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.
Intrahepatic gallbladder is a rare congenital variant among the ectopic gallbladder. Inadequate preoperative imaging studies might mislead the surgeon and most of the times can create unnecessary complications in the setting of cholecystectomy. Often these anomalies are either picked up intraoperatively or by retrospective diagnosis. Patients usually are at a high risk for developing cholelithiasis due to abnormality in the contractile ability of the gallbladder. The clinical symptoms can be misleading to many of the clinicians as recurrent dull aching right upper abdominal pain for many years, treated for acute peptic disease and dyspepsia.
Hemosuccus pancreaticus is a rare cause of obscure and intermittent upper GI bleeding, often life threatening. Usually seen in a patient with chronic alcoholic pancreatitis complicated with pseudoaneurysm of splenic artery in most of the cases. In the given case reports it was pseudoaneurysm of the posterior branch of inferior pancreaticoduodenal artery (IPDA) which accounts for less than 0.07% of total 10% of pseudoaneurysm of visceral arteries caused by hemosuccus pancreaticus. These patients usually present with an obscure moderate upper GI bleed. Early clinical, endoscopic and radiological diagnosis helps to determine the appropriate method of management. Most of the cases require the endovascular interventions like glue embolisation or metal coiling or beads, very few cases end up with explorative laparotomy. Here we report a rare case presentation of upper GI bleed due to pseudoaneurysm of IPDA in hemosuccus pancreaticus, it’s diagnosis and management.
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