A 29-year-old woman presented to the emergency room with complaints of abdominal pain for five days, multiple episodes of vomiting, mild fever for two days and mild abdominal distention. On examination abdomen was soft with mild tenderness and distention. There was no palpable mass and hyperperistaltic bowel sounds were present. Per rectal examination showed soft stools. Routine blood investigations were normal. Naso gastric drainage was bilious around 100 ml on insertion. An erect plain X-ray of the abdomen showed few gas filled small bowel loops with a few air fluid levels. Ultrasound examination of the abdomen revealed multiple minimally dilated fluid filled bowel loops. Computerised tomograhy of the abdomen showed dilatation of small bowel loops 4 -5 cm in diameter with transistion point seen at the level of proximal ileum. The large bowel distally appeared collapsed [ ABSTRACTTrichobezoars can rarely present with obstruction. This is usually due to collection of a hair ball in the stomach. We encountered an interesting case of small bowel obstruction due to a jejunal trichobezoar. The treatment generally is an enterotomy with removal of the hair ball. We report a case of a 29-year-old post partum female who presented to us with sub acute intestinal obstruction. Exploratory laparotomy revealed an impacted mass in the distal jejunum which was removed per anum without an enterotomy. Postoperative gastroscopy did not show trichobezoar in the stomach. This case highlights the importance of trichobezoar as a differential diagnosis in young women with small bowel obstruction that can be treated without an enterotomy and avoiding the risks and morbidities associated with it.

The child improved gradually, and at 6 months follow-up, he had good cosmetic outcome with improvement of vision.

No abstract

Infection along the congenital dermal sinus tract is well known. However, congenital dorsal dermal sinus presenting with intramedullary abscess is quite rare. The sinus tract usually presents in the midline and acts as a portal of entry for infection that may manifest as meningitis, extradural or subdural abscess and may further involve the cord. Surgical drainage of pus and complete excision of the sinus tract is the standard treatment. Here we describe an infant with an infected congenital dorsal dermal sinus with atypical presentation as large paracentral abscess in the upper back. We further highlight the importance of recognising and treating these skin dimples even when clinically silent to avoid catastrophic complications.

Abdominal complications after ventriculoperitoneal (VP) shunt surgery for hydrocephalus have been known to occur. The more common complications include peritoneal pseudocyst, obstruction of the lower end, and shunt infection. Perforations of the intra-abdominal hollow viscera leading to spontaneous extrusions of the peritoneal catheter via the natural orifices have also been reported. A rarer phenomenon still is the migration of the lower end of the VP shunt through the anterior abdominal wall, leading to the formation of a spontaneous umbilical fistula at a site unrelated to the surgical site. Eight cases have been described in the literature so far with various causes elucidated. We report this condition in a child 4.5 years after his shunt surgery and postulate different mechanisms for both early and late presentations of this condition.