INTRODUCTIONGallbladder perforation is a rare complication of acute calculous cholecystitis in adults. Perforation of gallbladder due to enteric fever is extremely rare condition. Pre-operative diagnosis is rarely made and mortality is high.PRESENTATION OF CASEWe report a case of acalculous gallbladder perforation following enteric fever in a 14-year-old boy, who presented as acute abdomen and responded very well after emergency laparotomy and cholecystectomy.DISCUSSIONEnteric fever is common in tropics and a common cause of bowel perforation. Acute cholecystitis is a rare complication of typhoid and gallbladder perforation is extremely rare complication. Ultrasound and CT lack specificity to detect gallbladder perforation. Diagnosis is usually made intra-operatively. Cholecystectomy is treatment of choice in such cases and provides good result.CONCLUSIONGallbladder perforation secondary to enteric fever requires a high degree of clinical suspicion. In typhoid endemic region, it should be considered as a differential diagnosis in patient presenting with a history of prolonged fever and signs of peritonitis. Early diagnosis and immediate surgical intervention are very important in reducing the morbidity and mortality. Cholecystectomy is the choice with a good outcome.

No abstract

Introduction Warfarin-induced skin necrosis is a rare but catastrophic complication of warfarin therapy, ranging in prevalence from 0.01% to 0.1%. This case report discusses a case of warfarininduced skin necrosis. Case reportWe report the case of an obese, 55-year-old woman who presented with extensive skin necrosis of the left lower limb on the fifth day of warfarin therapy and responded well with early diagnosis and treatment. Discussion Warfarin-induced skin necrosis is the result of a relatively hypercoagulable state produced by warfarin. Warfarin-induced skin necrosis typically occurs in obese, perimenopausal women of around 50 years of age with high loading doses of warfarin. Warfarin-induced skin necrosis typically involves skin and subcutaneous tissue overlying areas with significant adipose tissue, such as the breast, abdomen, thigh or buttocks. It presents within three to six days after beginning therapy. Conclusion Prevention and management of warfarin-induced skin necrosis in a timely manner should be emphasised to prevent permanent tissue damage. A more gradual approach using low initial dose and gradual increase in daily doses is believed to reduce the risk of warfarin-induced skin necrosis.