Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in polytraumatized patients including blunt abdomino-thoracic trauma due to road traffic accidents, fall from height and penetrating injuries. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. Late presentations are associated with increased morbidity. We report an interesting case of blunt traumatic diaphragmatic hernia in a 32-year-old man presenting 4 years after the initial abdomino-thoracic injury due to fall from height. He had herniation of the spleen and stomach. Through a left sub costal incision, the herniated organs were reduced and diaphragmatic defect closed with interrupted prolene suture.

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Introduction: Liver abscess can be dened as an infectious space occupying lesion of the liver. As India is a one of the tropical countries and home to 400 million people harboring E. histolytica, the causative organism of amoebic liver abscess, it is important to thoroughly understand of the liver abscess. It is caused by Entamoeba histolytica infestation. 3-9% Patients with amoebiasis may have amoebic liver disease. The amoebic liver tumor is more common in males but the pyogenic liver tumor has similar incidence of sex. Methods: Approximate 100 cases, above 14 years of age, irrespective of sex, getting admitted through SOPD, casualty or transferred from other department diagnosed as liver abscess or based on clinical suspicion, during the period of study were included in the study. All patients were thoroughly examined and case sheets were written in same set pattern to facilitate later comparison and written consent was obtained from all the patients for our study. Result: Mean age of our study group (cases) was found to be 43.45. Male: female ratio was found to be 6.12:1. The various parameters used in our study for develop scoring system are: age >50 years, duration of onset, history of alcoholism ( 5to 10 years or more than 10 years), total leukocyte count(>15000/cumm), bilirubin(>1.5mg/dl), INR(>1.5), total Sr. albumin(,3gm/dl), number of abscess cavity, total volume of cavity, pleural effusion if present on xray, diabetic status. Each parameter was assigned one point except for history of alcoholism more than 10 years, total leukocyte count >15000/cumm and multiple abscesses each of which was given 0 to 2 points.. Conclusion: Scoring systems can be introduced in any institution and can be incorporated into the management protocols of liver abscess.

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