this study is to present our clinical experience with periappendicitis. Methods : 36 of retrospectively reviewed 1232 acute appendicitis patients were found to have periappendicitis on histopathological examination. Histopathological finding of appendicitis with periappendicitis in emergency appendectomy, and cases of interval appendectomy were excluded. Descriptive statistics were used to summarize the data. Results : The most common diagnosis was salpingitis (12), followed by pelvic inflammatory disease (9), typhoid enteritis (5), peritoneal tuberculosis (3), inflammatory bowel disease (3), and amoebiasis (1), while 3 cases remained undiagnosed. Discussion : Periappendicitis is due to extra-appendicular pathologies resulting in serosal inflammation of the appendix without mucosal involvement. In the absence of any significant history, it is difficult to distinguish periappendicitis from the common entity of acute appendicitis only on the basis of clinical examination and laboratory parameters. Conclusion : Pre-operatively, it is difficult to diagnose periappendicitis, but it should be considered if the clinical signs and imaging findings are suggestive of any associated pathology in addition to the presence of typical picture of acute appendicitis and post-operatively if the patient develops any new clinical signs, as this can cause morbidity to a significant level.

Gastrointestinal stromal tumours, the most common mesenchymal tumours of the gastrointestinal tract, are immunohistochemically and ultrastructurally different from other mesenchymal tumours. They can occur anywhere in the GI tract, the commonest site being the stomach. GIST occurrence is not restricted to the bowel but can also involve unusual sites. The diagnosis and treatment of GIST have been revolutionized over the past decade. The mainstay of treatment remains surgical resection with adequate margins. Though these tumours are refractory to conventional chemotherapy or radiotherapy, they show a good response to molecularly targeted therapy with tyrosine kinase inhibitor. Hence, in cases where a tumour shows malignant potential, adjuvant treatment with tyrosine kinase inhibitor may prevent or delay relapse. This review summarises the current clinical and immunohistochemical knowledge of GISTs and their treatment.

Mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. Because of rarity, these tumors pose a diagnostic and therapeutic challenge. These tumors may remain asymptomatic, but commonly present as a painless mass. There are no clear treatment guidelines. Surgical excision with wide margin is the preferred modality of treatment. Medical therapy is indicated for inoperable and recurrent tumors. There are several isolated case reports on mesenteric fibromatosis with different and unusual presentations and its complications. Though several studies have been published on extra-abdominal fibromatosis as well as on extramesenteric abdominal fibromatosis, but extensive research studies are still lacking on mesenteric fibromatosis. The aim of this article is to present current knowledge on mesenteric fibromatosis, our experience of four cases, and comprehensive review of available literature.

Aims/Objectives To evaluate the sequential organ failure assessment (SOFA) score pertaining to the severity and outcome in acute pancreatitis, and compare its outcome with the APACHE II score in terms of accuracy and ease of operation with a view to establishing whether the SOFA scoring system can replace APACHE II in predicting severity and outcome of acute pancreatitis.

Pancreatic acinar cell carcinoma is a rare tumour, accounting for only about 1 % of all pancreatic tumours. The long-term survival for patients with acinar cell carcinoma is significantly better than the long-term survival of patients with pancreatic adenocarcinoma. As no large series of patients with acinar cell carcinomas exist, our understanding of this disease comes mainly from small case series and case reports. Aggressive surgical resection with negative margins is associated with long-term survival in these more favourable pancreatic cancers. There are no clear treatment guidelines for patients in whom complete surgical resection with curative intent is not possible. Acinar cell carcinomas are chemoresponsive to agents that have activity against pancreatic adenocarcinomas and colorectal carcinomas because of the shared genetic alterations between these cancers. The role of neoadjuvant or adjuvant chemoradiotherapy remains unproven. The aim of this article is to present current knowledge on acinar cell carcinoma and comprehensive review of available literature.

Background To compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging-magnetic resonance cholangiopancreatography (MRI-MRCP) in assessing the level and cause of obstruction in patients with obstructive jaundice, and to corroborate the preoperative diagnostic accuracy of MRI-MRCP and CT with operative findings.

Introduction Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors and to predict difficulty and degree of difficulty preoperatively by the use of a scoring system. Materials This prospective study was conducted in the department of surgery, Lady Hardinge Medical College and associated Dr Ram Manohar Lohia Hospital, Delhi, India. The parameters considered in the preoperative scoring method were old age, male sex, history of hospitalization, obesity, previous abdominal surgery scar, palpable gall bladder, wall thickness of gall bladder, pericholecystic collection and impacted stone. A total of 210 patients were included in the study. Results We found that history of hospitalization, palpable gall bladder, impacted stone and gall bladder wall thickness were statistically significant factors for prediction of difficult laparoscopic cholecystectomy. Sensitivity and specificity of this preoperative scoring method were found to be 95.74% and 73.68% respectively. Positive predictive values of this scoring method were 90% and 88% for easy and difficult cases respectively. Area under ROC curve was 0.86. Conversion rate from laparoscopic to open cholecystectomy was found to be 4.28%. Conclusion With the help of accurate prediction, high risk patient may be informed before hand regarding the probability of conversion and hence they may have a chance to make arrangements accordingly. On the other hand, surgeons also may have to schedule the time and team for the operation appropriately. Surgeons can also be aware about the possible complications that may arise in high risk patients.

Introduction: Majority of mesenchymal tumors of gastrointestinal tract are Gastrointestinal Stromal Tumor (GIST). It is, however, a rare tumor, accounting for less than 1% of primary gastrointestinal (GI) neoplasms. Though, these tumors are refractory to conventional chemotherapy or radiotherapy but show a good response to targeted adjuvant chemotherapy with tyrosine kinase inhibitors following surgical resection. Case Report: we report here a case of primary Extra-GIST tumor arising from mesentry of small bowel near duodeno-jejunal junction in a 69 years old male patient. The patient presented with a palpable mass in upper abdomen for past 15 days. On examination, a non-tender mobile lump of size around 17 × 10 cm, with bosselated surface and firm in consistency was palpable involving epigastric, left hypochondrium and umbilical region. Contrast enhanced computed tomography of abdomen revealed a heterogenous mesentric mass. On surgical intervention a mass was found involving mesentery near dudenojejunal junction without involvement of gastrointestinal tract. Complete surgical resection of the tumor was done and adjuvant chemotherapy with Imatinib mesylate was started as HPE revealing GIST with mitotic index of >10/50 HPF and 17 × 10 cm size placed the patient in high risk category. Patient was discharged on 12th of post-operative day with advice of regular follow-up. Conclusion: GIST occurrence is not restricted to bowel but can involve unusual sites also. The mainstay of treatment remains surgical resection with adequate margin. In cases where tumour has malignant potential (high mitotic figures on histopathology) adjuvent treatment with tyrosine kinase may prevent or delay relapse.

Primary hepatic angiosarcoma is a rare, aggressive tumor; composed of spindle or pleomorphic cells that line, or grow into, the lumina of pre-existing vascular spaces like sinusoids and terminal hepatic venules; with only about 200 cases diagnosed annually worldwide but it is the most common primary malignant mesenchymal tumor of the liver in adults and accounts for 2% of all primary hepatic malignancies. HAS occurs in association with known chemical carcinogens, but 75% of the tumors have no known etiology. Patients present with vague symptoms like abdominal pain, weight loss, fatigue or an abdominal mass. Hepatic angiosarcoma is usually multicentric and involves both lobes, entire liver may also found to be involved. CD31 is the most reliable marker. These tumors lack specific features on imaging, so, pathological diagnosis is necessary. There are no established treatment guidelines because of low frequency and aggressive nature of tumor, chemotherapy is only palliative, liver resection is indicated for solitary mass and liver transplant is contraindicated. The aim of this article is to comprehensively review all the available literature and to present detailed information and an update on primary hepatic angiosarcoma.