Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively.

HighlightsMeckel’s diverticulum (MD), a remanant of omphalomesenteric duct, is the most common congenital malformation of GIT.Most patients are asymptomatic. Patients develops symptoms due to its complications like bowel obstruction, hemorrhage, diverticulitis, Littre’s hernia or perforation.Case presented with persistent features of subacute intestinal obstruction due to herniation of bowel loops through unusual mesentery of Meckel’s diverticulum extending from base of diverticulum to the band which was running from it’s tip to adjacent mesentry encircling the herniated loops of intestine forming a complete hernial sac; a rarest way of presentation.Limitation of imaging modalities in diagnosis of complications of diverticulum.Surgical intervention indicated for patients with intestinal obstruction or high risk of incarceration. The treatment option is surgical resection with diverticulectomy and reduction of internal herniation.

Background: The fundamentals in the treatment of acute peritonitis include resuscitation, treatment of septicemia, control of the contaminating source and peritoneal toilet. Numerous studies have shown the roles of different solutions such as normal saline, antibiotics and betadine as intraperitoneal lavage, in reducing morbidity and mortality of peritonitis. The objective of this study was to present our findings on the role of intraperitoneal lavage with normal saline and normal saline followed by super-oxidized solution in patients with acute peritonitis. Materials and Methods: The patients were randomly allotted by slip method into two groups of 50 each. In the control group, after the definitive surgery for the pathology of peritonitis, the peritoneal cavity was lavaged with normal saline and closed after putting drains. In the study group, after the definitive surgery the peritoneal cavity was lavaged with saline followed by 100 ml of superoxidized solution and drains were closed for 1 h after abdominal closure. The patients were followed-up for morbidity and mortality. Results: Surgical site infection (SSI) was present in 27 out of 100 cases in both groups. In the study group, out of 7 infected cases, intraperitoneal fluid cultures were positive in 6 cases, but only 3 had positive swab cultures. In the control group, out of 20 infected cases, swab culture was positive in 16 cases (p = 0.0399). Among the study group, bowel sounds return in 4.10 ± 1.20 days compared to 5.9 ± 1.17 in the control group. In the study group, fever >100°F developed in 14 (28%) patients in the post-operative period whereas in the control group it was 29 (58%) (p < 0.0024). SSI rates in the two groups were (7/50) 14% and (20/50) 40% respectively (p = 0.0034). Conclusion: This study suggests that super-oxidized solution is effective and safe in reducing post-operative complications including SSI, burst abdomen and episodes of post-operative fever.

showed a left central-type facial palsy. The patient's left extremities were weak, with muscle power grade 3 in the upper limbs and grade 4 in the lower limbs. Laboratory examination revealed no abnormalities in the serum hypercoagulable panel. Electrocardiography revealed normal sinus rhythm without arrhythmia. Computed tomography and magnetic resonance imaging ( Fig. 1) confirmed the presence of a calcified tumour in the right and medial portion of the sphenoid ridge. The tumour compressed the first segment of the middle cerebral artery (MCA), thereby resulting in an acute thromboembolic MCA territory infarct. To prevent morbidity secondary to vascular injury, the patient underwent Simpson grade III resection through the pterional approach. The tumour was adherent to the surrounding frontal lobe and vessels, and the arachnoid membrane was not preserved. The vessel compression was resolved, but the hemiparesis persisted. The pathology revealed a psammomatous meningioma. After a 3-month rehabilitation programme, the patient recovered with mild paresis in the left upper extremity.Meningioma could result in acute infarction of the MCA as in the case of ICA and anterior cerebral artery. 1,2 We suspect that hypoperfusion resulted from external compression by the meningioma, and artery-to-artery thromboembolization contributed to the pathophysiology of our patient's hemiparesis. We also want to emphasize that in patients with acute infarction, the possibility of sphenoid ridge meningioma must be considered in the differential diagnosis.

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