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.

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.