Among the atypical manifestations of dengue fever, comprising 15.8% of all cases, acalculous cholecystitis forms a small subset. Acalculous cholecystitis is managed conservatively in majority of cases and a chance of gall bladder perforation is low (2-18%). Management of gall bladder perforation in the scenario of Dengue is sometimes complicated by presence of thrombocytopenia and its complications thereof. Mortality associated with gall bladder perforation is relatively high. Gallbladder usually perforates at the fundus and is to be dealt with surgically if it doesn’t localize. Laparoscopic management of gall bladder perforation is feasible as calot’s is relatively virgin (as there is no calculous disease). Thorough peritoneal toileting is possible and a chance of intra-abdominal abscess in post-operative period is a mere speculation. Laparoscopic management results in early recovery and fewer wound complications and lesser hospital stay.

Metastatic lesions in the small bowel are more common than primary lesions and account for 0.5% of all small intestinal malignancies. Most common is malignant melanoma followed by adenocarcinoma from pancreas, colon or stomach; and squamous cell carcinoma from lung, cervix, esophagus, skin, penis, ovary, pancreas and gallbladder. Gastrointestinal involvement as a manifestation of metastatic squamous cell carcinoma with unknown primary is relatively uncommon with very few being reported in the literature. The most common presenting symptom of small bowel lesions is subacute or acute obstruction and less commonly, bowel perforation, abdominal pain or hemorrhage. It is a diagnosis which dawns upon after the surgery when histopathology proves the same and therefore a thorough workup to establish the primary starts after the bailout procedure. Its clinical course is aggressive, characterized by a short preclinical history, resistance to chemotherapy, and overall dismal prognosis with a median life expectancy of 6 to 9 months as it represents a disseminated disease.

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Recurrence of hernia has significantly reduced with mesh repair. But mesh is a foreign material which has its own complications like haematoma, infection, sinus formation, mesh migration and erosion. Mesh migration and erosion although rare, is a challenging complication which requires surgical intervention. There are very few such mesh related complications reported in the literature. Authors report a case of mesh erosion resulting in chronic infection and formation of enterocutaneous fistula following incisional hernia repair 5 years after surgery. In this case small bowel segment containing mesh was resected and primary anastomosis was done. Migration of mesh also depends on the nature of mesh (biomaterial) and type of fixation. Although many techniques of hernia repair have been described (open or laparoscopic) care must be taken to fix the mesh to abdominal wall for prevention of delayed complications. Different techniques of repair, types of meshes have been discussed to prevent such complications.