Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. Here we present a 36-year-old man who came to the casualty with pain abdomen and distension for 2 days. Clinically, abdomen was asymmetrically distended more in the left hypochondrium and epigastrium region. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel. Exploratory laparotomy revealed dilated stomach with patchy gangrene over lesser curvature and fundic area. About 4 litres of brownish fluid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat). Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy. Necrosis of the stomach was confirmed on histopathology. The patient recovered well and was discharged on the tenth postoperative day.

SUMMARYWe present a case of distal large bowel obstruction, in the setting of a competent ileocaecal valve, the caecum is the most common site of perforation (for Laplace's law). We describe a case of obstruction at the rectum due to constricting carcinomatous growth, presenting with perforation of transverse colon (against Laplace's law). A 60-year-old women presented to the emergency department with acute abdominal pain. The pain was preceded by 3 days of intestinal obstruction. Clinically there was guarding and rigidity. Straight X-ray of the abdomen revealed free gas under diaphragm. Surgical exploration revealed transverse colon perforation with carcinoma of rectum. Loop transverse colostomy was performed as the patient was very sick. The patient improved slowly in the intensive care unit. To conclude, even though the caecum is the most common site for perforation in case of distal obstruction, perforation of transverse colon can occur otherwise as a unique presentation. BACKGROUND

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com Appendicular abscess in left inguinal hernia mimicking strangulationManash Ranjan Sahoo, Basavaraja C., Kumar A.T., Sunil Jaiswal ABSTRACT Introduction: The incidence of Amyand's hernia varies from 0.5-1%, whereas only 0.1% of all cases have appendicitis present in an inguinal hernia. Case Report: A 40-year-old male presented to emergency department with incarcerated left inguinal hernia and pain over the hernia since two days. Abdominal examination was normal except for tenderness and increased temperature over the left inguinal hernia. Through an inguinoscrotal incision opening of sac revealed pus and flakes with perforated appendix. Lower midline laparotomy incision was given and found the tip of perforated appendix to lie at the left deep inguinal ring. Appendicectomy with pelvic toileting was done. Bassini repair was done in the inguinal region. Conclusion:To conclude left sided Amyand's hernia is very rare. High index of suspicion is required for diagnosis and this should be kept as a differential diagnosis for such a varied presentation.

Aims and objectives: To assess feasibility, advantages, oncological safety, cost-effectiveness and short-term results of laparoscopic vs open total mesorectal excision (TME) for rectal cancer in a government sector hospital. Patients and methods: This comparative nonrandomized retrospective study analyzes the data of 70 patients with rectal cancer treated with low anterior resection (LAR) or abdominoperineal resection (APR) from May 2007 to June 2012. Of these 40 patients underwent laparoscopic TME and 30 underwent open TME. Both the groups were comparable. Results: Laparoscopic surgery took longer to perform (200 vs 150 min), but was accompanied by less blood loss (200 vs 800 ml) and fewer postoperative complications. Enteric function recovered sooner after laparoscopy than open surgery.Hospital stay was shorter for patients who underwent a laparoscopic surgery (7 vs 10 days). The mean number of harvested lymph nodes was greater in the laparoscopic group than in the open group (12 ± 3 vs 9 ± 2). Mean follow-up time was 30 months (range: 28-32 months). No local recurrence was found. Conclusion: This study shows that laparoscopic TME for rectal cancer is a safe and feasible technique with some short-term benefits over open TME.