Acute pancreatitis is commonly diagnosed clinically, with its classical presentation of upper abdominal pain, backed by raised serum levels of enzymes amylase and lipase. However, unusual presentation of this common surgical emergency as a psoas abscess is a rare fi nding which can lead to missed diagnosis with a fatal outcome. We present here two such cases of acute necrotising pancreatitis masquerading as psoas abscess, with no classical clinical symptoms and only mildly raised levels of serum amylase and lipase. The region of pancreas involved by necrosis infl uenced the site of presentation of the psoas abscess. In the fi rst case, acute necrotising pancreatitis involving head and neck of pancreas presented as psoas abscess presenting in the right lumbar region, while the left side collection due to pancreatitis involving body and tail of pancreas manifested as an abscess in left fl ank. While evaluating the aetiology of a psoas abscess, a diff erential diagnosis of necrotizing pancreatitis should be kept as a possibility.
Hydatid cyst remains a global health problem. Intraperitoneal hydatid cyst rupture is a life-threatening complication because it causes serious hemodynamic instability and allergic reactions. No clearly defined guidelines exist for dealing with ruptured cysts or intraperitoneal spillage, though emergency exploration remains the standard approach. We present here a case of a 35 -year- old woman who developed spontaneous rupture of a Giant hepatic hydatid cyst. However, patient could not be taken up for emergency surgery in view of very poor chest condition. She was managed by placement of an intra peritoneal drain and lavage with hypertonic saline. Subsequently, patient underwent two surgeries for definitive treatment of the giant hydatid cyst. At one year of follow- up, patient has no evidence of any recurrent disease. Intraperitoneal drain placement and lavage with hypertonic saline may be considered an option to contain peritoneal implantations while patient is being optimised for exploration.
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