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Introduction: Fournier's gangrene is an extensive necrotizing soft tissue infection of the perineum affecting the skin, soft tissues, and muscles. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. Treatment of Fournier's gangrene entails treating sepsis, stabilizing medical parameters, and urgent surgical debridement. The present study was conducted to study the surgical outcome in operated cases of Fournier's gangrene in the department of general surgery at a tertiary care centre. Methods: The present prospective clinical observational study was carried out on 62 patients with gangrene of the genitalia and perineum who came to the Department of general surgery in a tertiary care centre from October 2019 to October 2021. The diagnosis of Fournier's gangrene was established clinically based on presenting history and physical examination and supported by investigations. Results: 40.32% of patients were in the age group above 60 years. There was a male preponderance with 24.59% morbidity. Scrotal swelling was the most common presenting complaint in 60 patients (96.77%). 45.16% of patients presented within 7 days and had a morbidity of 28.57% with no mortality. 77.41% etiological factor of FG was idiopathic. Diabetes Mellitus (27.41%), chronic alcoholism (22.58%), and smoking 17.74%), were the commonly observed comorbid condition. Testicular repositioning with secondary suturing was done in 65.38% of patients. Conclusion: Early stabilization of hemodynamic status and immediate debridement of whole necrotic tissues with appropriate antibiotic cover will certainly reduce the risk of morbidity. The presence of diabetes, advanced age, delayed presentation, and systemic sepsis on admission are individual risk factors described to predict mortality. [ABSTRACT FROM AUTHOR]

Introduction: Haemorrhoid is a common surgical condition occurring in 4.4% of adults with a peak prevalence between 45 and 65 years of age. A haemorrhoidectomy is the standard treatment for patients with grade III or IV internal haemorrhoids. Recently Harmonic scalpel has been used for haemorrhoidectomies, since it reduces operative bleeding. The present study was conducted to analyse and compare outcomes of haemorrhoidectomies performed with an ultrasonic scalpel and monopolar electric cautery. Material and Methods: The present study was carried out at a tertiary care centre over a period of two year from October 2017 to October 2019. A total of 60 patients, with history suggestive of haemorrhoids were screened and those diagnosed with grade III or grade IV haemorrhoids were enrolled in the study. The patients were randomised to either Group A (haemorrhoidectomy using electrocautery) or Group B (haemorrhoidectomy using Harmonic scalpel). Milligan-Morgan open hemorrhoidectomy using electrocautry and harmonic scalpel were performed as per the group. Observations: The most common age group to be involved was 31-40, 23 patients (38.3%). Males were affected more than females, with a male to female ratio of 7.6:1. The primary presenting symptom was painless bleeding per rectum in 44 patients (73%) and prolapse was seen in 33 patients (55%). 29 patients (48.3%) had grade III and 31 patients (51.7%) had grade IV haemorrhoids. Post-operative bleeding was significantly less in harmonic scalpel haemorrhoidectomy [ 3(10%), 8(26.7%), p =0.04]. Post-operative pain was significantly greater in the conventional electrocautery group as compared to the harmonic scalpel group on post-operative days 1,5 and14. Conclusion: It can be concluded that Scalpel approach have reduced pain in immediate post-operative period and at 24 hours with fewer analgesics required. We strongly advocate the use of Harmonic Scalpel devices for haemorrhoidectomy when and where possible, especially for high grade. [ABSTRACT FROM AUTHOR]

Introduction: Acute intestinal obstruction is one of the commonest and potentially dangerous surgical emergencies with a high frequency of morbidity and mortality if managed inappropriately. Although the mortality is decreasing with a better understanding of pathophysiology, improvement in radiological diagnostic techniques, fluid and electrolyte correction, potent antimicrobials, surgical management, and improvement in anaesthesia. The present prospective study was conducted to find out various etiological factors of mechanical intestinal obstruction and to evaluate morbidity and mortality in adult patients. Material Methods: The present prospective observational study of 290 patients with adult intestinal obstruction was carried out from December 2016 to October 2018 in the Department of Surgery at a Tertiary Care Hospital. The study included a total of 290 patients out of which 218 underwent surgical management and 72 underwent management conservatively, hence aetiology of intestinal obstruction was studied in the operative patients. Results:The peak age incidence was seen between 31-60 years in small bowel obstruction. Abdominal pain 283(98%) and distension 278(96%) were the most common presenting complaints. Out of 290 patients 218 (75.17%) patients underwent a surgical procedure in whom the most common intraoperative findings were adhesions and bands seen in 84 cases (38.53%) which were post-operative. Malignancy was seen in 6 cases (9.17%) involving small bowel. Adhesiolysis was the most common procedure done in 94 cases, with 78 cases of postoperative adhesive intestinal obstruction. Surgical site infection was the most common complication 109(50%). Conclusion: Clinical, radiological, and operative findings put together can bring about the best and most accurate diagnosis of intestinal obstruction. Among the factors influencing mortality and morbidity are age, state of hydration, the viability of the bowel, aetiology of obstruction, site of obstruction, delay in diagnosis and surgical intervention and associated medical illness. [ABSTRACT FROM AUTHOR]

Internal hernias mainly result from the extension of the intestine through a defect within the peritoneum or mesentery. They may be either congenital or acquired. Paraduodenal hernia (PDH) is a rare congenital anomaly that results from an error of rotation of the midgut. PDHs are the most common form of internal hernias, accounting for 53% of all internal hernias. PDHs are difficult to diagnose because the clinical symptoms are variable. Herewith we reported, a 28 year old male patient came to casualty with -c/o Pain in abdomen since 1month was admitted. This was associated with h/o abdominal distention since 4days, h/o not passing stool since 2days, h/o multiple episodes of vomiting since 2 days which was bilious & non projectile in nature. Paraduodenal hernia is very rare, and preoperative diagnosis is difficult because there are no specific symptoms or physical examination findings. [ABSTRACT FROM AUTHOR]