Left paraduodental hernia causing acute small bowel obstruction

Paraduodenal hernias are rare fascinating variety of hernias that arise in the potential spaces and folds of the posterior parietal peritoneum adjacent to the ligament of Treitz. These may present with chronic intermittent abdominal pain, acute small bowel obstruction of bowel ischaemia. Treatment is by surgery. We present a case of a 32-year-old male who had previously presented to us on multiple occasions with abdominal pain that had always relived by its own. Only this time he presented with acute intestinal obstruction. The anatomy, management and significance of considering this uncommon diagnosis while examining a patient with acute small bowel obstruction are discussed

Spontaneous tubercular enterocutaneous fistula developing in the scar of a surgery done 14 years earlier

We report a case of spontaneous tubercular enterocutaneous fistula, which occurred after a long interval of 14 years after an appendicectomy. A 32-year-old male presented with the complaint of fecal matter coming out continuously from an opening present over the scar of previous surgery. The only significant past history was that of appendicectomy done 14 years back for acute appendicitis [nontubercular]. Histopathology of tissue taken from the margins of the fistulous opening showed caseating granuloma, consistent with tuberculosis. Treatment was provided successfully in the form of fistulectomy and right hemicolectomy with ileotransverse anastomosis along with a 9-month course of four-drug antitubercular treatment. Regular follow-up for the last 2 years has been uneventful