Isolated penile Fournier’s gangrene is a rare condition causing significant morbidity to the patients. It occurs due to urinary tract infection or trauma. We describe an elderly male who presented with blackish discoloration of the skin of the penis with fever. Examination revealed a necrotic patch over the shaft of the penis without any other foci of infection around the perineum. Penis was debrided, and the antibiogram showed Escherichia coli sensitive to amikacin. He received seven days of antibiotics, and the wound granulated well. A split skin graft was used to cover the wound to prevent contraction. This unusual presentation requires expeditious management to prevent mortality and morbidity.

Adenocarcinoma is the most common variant of gallbladder carcinoma. Adenosquamous carcinoma and pure squamous cell carcinoma are rare variants accounting for only up to 3% of the tumors. Pure squamous cell carcinoma of the gallbladder is reported and its incidence is less than 1%. Usually they present at advanced stage and many of the times these are unresectable. Hence survival in patients with squamous cell carcinoma is less than adenocarcinoma, and carries a bad prognosis. We report a rare case of squamous cell carcinoma gallbladder, which was well differentiated, diagnosed early and resected completely. Postoperatively patient is planned for adjuvant chemotherapy.

Suprapubic catheterization (SPC) is one of the standard procedures in urological emergencies. The common complications of SPC include loss of track, hematuria, catheter blockage, and catheter-related infections. However, severe complications like bowel injuries, including intestinal obstruction and perforation, can also occur. We present the case of a 54-year-old lady who had received pelvic radiation 30 years ago for carcinoma cervix. She presented to a secondary-level care center with anuria. On failure of per urethral catheterization, she repeatedly underwent unguided SPC. However, unsatisfied with her recovery, she was brought to our tertiary care center by her relatives. She was found to have inadvertent placement of SPC in the small bowel, which was confirmed preoperatively by ultrasound and CT. Intraoperatively, the SPC catheter was seen inside the terminal ileum causing ileal wall necrosis and a localized feco-purulent collection. Urinary bladder rent was also noted at the site of the earlier SPC. Resection of distal ileum with double barrel ileostomy, followed by primary repair of the bladder wall, was done. Unfortunately, she succumbed to overwhelming sepsis and expired in the postoperative period. This case emphasizes a potential higher risk of life-threatening bowel injury due to SPC insertion in patients with previous pelvic irradiation. Such highrisk cases should be approached with the utmost care, preferably under ultrasound guidance. For safe practice, the British Association of Urological Surgeons' guidelines for SPC insertion should be followed.

Superior mesenteric arteriovenous fistula is an extremely rare vascular malformation with most cases occurring following abdominal trauma or surgery. They are often asymptomatic or present with various abdominal symptoms with or without features of portal hypertension. A 30-year-old man developed fistulising of the superior mesenteric artery into the superior mesenteric vein following bowel resection surgery for an acquired midgut volvulus. Although endovascular management remains the treatment of choice in such cases due to increased morbidity of a repeat abdominal surgery, definite risks remain, such as coil migration, which happened in this case. The open surgical approach remains the only option in such instances.