Abdominal cocoon in a young man / 世界急诊医学杂志（英文）

BACKGROUND: Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered. METHODS: A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy. RESULTS: The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fibrocollagenic tissues with a mixed inflammatory infiltrate, without any evidence of tuberculosis. CONCLUSIONS: Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.

Free tubercular perforation of the ileum / 世界急诊医学杂志（英文）

BACKGROUND:Peritonitis secondary to small bowel perforation is a common surgical emergency seen across the globe.METHODS:A young male patient presented with ileal perforation that was repaired primarily. He recovered uneventfully after the operation.RESULTS:Histopathology of the margins of the perforation revealed tuberculosis. A search for evidence of a primary focus of tuberculosis was unsuccessful. The patient was started on anti-tubercular therapy and he was followed up with good results.CONCLUSION:This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

Traumatic lumbar hernia / 世界急诊医学杂志（英文）

BACKGROUND: Trauma has various presentations ranging from common injuries that are easily managed to uncommon presentations such as traumatic hernia that may be missed. METHODS: Despite being operated for fracture of the femur after a road traffic accident, a 50-year-old female patient remained undiagnosed with a right sided traumatic lumbar hernia for nearly six months after the accident. In this period, the patient underwent incision and drainage thrice for swelling in the right flank which was diagnosed as an infected hematoma by a doctor. RESULTS: The patient underwent surgery for repair of traumatic lumbar hernia by combined fascia lata graft and mesh hernioplasty. She remains well on follow-up. CONCLUSION: This case underscores the need for awareness of this entity for correct diagnosis and appropriate management that are the key to avoiding complications.

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.