A rare complication of simultaneous rupture of liver abscess with caecal perforation occurs mainly in malnourished patients and carries a high mortality rate. In invasive amoebiasis, the trophozoites penetrate the intestinal mucosal layer causing amoebic colitis which is carried along the portal circulation to produce liver abscess that is more prone to rupture in cases of immunocompromised status. Here we report 4 cases of ruptured liver abscess associated with caecal gangrene which were operated at our institute. All 4 patients were male who were chronic alcoholics and presented with ruptured amoebic liver abscess and simultaneous perforation of caecum that was identified on exploratory laparotomy. The different approaches to surgical management of these patients is discussed, wherein early identification and timely intervention remain as mainstay of treatment in all cases.
Isolated colonic injury due to blunt abdominal trauma is very rare. Modalities of detecting colonic injuries are also very inconclusive in the background of a blunt trauma abdomen. Here we present a case of blunt trauma abdomen in a 45 year old male who sustained steering wheel injury in a road traffic accident 5 days ago and presented with symptoms and signs of peritonitis. Ultrasonography showed free fluid in the pelvis that was confirmed by contrast enhanced CT of the abdomen which revealed additional intraperitoneal air pockets with hemoperitoneum. Patient was taken up for emergency laparotomy and findings included fecal peritonitis, sigmoid colon perforation with impending transection. Peritoneal lavage with Hatmann’s procedure was done. Due to lack of a definitive diagnostic method, it is very challenging to detect such injuries and this will lead to delay in treatment and subsequently results in high morbidity and mortality.
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