Perforated isolated jejunal diverticulum: a rare cause of acute abdomen

A 45-year-old female presented with pain in peri-umbilical region for past one day along with history of non-bilious vomiting and non passage of stool and flatus for past one day. On physical examination, patient was afebrile, mild dehydration was present, tachycardia of 102 beats per minute with normal blood pressure. On clinical examination, the abdomen was diffusely tender with rebound tenderness. Bowel sounds were absent. Laboratory investigations revealed leucocytosis. An erect plain chest X-ray was done, didn’t reveal any gas under the diaphragm. Contrast enhanced computed tomography abdomen was done which showed a hollow viscus perforation with intra-abdominal free air and pelvic free fluid. Patient was resuscitated with IV fluid, broad-spectrum antibiotics were started and immediately taken up for exploratory laparotomy. Three jejunal diverticula identified at mesenteric border, with pin-head perforation in one of the diverticula. Small bowel resection including the three diverticula and primary end-to-end anastomosis was performed. Post-operative period was uneventful. Patient discharged on satisfactory conditions. This case stresses the importance to consider this entity in cases of unexplained gastrointestinal symptoms because any treatment delay may lead to unsuccessful clinical outcome.

Primary Malignant Melanoma of the Lung: Case Report and Literature Review.

Primary malignant melanoma of the lung (PMML) is an extremely rare tumour with only sporadic case reports. We report the occurrence of PMML in a 58-year-old female. Although extremely rare, it must be considered in the differential diagnosis of bronchogenic carcinoma and a detailed systemic examination must be done to rule out any primary skin or eye involvement.

MSCT angiography diagnosis of thrombosis in external jugular venous aneurysm: case report and review of literature.

True venous aneurysms are rarely-observed causes of neck swelling reported in children. We describe a 59-year-old female with a history of left-sided neck swelling due to external jugular venous aneurysm diagnosed by MSCT angiography. Thrombosis in external jugular venous aneurysm as in this case is extremely rare. Incidental note was made of the coexistent right internal jugular phlebectasia. A brief review of literature of this entity has been discussed.

Tubercular splenic abscess in an immunocompetent patient--a rare entity.

Tubercular splenic abscess is an uncommon entity. It has been reported in association with immunodeficiency states. Tubercular splenic abscess in an immunocompetent patient is extremely rare. A 24 year old female who had already received a complete course of anti-tubercular therapy (ATT) for pulmonary tuberculosis was diagnosed as having tubercular splenic abscess. She was successfully managed by performing splenectomy. Operative findings and histopathological examinations confirmed the diagnosis.

Primary small gut volvulus in adult presenting with hematemesis.

Small gut volvulus is rare in adults and usually presents with acute intestinal obstruction. We report a 25-year-old man with primary small gut volvulus who presented with hematemesis. The gangrenous gut was resected at laparotomy. He is well 3 months later.

A 35-year old man with a non-resolving pleural effusion.

A thirty-five-year old male, a nonsmoker, was referred to us for evaluation of progressive pulmonary disease. His clinical course during the past 2 years was characterized by paroxysmal attacks of cough with scanty mucoid sputum. This was accompanied by intermittent fever and malaise. There was no history of wheezing, nasal symptoms or loss of weight. Eighteen months prior to referral, based on his symptomatic and roentgenologic profile, he was clinically diagnosed as a case of tuberculous mediastinal lymphadenitis. He was initiated on antituberculous therapy (ATT) comprising rifampicin 450 mg, isoniazid 300 mg, pyrazinamide 1500 mg and ethambutol 800 mg once daily. Prednisolone (10 mg thrice daily) was added after 2 months when the patient did not experience any relief. He was however irregular with the oral steroids and stopped it after 1 month. One year prior to referral, while on ATT for 6 months, he had few episodes of blood-streaked sputum, episodic exertional dyspnoea, and rightsided chest pain that increased on coughing and deep breathing. This was diagnosed as right-sided pleural effusion, and the patient was initiated on second line ATT in the form of kanamycin 1gm intramuscularly, sparfloxacin 400 mg, prothionamide 750 mg, clofazamine 200 mg, clarithromycin 500 mg, thiacetazone 150 mg and isoniazid 300 mg once daily. Kanamycin was stopped after 6 months but the other drugs were continued for a period of 1 year. In spite of regular second line ATT for 1 year, the patient remained symptomatic and as the effusion persisted, he was referred to us for evaluation. Physical examination revealed a middle-aged male in no acute distress. There was no clubbing or cyanosis. Chest examination suggested a right-sided pleural effusion. Examination of other systems, including an ophthalmologic referral, did not detect any abnormality.

In vitro evaluation of sulfadrugs against fungi causing otomycosis.

The efficacy of four sulfadrugs i.e., sulfadiazine, sulfamethoxazole, sulfaguanidine and sulfamoxole were taken in different doses (500, 1000, 1500, 2000 and 2500 ppm) to test their effectiveness against five pathogenic organisms for the control of mycelial growth and sporulation. Amongst the drugs tested sulfamethoxazole seems to be most effective against most of the test fungi showing 96.78, 90.53, 86.62, 54.16 and 43.91 percent inhibition in mycelial growth of P. nigricans, A. flavus, A. corymbifera, A. niger and C. albicans, respectively at its 2500 ppm dose in the basal medium. Gradual reduction in sporulation in all the test organisms almost in all the sulfadrugs have caused inhibition in sporulation, in comparison to their respective controls. Maximum inhibitory effect of sulfadiazine was recorded in A. niger showing 77.26 percent inhibition in the mycelial growth at a dose of 2500 ppm. Sulfaguanidine at its higher dose i.e., 2500 ppm proved to be most toxic against A. corymbifera causing 56.39 percent inhibition in the mycelial growth, while the same dose could not be found much effective against other test fungi. Sulfamoxole was found to be quite effective against most of the test fungi causing 47.16 to 85.86 percent inhibition in the mycelial growth. A gradual inhibition in the vegetative growth and sporulation or budding in all the test fungi was noted by increasing the concentrations of the test sulfadrugs.