Areca Nut - An Unusual Cause Of Small Intestinal Obstruction

Ingested foreign bodies are commonly encountered in clinical practice, especially in children. Till now, no case has been reported in the literature where a small intestinal obstruction was produced as a result of foreign body (areca nut) ingestion. We report a case of a 30-year-old female clinically presented as an acute intestinal obstruction of 4 days duration. Her plain X-ray abdomen showed multiple small intestinal fluid levels. Abdominal ultrasound showed dilated loops of small intestine. Contrast-enhanced computed tomography abdomen showed an intraluminal non-enhancing lesion near ileocecal junction. Exploratory laparotomy revealed 3 cm×2.5 cm× 2.5 cm rounded foreign body (swollen areca nut) causing an intestinal obstruction which was removed by enterotomy. There was no ileal stricture or diverticulum noted. Post-operative period was uneventful

Surgical manifestations of scrub typhus: A diagnostic dilemma.

Scrub typhus, a zoonosis caused by Orientia tsutsugamushi, is a systemic febrile illness. The disease presents with diverse clinical manifestations, ranging from subclinical disease to multiorgan failure and fatal disease. It may rarely present as an acute abdomen which may lead to a diagnostic dilemma. We describe two serologically confirmed cases of scrub typhus presenting as acute abdomen—one mimicking acute appendicitis and the other acute cholecystitis, both managed non-operatively. A high index of suspicion, along with subtle indicators in the history and clinical examination help avoid unnecessary surgery in such cases.