BackgroundRichter’s hernia has an early misleading presentation with tendency to strangulation due to common lack of obstructive symptoms which may lead to delay in diagnosis and hence increased mortality. Rarely inguinal Richter’s hernia may present with an uncommon complication of spontaneous fistula. The development of spontaneous faecal fistula secondary to incarcerated inguinal hernias is much rarer among the adult population as compared to the paediatric age group. Most of these fistula have been reported from developing countries like India and Nigeria and is usually the result of poverty, lack of knowledge, neglect, late presentation and lack of proper management.Case presentationA 62 years old male presented with chief complaints of multiple openings with faecal discharge in the right groin for last 20 days with no history of constipation, trauma, and urinary or other abdominal complaints. CT scan revealed a small gut loop communicating with anterior abdominal wall. Exploratory laparotomy revealed a loop of distal ileum adherent to the internal inguinal ring which was retrieved back into the abdominal cavity. There was perforation over the loop. Resection of the segment of ileum involved was done with ileo-ileal hand sewn anastomosis and the internal inguinal ring was closed from inside of the peritoneal cavity. The openings in the skin over the inguinal region were communicated with each other and laid open due to cellulitis of the area involved and pus discharge.ConclusionSpontaneous faecal fistula in inguinal region following rupture of strangulated Richter’s hernia especially in adults is very rare and can occur even in absence of obstructive symptoms. In presentation of any groin swelling, there is need for an early accurate diagnosis followed by prompt treatment. The delay in its diagnosis and management may result in this rare complication of spontaneous faecal fistula. This reflects the state of health care in the developing world and needs to be addressed by the concerned authorities.

Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively.

HighlightsMeckel’s diverticulum (MD), a remanant of omphalomesenteric duct, is the most common congenital malformation of GIT.Most patients are asymptomatic. Patients develops symptoms due to its complications like bowel obstruction, hemorrhage, diverticulitis, Littre’s hernia or perforation.Case presented with persistent features of subacute intestinal obstruction due to herniation of bowel loops through unusual mesentery of Meckel’s diverticulum extending from base of diverticulum to the band which was running from it’s tip to adjacent mesentry encircling the herniated loops of intestine forming a complete hernial sac; a rarest way of presentation.Limitation of imaging modalities in diagnosis of complications of diverticulum.Surgical intervention indicated for patients with intestinal obstruction or high risk of incarceration. The treatment option is surgical resection with diverticulectomy and reduction of internal herniation.

HighlightsA case of internal abdominal herniation through a defect in transverse mesocolon with congenital abnormality of hands and feets.Reduction along with derotation of gut with closure of the rent and fixation of the caecum to lateral peritoneum done.Due to the risk of strangulation of the hernial contents, even small internal hernias are dangerous.Herniation through transverse mesocolon is very rare and preoperative diagnosis of mesenteric defect is difficult.Surgical decision-making is on the basis of clinical findings of intestinal strangulation or ischemia.