Pneumoperitoneum is more pathognomonic of ruptured hollow viscera which requires urgent surgical intervention. But uncommon surgical entities may present with pneumoperitoneum. Splenic abscess is a relatively rare medical condition that results from bacteraemia. Pneumoperitoneum in a ruptured splenic abscess is very uncommon and is often misdiagnosed as a perforation. Spontaneous rupture of splenic abscess is a life-threatening emergency mandating early surgical intervention. We report a case of ruptured splenic abscess which presented with peritonitis and pneumoperitoneum, managed successfully by splenectomy.

Cutaneous horn is a conical, circumscribed, dense hyperkeratotic protrusion from skin with epithelial cornification. It is also known by the Latin name ‘Cornu cutaneum’. This rare medical entity resembles animal horn but histological disparity is present between both. They are more commonly present in sun exposed sites or areas that are prone for actinic radiation, burns and hence frequently seen in forearm and upper part of face. Only few cases have been reported with cutaneous horns in unusual sites. Cutaneous horns occurring in oral cavity or perioral regions are extremely rare. The significance of knowing about this dead keratinous cutaneous horn is that it may occur as a part of or in association with a wide range of underlying pathologies, either malignant, premalignant or benign. Majority are due to benign pathologies. We report an unusual presentation of cutaneous horn in left oral commissure of a 45-year-old gentleman which is an extremely rare perioral location for such an ailment.

Background: The purpose of our study was to compare the effect of vacuum assisted closure (VAC) therapy and conventional dressings in patients with open wounds due to necrotizing fasciitis (NF) on the basis of healing rate, infection control, frequency of dressing and pain score.Methods: The study evaluated 50 patients admitted with NF requiring surgery over a period      of 18 months.  The patients were randomized to two groups. In group A patients, the wounds were managed with conventional dressings and in group B patients, negative pressure wound therapy (NPWT) was applied. Serial assessment of both groups was done for four weeks. The parameters including size of wound, wound bed, granulation tissue formation, color, amount and odor of exudate, edema, frequency of dressing, re-debridement and pain were monitored and analysed.Results: In our study, patients with NF wounds who underwent VAC therapy had earlier granulation tissue formation, resolution of infection and readiness for skin grafting. The frequency of dressing, requirement of re-debridement, resolution of edema, odor, skin maceration, inflammation around wound and pain significantly reduced in group B (VAC) when compared to conventional dressing group.Conclusions: When compared to the conventional dressing on NF wound, application of VAC helped in early appearance of granulation tissue, significant reduction of inflammation, wound odor, exudate, need for re-debridement, frequency of dressing and pain. Thus, VAC dressing can be considered as a better option in the management of NF wounds.