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Introduction: This study aims to predict the mortality and morbidity of patients with peptic ulcer perforation by PULP score. This scoring system has been chosen as the variables required (age, comorbidities, concurrent steroid use, shock on admission, serum creatinine levels, time from perforation to admission, and ASA scores) can be easily calculated with available investigations in hospitals. This study was done in the department of general surgery Dr D. Y. Patil medical college, hospital, and research institute. Fifty patients admitted with peptic ulcer perforation were included in this study after getting their informed consent. Scores of 0-7 were associated with low risk, and 8-18 were associated with a high risk of mortality preoperatively. Result 50 patients were studied in the last two years i.e. November 2018 to October 2020, 43 (86%) were males, and the remaining 7 (14%) were females. 9 (18%) experienced death, and 41 (82%) survived. 20 (40%) were morbid, and the remaining 30 (60%) were not morbid. Eight patients of high risk died, and 20 patients of low and high risk had morbidity. A comparison of this study with M. H. Moller et al., the study showed that the results are almost similar, except for slightly increased mortality and morbidity rates observed in patients with a score of 8-18. Conclusion PULP score is easy to calculate risk stratification of a patient with a perforated peptic ulcer so that patients with higher scores can receive greater intensive care.

Diaphragmatic hernia is protrusion of the abdominal contents into the thoracic cavity. It is a congenital defect of the diaphragm. It is most commonly encountered in infancy but rarely in adults. Here, we would like to present a rare case of 75-year-old male with Bochdalek's hernia. The patient had presented for the first time in his life for his symptoms. This case report emphasises the rare presentation of Bochdalek's hernia in an elderly male. The patient was treated using minimal access surgery i.e., laparoscopic approach and hence had a better post-operative outcome.

Highlights • Among the oesophageal tumour, only less than 10% are benign and leiomyoma is the most common tumour representing approximately two-thirds of the cases. • Malignant transformation in leiomyomas are rare and cannot be accurately identified with needle aspiration biopsy making resection followed by histopathological evaluation vital. • Malignant transformation in leiomyomas is rare and cannot be accurately identified with needle aspiration biopsy making resection followed by histopathological evaluation vital., Introduction Benign tumors of the esophagus are rare. However, among them, leiomyomas are common. Tumors larger than 5 cm are rare and may present as dysphagia or epigastric pain. Combined esophagoscopy and video-assisted thoracoscopic surgery or laparoscopic trans hiatal resection are used the management of leiomyoma of esophagus. Presentation of case This case report illustrates the case of a young male who presented with dysphagia and occasional dyspnea. Imageology demonstrated an esophageal mass which on surgical exploration and histopathology, confirmed the diagnosis of leiomyoma. Discussion Esophageal leiomyomas vary in their presenting size from a few centimeters to greater than 5 cm which are rare. The preferred surgical technique for leiomyomas is transthoracic enucleation without opening the mucosa, which is easier, faster, and safer compared to resection. In our patient, due to the size and location of the tumor, it was resected using an abdominal approach, and a distal esophagectomy and esophagogastrostomy were performed. Conclusion A multi-modal approach involving both the endoscopic and radiologic examinations is crucial in ensuring that the morbidity of malignancy is avoided.

Head and neck cancer is the sixth most common cancer worldwide. The single most important factor affecting prognosis for squamous cell carcinoma is the status of the cervical lymph nodes. Metastasis to the regional lymph nodes reduces the 5-year survival rate by 50% compared with that of patients with early-stage disease. The American cancer society reports that 40% of patients with squamous carcinoma of the oral cavity and pharynx present with regional metastases to the cervical lymph nodes. This activity presents the steps for safe and optimum neck dissection. Objectives of the study were to identify the anatomical structures in neck dissection, review the complications of head and neck surgery and summarize the importance of care coordination and to improve outcomes for patients undergoing head and neck surgery.

The existing coronavirus 2019 (COVID-19) pandemic is challenging healthcare systems at global level. We provide a practical strategy to reform pathways of emergency elective onco-surgery and colorectal surgery in the COVID- 19 pandemic. The novelists, from areas affected by the COVID-19, thought to outline the key-points to be conferred. Responsibilities were allotted, concerning specific characteristics of surgical emergencies, onco-surgery and colorectal surgery during the pandemic, including the administrative management of the catastrophe in India. The endorsements were collected and summarized. During the swift spread of COVID-19, it remains thoughtful to halt non-cancer procedures and prioritize surgical emergencies. Endoscopy, proctological procedures have to be completed selectively. With colorectal emergencies, a conservative approach is recommended. Detailed procedures should be followed when operating on COVID-19 patients, using committed personal protective equipment and adhering to specific rules, containing minimally invasive surgery. These guidelines summarize the strict instruction of entry/ exit into theatres and operating block as well as advice on performing procedures carefully to decrease risk of contracting the virus. It is likely that restructuring of health system is required, at central, state, and district levels. A description of the strategy adopted in Dr. D.Y. Patil Medical College Hospital, Kolhapur is provided. Evidence on the management of patients requiring surgery for surgical emergencies, onco-surgery and colorectal conditions during the COVID-19 pandemic is presently deficient. Healthcare professionals have succeeded with high volumes of surgical patients during the pandemic, could be useful to alleviate some risks and decrease exposure to other patients, public and healthcare staff.

Spindle cell sarcoma is a rare tumor that arises most commonly from the peripheral and deep soft tissues. It usually occurs in the extremities but rarely present as a large abdominal mass, and in this case it was a recurrent tumor involving whole of rectus muscle on right side. We report the case of a 42 year old male who presented with abdominal swelling and distention. CT scan showed a mass occupying the whole of the abdomen and pelvis. Exploration of abdomen revealed a hard mass about 13×10×11 cm in size. Complete excision was done, the huge defect was closed by transposition of left side rectus abdominus muscle with prolene mesh, which was a challenging task in this case. On histopathology and immunochemistry a high grade spindle cell carcinoma was confirmed.