CASE 1

6 months old boy, was brought to surgical OPD with chief complaints of
Non palpable testis on right side since birth.
The other testis is normal
No history of pain in inguinoscrotal region.
No history of trauma to scrotum in past.
No history of any swelling in scrotum.
Bowel and bladder habits are normal.

Child was a normal vaginal delivery with normal AFI, full term low birth weight with
normal milestones.
EXAMINATION
Patient is conscious cooperative and well oriented to time place and person.
Pulse - 120/min, R/R - 26/min, Temp. - 98.6 F
Secondary sexual characteristics normal.
P/A Soft, Nondistended Non Tender
Local Examination - Right scrotum Empty, Non Tender and smaller as compared to left
side. A small swelling 1 cm in diameter can be felt at inguinal canal.
Left scrotum is normal with palpable testis.
Cough Impulse positive on right side.
CASE 2
A 06 years old boy was brought to surgical OPD with chief complaints of
-Abnormal stream of urine while micturating from the undersurface of the penis since
birth.

Child was a normal vaginal delivery with normal AFI, full term with normal milestones.
EXAMINATION
Patient is conscious cooperative and well oriented to time place and person.
Pulse - 84/min, R/R - 16/min, Temp. - 98.6 F
Secondary sexual characteristics normal.
P/A Soft, Nondistended Non Tender
Local Examination - Non circumcised with external urethral meatus seen at subcoronal
region with mild ventral chorded. Bilateral testis can be felt in the scrotum.
Hooded perpuce on dorsal aspect of glans.
CASE 3
A 02 months old boy was brought to surgical OPD with chief
complaints of

Cystic swelling in the midline in the lower back about five cms in
radius since birth.

No history of fecal or urinary incontinence

Child was a normal vaginal delivery with normal AFI, full term with
normal milestones
EXAMINATION
Patient is conscious cooperative and well oriented to time place and person.
Pulse - 104/min, R/R - 21/min, Temp. - 98.6 F
P/A
Soft, Nondistended Non Tender
Local Examination:
Fluctuant Cystic swellling seen on the lower back in the midline about 3
cm in radius .
Trans illumination Positive.
Cough Impulse positive.
CASE 4
A 24 years old male came to surgical OPD with chief complaints of

-Perianal purulent discharge since two months.

There is history of perianal abscess in past for which incision and

drainage was carried out.

No history of fever, pain, rigours or chills

EXAMINATION

Patient is conscious cooperative and well oriented to time place and person.

Pulse - 68/min, R/R - 14/min, Temp. - 98.4 F

P/A Soft, Nondistended Non Tender

L/E - A scar mark present at 2 o clock position. An external opening can be seen at 3 o clock
position 2cm from anal verge with seropurulrnt discharge being expressed on pressing

DRE : A fibrous cord like structure can be felt at around 9 o clock position . No mass palpable.
Examining finger stained with normal colour stools

Proctoscopy : Normal
CASE 5
A 32 years old female came to surgical OPD with chief complaints of

-Constipation since 2 months.

-Something coming out per rectum since one month.
-Bleeding P/R since 1 month.

Bleeding was painless, bright red in colour and was not mixed with
stools. Bleeding was perceived on the toilet paper.

No history of weight loss/ loss of appetite .

No history of obstipation.
No history of Mucous in stools.
EXAMINATION

Patient is conscious cooperative and well oriented to time place and person.

Pulse - 76/min, R/R - 15/min, Temp. - 97.6 F

Pallor - positive

P/A Soft, Nondistended Non Tender

Local Examination:
DRE :-Persianal skin positive. Mass seen at 3 , 7 and 11 O clock position. No mass palpable. Finger
stained with normal colour stools. Rest normal.

Proctoscopy :- Bluish coloured mass seen at 3 o clock and 7 o clock position about 4 cm from
anal verge
Case 6
o 15 y old female, student, presented to emergency with history of
o multiple episodes of vomiting x 4 days
projectile in nature
contains partially digested food,
yellow in color,
foul smelling
not blood tinged
o abdominal distention x 2 days
increasing progressively with time
sudden onset
relieved after vomiting
o History of corrosive substance ingestion is present x 1 month back for which
patient was managed conservatively.
 On examination:

Patient is conscious, cooperative, oriented, emaciated, with sunken eyes, dry coated
tongue, PR – 110/ min, BP – 96/60, RR – 22/min.

On abdominal examination:
Abdomen is protuberant, with visible peristalsis present in upper abdomen from left to
right. J shaped lump is present in upper abdomen in epigastric region extending into
the left hypochondrium with tympanic note on the lump. Succussion splash is present
and stomach is dilated on ausculto-percussion test.

Patient was diagnosed as case of gastric outlet obstruction after radiological

investigations and underwent an operative procedure to aid in feeding until definitive
procedure is planned.
Case 7
• 43 y old male presented to emergency with chief compliant of road traffic accident
with blunt trauma chest x 1 hour back. Complaint of difficulty breathing is present
with complaint of pain in chest.
• On examination:
• Patient is conscious, oriented with GCS- 15/15.
• PR- 106/ min
• Bp – 100/60
• Spo2 – 79%
• RR – 36/ min
• Trachea deviated to right
• Tenderness is present over L upper chest. With bony crepitus present. Air entry is
decreased over L side of chest. No abnormality detected over right side of chest.
• Patient immediately underwent an operative procedure.
On examination:

Left sided chest drain present , column functional with no

air leak, serous discharge present with improper dressing.
Peridrain skin is normal.
Case 8
o A 35-year-old man, strained to pick up a heavy table, he suddenly felt a sharp pain in his
right groin. Later, he noticed that a painful bulge had developed in his groin which
disappeared when he laid on his back and re-appeared on standing/walking. After several
months, the pain and the bulge in his groin increased. no history of weight loss or altered
bowel habits. There are no complaints of fever or lower urinary tract symptoms.
On examination:

A swelling begins about midway between the anterior superior iliac spine
and the midline, progressing medially for about 4 cm, then turning toward
the scrotum, on the right side. The swelling is reducible, with positive
cough impulse and negative transillumination. Right testis is felt separately.
Left scrotum and testis show no abnormalities. Overlying scrotal skin is
normal. Rest of general physical and systemic examination is
unremarkable.
Case 9
• A 47 year old female, married,G2P2, came with c/o a lump she felt in her right breast on
Self breast examination, 6 months ago. It has gradually enlarged in size since then and
redness of overlying skin has developed. History of dimpling of skin overlying the lump
since 1 month
• There is no associated history of pain or nipple discharge (bloody or otherwise). She did
not notice any weight loss or loss of appetite. No history of any swelling in the left breast
and neck swelling, cough, chest pain or hemoptysis. No history of fever. She attained
menarche at age 13. Her last child birth was 12 years ago. Presently, she is menopausal.
Local Examination:
On inspection, there is approx. 3 x 3 cm mass in right breast in upper outer quadrant, with dimpling of
overlying skin and erythema.
On palpating, it is firm to hard in consistency, nodular, non-tender, mobile horizontally but not
vertically, fixed to the overlying skin but not to chest wall. There is no ulceration. Nipple and areola
show retraction but no ulceration or discharge. Axillary tail is free from mass . About 1.5 x 1.5 cm
firm to hard, mobile, non-tender lymph node is palpable in right axilla.
Contralateral breast is normal on inspection and palpation with no lymphadenopathy in left axilla.
General examination is remarkable for mild pallor. Rest of systemic examination is normal.
Case 10
• 43 y old male , presented to emergency with chief complaints of fever which started
12 days back, insidious onset, which was low grade initially and later became high
grade, associated with rigors and chills. And history of pain abdomen x 3 days, initially
started over right lower abdomen and later spread to involve the whole abdomen in
past one day. History of nausea is present.
• Exploratory laparotomy was done and patient was found to have ileal perforation.
 ON EXAMINATION
Patient is conscious , alert , oriented . Pulse 80/min , bp 120/76 mmhg. Temp 98.5F.
On abdominal examination :
soft, non distended with midline laparotomy scar with ileostomy in right iliac fossa with
normal surrounding skin. Stoma is well functioning with fecal discharge.
Case 11
 HISTORY

01 year old male child with term normal vaginal delivery presented with swelling in
the left inguinoscrotal region, increased on crying
 Local EXAMINATION

-Left sided inguinoscrotal swelling present .

-Reducible .

-Not Possible to get above swelling.

Case 12
 History

30 year old male presented with swelling in the left scrotum

which is painless, gradually increased in size.
 Local Examination

• Swelling present in the left scrotal region .

• Non reducible .

• Soft in consistency with sensation intact .

• Possible to get over the swelling.

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Case 13
❖ Kailash s/o Bherulalji ,30 year , hindu, married male, resident of Doda admitted in
surgery ward with alleged H/o Road traffic accident by cartwheel after which he had
complaints of

• Pain in left lower leg * 15 days.

• Swelling in left lower leg * 14 days.
• Pus Discharge from swelling * 10 days
• Ulcer over left lower leg * 10 days
LOCAL EXAMINATION :

• Single large ulcer present on dorsum of left lower foot extending from 5cm away
from great toe to lateral malleolus.

• Irregular shaped ,nearly 15cm * 7cm in size.

• Margin- inflamed and oedematous.

• Edge-Sloping and punched out

• Floor- Slough present

• Base-underlying Muscles and bones.

• Skin around Ulcer is hyper pigmented.

Case 14
 History

40 year old male presented with complaints of :

• Dragging pain in scrotum.

• Swelling for 2 months

 Local EXAMINATION

⮚ Swelling present in the left scrotum with dilated tortous veins in the upper pole of
the testis.

⮚ No impulse on coughing.

⮚ Swelling reducible on lying down.

Case 15
66 year old male, pars ram daily wager of kishtwar presented with complaints of:

• On and off pain in the left leg for 30 years.

• Recurring ulcers in the left leg for 27 years.
• Pigmentation of left lower limb.
Local Examination
Inspection :

• Patient is examined in standing position.

• Long, tortuous and dilated veins are seen extending from above the medial malleolus to above the
knee.
• Localised swellings are seen on the antero-medial aspect of the left leg along the course of the
long saphenous vein.
• Skin of the lower left leg is hyperpigmented and thickened.
• There is eczema over the medial malleolus.
• The toes are hyperpigmented.
• There is no impulse on coughing at the saphenous opening.
Inspection

Lower left leg (Medial Aspect) Lower left leg (Lateral Aspect)

Dept. of Surgery, Gauhati Medical

College & Hospital
 Inspection
• There are two ulcers present on the lower left leg. One is
above the medial malleolus with scab over the
ulcer, and another ulcer above the lateral malleolus.

Dept. of Surgery, Gauhati Medical

• Size:
Medial malleolus: 11x7cm (apprx)
Lateral malleolus: 4x2cm (apprx)

College & Hospital

• Shape:
Medial malleolus: Irregular
Lateral malleolus: Vertically oval
• Margins: Irregular, with a sloping edge (Both ulcers)
• Floors: Covered with scab.
• No discharge or bleeding present.
Case 16
A 26 years male patient presented with a gradually increasing swelling in the back
of the neck for last 4 years . The swelling was about 2 cm in size at the onset and
then gradually increased in size to attain the present size of about 5 cm, no history
of rapid increase in size of the swelling , no pain over the swelling , no other
swelling in other parts of the body.
 On local examination
• A soft, globular swelling, 5 cm in diameter is found in the back . Surface is
lobulated and the margins are rounded, well defined and slips under the finger.
Fluctuation and transillumination are negative. The skin is free and the swelling
is freely mobile on the underlying structures. The swelling becomes more
prominent on contraction of the underlying trapezius muscle.
Case 17
A 30 years male patient presented with a swelling in left side of the scrotum for last 3
years. The swelling is slowly increasing in size. There is no history of alteration in size
of the swelling during standing, walking, with strenuous activities or on lying down.
There is no pain over the swelling and patient has no other complaints.
 On Local Examination
• On inspection there is swelling on left side of the scrotum. The swelling does
not show expansile impulse on cough. On palpation it is possible to get above
the swelling. The swelling is soft cystic in feel, surface is smooth, margins are
rounded, non-tender, fluctuation is positive, transillumination is also positive, no
palpable expansile impulse on cough is present, dull on percussion. The testis
cannot be felt separately from the swelling.
Case 18
 History

■ A 1 ½ year old male child was brought to the hospital by his

parents with following history :

■ Status Loop sigmoid colostomy for ano-rectal malformation 1 ½

year back

■ Patient was diagnosed as ano-rectal malformation/imperforate

anus at the time of birth and was operated on 4 day after birth.
th
 On examination

■ Child is active, alert, moving all limbs, well built, no pallor.

■ P/A: soft,nontender,non distended, A flush stoma is seen in left iliac fossa extending into
lumbar region having 2 lumens. Peristomal skin is normal.

■ Stoma bag contains thick fecal content.

Case 19
■ A 10 month old girl child was brought to the hospital by her parents when they noticed
progressive swelling of the head.

■ There was history of poor feeding and one episode of vomiting.

■ There was no history of trauma or fever.

■ There was n.o history of abnormal body movements

■ Baby was born by full term vaginal delivery and is breastfed.

■ Immunization as per IAP schedule.

 On Examination

■ Child is active and moving all limbs.

■ On inspection there was enlargement of head with dilated scalp

veins.

■ The anterior fontanelle is bulging.

■ Limbs tone is normal and there is no neuro-deficit.

Case 20
A 30 year old male presented with slowly growing swelling in the
back of the chest for last 3 years .
Swelling was about 1cm in size at the onset and then gradually
increased in size.

Patient comlaints of occasional discharge of greyish white material

from swelling which has offensive smell.
No other swelling in other parts of the body.
On local examination:
A soft globular soft , cystic swelling 3cm in size present on the back of the
chest.
Surface is smooth and margins are well defined.

Tansillumination are negative.

There is punctum on the surface of the swelling and skin is fixed to the
swelling.
Swelling can be indented by pressure.
Case 21
5 months old child presented with complaints of split in lip and
palate since birth.
Associated with difficulty in feeding with nasal regurgitation.
Not associated with any nasal deformity or any respiratory
symptoms.
On local examination:

slit shaped defect present on the lip on the left side of the
philtrum forming incomplete cleft lip.
CASE 22
60 year old male presented in emergency with complaints of:
urinary retention
pain suprapubic region.

History of similar complaints in the past.

On abdominal examination:

abdomen is soft , suprapubic bulge present.

ON digital rectal examination:

prostate grade 3.
Case 23
30 year old male presented in emergency with alleged history
of road traffic accident with complaints of
loss of conciousness
vomiting 2-3 episodes
history of nasal bleed
On examination :
GCS: 13/15
Puipls bilateral equal size reactive to light
pulse 60/min
bp 110/70 mmhg
chest bilateral clear
per abdomen soft non tender non distended.

Local examination:
stitched wound about 5 cm over left frontal region
bilateral black eye .
Case 24
25 year old male presented with complaints of :

Swelling back side of chest for 5 days

Associated with pain, severe in nature , throbbing pain.

No history of fever.
On local examination:

There is swelling on the back of the chest about 6 cm in diameter .

Swelling is tender and fluctuant.

Overlying skin is red and shiny.

Case 25
35 year old male patient presented in surgery emergency with history of
road traffic accident with trauma to chest.

History of breathlessness present.

History of chest pain present.

No history of loss of conciousness, vomiting or ENT bleed.

On examination:

Patient is tachypniec, pulse 110/min, bp 100/60 mmhg , spo2 84% at room air.

GCS: 15/15, Pupils : bilateral equal size reactive to light.

Chest decreased air entry on left side with paradoxical breathing pattern.

Per abdomen : soft, non distended.

On local examination: patient has bruises over left side of chest with bony crepitus.
Tenderness present on the left side of the chest.