Gall Bladder Perforation Secondary to Enteric Fever: An Interesting Case of Acute Abdomen

Gallbladder perforation usually occur in acute obstructive (calculus) cholecystitis, and its incidence is high in patients with diabetes mellitus, recent severe trauma, critical illness, severe burn. 2-11% patients of acute cholecystitis progress to gallbladder perforation. Acute cholecystitis is a rare complication of enteric fever and perforation of gallbladder in such cases is an uncommon occurrence in pediatric population. Clinical features of spontaneous gall bladder perforation are non-specific especially in children. Ultrasound as well as computerized tomography (CT) abdomen and pelvis lack specificity for detecting gallbladder perforations in enteric fever. Diagnosis is usually confirmed intraoperatively when the gallbladder is visualized and perforation is seen. Hence the treating surgeon must consider this rare condition in differential diagnosis while treating any child with acute abdomen.

Pleomorphic Adenoma of the Accessory Axillary Breast: A Rare Case Report

Pleomorphic adenoma (PA) is the most common tumor type in the salivary gland. PA is uncommon in the breast tissue. Only 73 cases of PA of the breast have been reported in the world literature. But no case in the accessory axillary breast has been reported so far. It is most commonly seen in postmenopausal women and is characterized by an admixture of epithelial and myoepithelial cells embedded in abundant myxomatous stroma. Its clinical and histologic appearance can be challenging and may lead to a misdiagnosis of invasive carcinoma. We report a case of pleomorphic adenoma (benign mixed tumor) of the accessory axillary breast, which is an extremely rare location for this tumor.

Traumatic Spigelian Hernia in Adults: A Rare Clinical Scenario

Handlebar hernias are very rare and arise following a sudden force from a handle-like object impacting a focal area of the abdomen, which results in a disruption of the underlying abdominal muscle and fascia without necessarily disrupting the overlying skin. Other than a reducible swelling on the abdominal wall, the physical examination of such patients is usually unremarkable and the diagnosis could easily be missed. Delay in the diagnosis can lead to incarceration or strangulation of bowel loops and subsequent morbidity. A large proportion of reported cases are in children. Here, we are reporting a case of traumatic Spigelian hernia following blunt trauma in an adult male. The significance of our case is that it provides some evidence that blunt trauma to abdomen may play an etiological role in development of some Spigelian hernias in adult as well.

Sclerosing Adenosis in Axillary Supernumerary Breast: A Case Report

Swellings in the axilla especially in women are always viewed with suspicion owing to a large number of these being associated with breast carcinoma presenting as nodal metastasis. In a country like India, tuberculous lymphadenopathy is also amongst the first differentials. We present a case of a woman with left sided axillary swelling which on Fine Needle Aspiration Cytology (FNAC) turned out to be sclerosing adenosis of the accessory axillary breast. Accessory breasts may present as asymptomatic masses or cause symptoms such as pain or restriction of arm movements. Both benign and malignant tumors can arise in accessory breasts. So far cases of fibroadenoma and carcinoma breast have been reported but sclerosing adenosis has never been reported. Accessory breasts as mass in the axilla may prove to be a diagnostic challenge for surgeon. FNAC being an easy and accurate technique can be very helpful in differentiating such lesions.