Pneumoperitoneum is more pathognomonic of ruptured hollow viscera which requires urgent surgical intervention. But uncommon surgical entities may present with pneumoperitoneum. Splenic abscess is a relatively rare medical condition that results from bacteraemia. Pneumoperitoneum in a ruptured splenic abscess is very uncommon and is often misdiagnosed as a perforation. Spontaneous rupture of splenic abscess is a life-threatening emergency mandating early surgical intervention. We report a case of ruptured splenic abscess which presented with peritonitis and pneumoperitoneum, managed successfully by splenectomy.

Cecal leiomyomas are rare benign tumors of smooth muscle arising from the colonic muscularis mucosa or muscularis propria. They are usually asymptomatic in nature and, if symptomatic, may present as pain in the abdomen, intestinal obstruction, or bleeding. In some cases, leiomyoma can cause free perforation leading to peritonitis. Contrast-enhanced computed tomography (CECT) and colonoscopy were the diagnostic modalities used for evaluation. It is extremely unusual for a benign lesion of the cecum to present as a ruptured subcutaneous abscess. A 40-year-old man presented to the surgical emergency with complaints of right loin swelling and dull aching pain for one week. The patient did not have any significant medical history. Examination revealed a 5×5 cm swelling in the right anterior lumbar region. Blood investigations revealed anemia with leukocytosis. An abdominal CECT revealed a 9×6 cm heterogeneous enhancing mass lesion arising from the cecum with hypodense areas abutting the anterior abdominal wall and tracking into the intermuscular plane. The patient underwent surgical exploration, and a 9×6 cm growth arising from the cecum with a localized abscess tracking into the intermuscular plane in the right anterior abdominal wall and forming a subcutaneous abscess was intraoperatively found. A right hemicolectomy with ileocolic anastomosis was done, with external drainage of the subcutaneous abscess. Histopathological examination of the resected specimen revealed a leiomyoma of the cecum with abscess. To the best of our knowledge, this is the first report of a case of cecal leiomyoma to rupture into the subcutaneous space and present as a flank abscess.

Cystic lymphangioma of the parotid gland is an uncommon congenital lymphatic malformation. Its occurrence in patients of advanced age is infrequent. Patients usually present with painless soft swelling, often having experienced a long duration of symptoms. Lymphangioma among the salivary glands frequently involves the parotid gland. When evaluating cystic lesions of the parotid gland, cystic lymphangioma should be included in the differential diagnosis in addition to Warthin’s tumor, branchial cyst, cystic pleomorphic adenoma, and cystic mucoepidermoid tumor. Ultrasonography (USG) and magnetic resonance imaging (MRI) are useful in diagnosing cystic lymphangioma and help to identify the lesion. Fine needle aspiration cytology (FNAC) may show lymphocytes, salivary epithelial cells, and rarely, endothelial cells. FNAC is often inconclusive; this was the case in our investigation of the cystic lesion presented here of a 50-year-old woman who presented with a slowly growing swelling and a dull aching pain over the right parotid region for the past two years. On examination, there was a non-tender, cystic swelling of 5×5 cm in the right parotid region causing lifting the earlobe. There was no cervical lymphadenopathy or any facial nerve palsy associated with the swelling. USG of the parotid gland revealed a cystic lesion in the superficial lobe of the parotid. Results of FNAC performed on the lesion were inconclusive. The patient was posted for surgery and the cyst was excised. Final histopathology of the lesion gave the diagnosis of cystic lymphangioma of the parotid gland. The patient was kept under follow up for six months to watch for any local recurrence, but none occurred.