Delayed Splenic Rupture due to an Occult Primary Injury.

Spleen, due to its unique position and relative mobility, is the most vulnerable organ in blunt abdominal injuries. After splenic trauma, hemodynamically unstable patients are treated with splenectomy. Delayed splenic rupture presents 48 to 72 hours after blunt abdominal trauma and is a rare entity. It is usually associated with low-velocity blunt injuries. The sequela is usually a minor trauma that is concealed initially and presents later as subcapsular hematoma, hemodynamic instability, abdominal pain, and positive Kehr's sign in most cases. Computed tomography is the investigation of choice in such cases. We discuss here a case of delayed splenic rupture that presented after eight weeks of a minor abdominal injury due to a fall. The patient presented with a tender left hypochondrium, positive Kehr's sign, and tachycardia. Computed tomography of the abdomen revealed delayed splenic rupture and hemoperitoneum. As the initial imaging is usually normal in these cases, a routine follow-up and close monitoring of trauma patients can help in the early detection of complications. Key Words: Splenectomy, Splenic rupture, Kehr's sign, Hemoperitoneum.

Double Peptic Ulcer Perforation due to Cumulative Effects of Post-surgery Stress and NSAIDs: A Rare Event in Surgical Practice.

Peptic ulcer disease affects a large number of people around the world. Complications occur in 10-20% of patients and perforation develops in 2-14% of the cases. It can either be in the pyloric part of the stomach or in the first part of duodenum. Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) abuse and smoking are noted to be the most common risk factors in developing countries. Other risk factors are steroid abuse, post-surgery stress, burns and Zollinger-Ellison syndrome. Although small perforations can be treated conservatively but Graham patch repair is the treatment of choice. Double peptic ulcer perforation is a rare event with only a few cases reported worldwide. This patient presented with double peptic ulcer perforation in emergency due to post-surgery stress. She had cesarean section 10 days earlier with delayed recovery. Key Words: Peptic ulcer disease, Perforation, Graham patch repair, Cesarean section.