The management of Carcinoma of the Rectum is fairly standardized and protocolized, based on universally followed guidelines, including the NCCN, ESMO, and ASCO guidelines. However, there are certain advances and practices recommended which are contentiously requiring further debates and studies. The present study addresses these issues in its right perspective based on literature evidence.

Background: In spite of the availability of various treatments for fistula-in-ano, consensus cannot be reached as to the best form of treatment with regards to recurrence and incontinence. Fistulotomy and fistulectomy remain the two most commonly practiced surgeries. The study was undertaken to compare the recurrence rates and fecal incontinence in patients undergoing fistulotomy or fistulectomy. Materials and Methods: Hundred and ten patients with primary or recurrent fistula-in-ano of low anal type were included. Fistulectomy and fistulotomy were performed in 53 and 57 patients, respectively. The final follow-up at 6 months postoperative was done to assess any recurrence. The patients were required to fill Wexner's questionnaire at the monthly follow-up to monitor incontinence. Statistical significance of the difference of categorical and continuous variables was tested using the Chi-square test and unpaired t-test, respectively. Paired t-test was used for intra-group comparison. Results: At 6^th month follow-up, Wexner's score was normal in 49/53 (92.5%) and 52/57 (91.2%) fistulectomy and fistulotomy patients, respectively, which was not statistically significant (P = 0.564). Mean Wexner's score at 6 months follow-up was significantly less as compared to 1^st week follow-up in both fistulotomy and fistulectomy groups. Recurrence rate was 5/57 (9.4%) and 7/53 (12.3%) in fistulectomy and fistulotomy patients, respectively, at 6 months follow-up which was not statistically significant (P = 0.763). Conclusion: Fistulotomy and fistulectomy are equally effective in the treatment of low anal fistulas with acceptable rates of recurrence and fecal incontinence at 6 months follow-up after surgery.

Here, we report a rare case of large ischiorectal fossa (IRF) soft-tissue sarcoma with involvement of the rectum. The patient was operated with laparoscopic abdominoperineal resection and wide local excision of a tumor through the posterior approach. Postoperatively, the patient received adjuvant radiotherapy and chemotherapy. Surgical resection is the mainstay of treatment and includes resection of surrounding organs to get adequate surgical margins for locally advanced IRF tumors. Laparoscopic approach causes less morbidity and early recovery.

Morgagni hernias (MHs) are rare and constitute about 2% of all diaphragmatic hernias. Although uncommon, it has the potential for considerable morbidity if the diagnosis is missed. We present a case report of a 70-year-old elderly diabetic female, who presented in casualty with breathlessness, acute upper abdominal pain, and vomiting. Chest X-ray and contrast-enhanced computed tomography scan chest and abdomen revealed a right-sided MH with impending ischemia of transverse colon as content. The patient underwent emergency exploratory laparotomy with primary tension-free suture repair of hernia defect after reduction of contents back in the peritoneal cavity, and transverse loop colostomy was fashioned. Postoperative course was uneventful. MHs being rare in occurrence, present a dilemma in diagnosis. A high index of suspicion with radiological assistance is required while assessing elderly patients presenting with respiratory distress to prevent morbidity and mortality.

Only in 15% of cases, colonic volvulus is one of the causes of large-bowel obstruction. Splenic flexure volvulus is the rarest subtype of colonic volvulus (<1% of cases). We report one such case in a 50-year-old female, who was subjected to extended left hemicolectomy after stabilization. The histopathology report showed no evidence of malignancy.

Small-bowel obstruction is a common cause of acute abdomen throughout the world. Internal hernia as the cause of small-bowel obstruction is exceedingly rare and accounts for only about 1% of all acute obstructions. Of this, a very small fraction may occur through defects in the broad ligament, whether congenital or iatrogenic. The symptomatology is consistent with that of small-bowel obstruction due to any other cause rendering preoperative diagnosis extremely difficult. Most cases are recognized intraoperatively. The complications are dreaded, as bowel gangrene and perforation secondary to prolonged herniation are well documented. A high index of suspicion is, thus, needed. In this case report, we present a patient of jejunal loop herniation into broad ligament who presented with acute intestinal obstruction.