The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms. Overwhelming post-splenectomy infection (OPSI) is a serious disease that can progress from a mild flu-like illness to fulminant sepsis in a short time period. However, recognition and clinical management of OPSI is not well established. Patients who are asplenic or hyposplenic are at an increased risk for infection and death from encapsulated organisms and other dangerous pathogens. Although relatively rare, it has a high mortality rate with delayed or inadequate treatment, and therefore it is important for Emergency Physicians to be familiar with it. Durations between Splenectomy and onset of OPSI ranged from less than 1 wk to more than 20 years. Although the mortality rate from OPSI has been reduced by appropriate vaccination and education. The precise pathogenesis and a suitable therapeutic strategy remain to be elucidated. Overwhelming postsplenectomy infection (OPSI) is a serious fulminant process that carries a high mortality rate.

Diabetic ulceration of the foot represents a major global medical, social and economic problem. It is the commonest major end-point of diabetic complications. Diabetic neuropathy and peripheral vascular disease are the main etiological factors in foot ulceration and may act alone, together, or in combination with other factors such as microvascular disease, biomechanical abnormalities, limited joint mobility and increased susceptibility to infection. In the diabetic foot, distal sensory polyneuropathy is seen most commonly. The advent of insulin overcame the acute problems of ketoacidosis and infection, but could not prevent the vascular and neurological complications. Management of diabetic neuropathic ulcer by appropriate and timely removal of callus, control of infection and reduction of weight bearing forces. Management of diabetic ischaemic foot are medical management, surgical management and percutaneous transluminal angioplasty of stenosed and occluded lower extremity arteries. Foot ulceration in persons with diabetes is the most frequent precursor to amputation.

HighlightsEventration of diaphragm is an abnormal elevation of an intact diaphragm characterized by a developmental abnormality of the diaphragm musculature.Eventration may be complicated by acute gastric volvulus, chronic gastric volvulus, or chronic recurrent volvulus of the splenic flexure of the colon.Symptomatic gastric volvulus associated with diaphragmatic eventration is a surgical emergency.

HighlightsSmall bowel obstruction (SBO) is a common occurrence in adult surgical procedures.About 60% of SBO are currently accounted for adhesion mainly due to previous laparotomy.Acute, non-postoperative SBO is less common.Preoperatively, it is often difficult to identify the cause of the ileus.

HighlightsTraumatic auricular amputation due to human bite is not a common event.Human bites are as serious as animal bites because they induce a higher incidence of infectious complications.The traumatic loss of an ear constitutes a great esthetic deformity and considerably affects the patient's psychology.