Introduction and Importance: Intramuscular hemangiomas are benign lesion that rarely occurs within the skeletal muscle of the head and neck regions. These lesions present with nonspecific symptoms resulting in only a few instances of accurate preoperative diagnosis. Case Presentation: A 20-year-old male presented with swelling over the nape of the neck on the right side. On clinical examination, the solitary swelling was 4×4 cm on measurement, soft on consistency with regular margin, fluctuant, with no skin changes over the swelling, nontender, no restriction in range of motion of the neck, and no pulsation felt. Clinical Findings and Investigations: Ultrasonography and contrast-enhanced MRI revealed intramuscular hemangioma involving the right splenius capitis muscle with no extension to adjacent muscles and minimal extension to the subcutaneous tissue. Interventions and Outcome: Excision of the lesion along with splenius capitis was performed with stable postoperative hemodynamics. Conclusion: Since intramuscular hemangiomas pose a challenge in preoperative diagnosis, it requires the sensible use of imaging modalities. Although several treatment modalities have surfaced, intramuscular hemangiomas require definitive operative management to reduce their recurrence.

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Introduction and Importance: Intussusception is a rare surgical condition in adults less commonly confined to small bowel. Adult intussusception is an indication of surgical resection due to possibility of ischemia and malignant pathological cause like gastrointestinal stromal tumor (GIST) as in this case. Case presentation: A 32-year-old male presented with abdominal pain and vomiting for 3 days. Vitals parameters and abdominal examinations were normal. Abdominal ultrasonography revealed target sign suggesting ileoileal intussusception in right lower quadrant. Abdominal contrast-enhanced computed tomography of abdomen showed features suggestive of ileoileal intussusception. Diagnostic laparoscopy was done which was later turned to laparotomy for segmental resection and anastomosis of ileum for ileoileal intussusception. Polypoidal growth noted in the resected section of ileum was found to be GIST (CD117 and DOG-1 positive) which was considered to be the lead point. Patient recovered well during postoperative period and later referred to oncology clinic for chemotherapy. Clinical discussion: Intussusception and subsequent obstruction are very uncommon presentation in a patient with GIST because of their tendency to grow in an extraluminal fashion. As intussusception is rare in adult, high level of suspicion and proper imaging technique plays important role in diagnosing the condition. Conclusion: Ileoileal intussusceptions due to GIST are a rare clinical entity in adult intussusceptions and generally have a vague variable clinical presentation thus requiring high index of clinical judgement and suspicion with judicious use of imaging.

Introduction and Importance: Primary thyroid tuberculosis is an extremely rare extrapulmonary involvement by the causative agent, Mycobacterium tuberculosis. Its rarity and resemblance to thyroid malignancy led to unnecessary aggressive operative interventions. Case Presentation: A 54-year-old female presented with recent onset dysphagia and foreign body sensation in the throat for 3 months, and anterior neck swelling since last 10 years. Clinical Findings and Investigations: A single nodular firm anterior neck swelling was present which moves with deglutition. Thyroid function test was normal. Ultrasonography thyroid revealed TIRADS-3. Fine-needle aspiration cytology was suggestive of papillary carcinoma of thyroid. Interventions and Outcome: Total thyroidectomy with central compartment neck dissection was performed. Histopathology of the thyroid specimen revealed tubercular thyroiditis. Postoperatively, Mantoux test and interferon gamma radioassay were positive. Antitubercular therapy was given for total of 6 months. Conclusions: With ultrasonography-guided fine-needle aspiration cytology, preoperative diagnosis of primary thyroid tuberculosis is quite challenging even in tuberculosis endemic countries. So, it should be considered one of the differential diagnoses despite negative relevant history and without clinical cervical lymph nodes involvement with cytology proven suspicious papillary thyroid cancer before proceeding for surgical intervention.

Introduction and Importance: Injuries from animal attack are one of the major public health problems at present scenario globally. Proper documentation is required for the study of different types of injuries caused by animal attacks so that early intervention can be done during life-threatening conditions. Case Presentation: A 36-year-old male presented with an alleged history of attack by two rhinoceros sustaining injuries over the abdomen, chest, shoulder and thigh. Clinical Findings and Investigations: There was a lacerated abdomen with evisceration of the stomach, small intestine, transverse colon and omentum and a lacerated wound over the left lateral thigh and left buttock along with the right shoulder. Extended Focused Assessment with Sonography in Trauma ultrasound showed minimal free fluid in the pelvis. Blood profile revealed reduced haemoglobin and deranged prothrombin time/international normalized ratio. Interventions and Outcome: Patient underwent exploratory laparotomy twice with repair of diaphragmatic injury, excision of avulsed greater omentum in the first setting and repair of gastric perforation in the second setting with stable haemodynamic status. Conclusion: Abdominal evisceration injury by rhinoceros attack is life threatening though rare. Its management should consist of assessing for and controlling associated haemorrhage, assessing for bowel content leakage, covering the eviscerated abdominal contents and early reduction of viscera if there is no active bleeding.