A 35-year-old woman was seen as an outpatient with a 3-month history of pain in the right iliac fossa. A CT scan of her abdomen revealed the presence of a mucocele of the appendix. Intra-operatively, an appendico-appendicular intussusception was found. Histology confirmed the presence of a mucinous cystadenoma with the presence of acellular mucin on the serosal surface of the appendix. This association has rarely been described in the literature. Prompt surgical intervention is advocated to prevent the subsequent development of pseudomyxoma peritonei. We present a case of intussusception of the appendix with a mucinous cystadenoma as its lead point.

Background: Chronic otitis media (COM) of mucosal type is a chronic condition of middle ear characterised by permanent perforation of tympanic membrane and hearing impairment, which is commonly seen in developing countries due to various factors such as low socioeconomic status, virulence of the organism, poor personal hygiene, increased antibiotic resistance, recurrent episodes of upper respiratory tract infections and inadequate health facilities. So, early and effective measures to be undertaken to prevent possible complications. Aim:To determine whether there is any difference in bacterial isolates in clinically diagnosed chronic otitis media compared with adenosine deaminase enzyme (ADA) level proved chronic otitis media. Materials and methods:Total 80 patients were included in the study selected on a random basis and divided into two groups. Group A consisted of 40 patients diagnosed clinically as chronic otitis media and group B consisted of 40 patients diagnosed as ADA level proved chronic otitis media. The discharge was collected from the middle ear with a sterile cotton swab and sent to the microbiology department immediately for further processing of the sample and to identify the microorganisms. A blood sample is collected from 40 patients of group B to estimate the adenosine deaminase level. Results:We have deciphered that Pseudomonas aeruginosa was the most common bacteria isolated in both the groups. In this study, none of the samples shows mixed growth or anaerobic organisms. Conclusion:From this study, we concluded that the increased level of serum adenosine deaminase can be used as one of the indicative tools in chronic otitis media and its raise indicates the chronicity of the disease. ADA level will be an essential diagnostic tool in identifying the bacterial isolates.

We present a case of a 61 years old lady operated 2 years back for severe superior mesenteric artery stenosis with a surgical vascular graft and presenting as acute severe abdominal pain and vomiting. Her CT angiography showed occlusion of the surgical vascular graft with graft migration into small bowel. Both the findings of graft occlusion and bowel perforation were optimally demonstrated on the CT angiography study. The alarm of bowel perforation in addition to graft infection was raised by the presence of air pockets within the graft and its communication with bowel lumen. Coexistent graft infection was evident on graft culture.

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Cerebrospinal fluid (CSF) fistula is an increasingly common condition these days with traumatic cause being commoner than either surgical or nonsurgical trauma. The patient usually presents either with rhinorrhea or less frequently otorrhea. Computed tomography (CT) cisternography is widely used in the diagnostic workup of such patients. It helps to localize the site of leak and to establish the underlying cause. The purpose of this article is to present an overview of CT cisternography findings in various types of CSF fistula, i.e., rhinorrhea, otorrhea, and otorhinorrhea and the management based on them. Magnetic resonance cisternography was not utilized as the CT provides bony detail much better, which is useful for the operating surgeon or endoscopist.