Modified Graham patch repair for cecal perforation: A case report.

INTRODUCTION AND IMPORTANCE: Acute appendicitis is a common cause of acute abdomen worldwide. The complications associated with it can sometimes be unpredictable and pose a dilemma in the management of such complications. CASE PRESENTATION: A case of 18 year female with complaints of right iliac fossa pain and vomiting was diagnosed clinically as acute appendicitis and underwent emergency open appendectomy where a cecal perforation was encountered intra-operatively for which a Modified Graham's Patch Repair was done. CLINICAL DISCUSSION: Acute appendicitis can sometimes present with complications like perforation, among which cecal perforation is rare and difficult to diagnose in the initial setting. Perforated appendicitis or colon can increase morbidity and mortality significantly. High degree of suspicion and early surgical approach can lead to identification of rare complications, which can still pose a surgical dilemma on the approach of management. CONCLUSION: Cecal perforation in suspected acute appendicitis is a rarely encountered intra operative complication. Management approaches can range from less invasive suture with omental patch repair to more invasive right hemicolectomy.

An ischemic complication of a snake bite: Case report.

INTRODUCTION AND IMPORTANCE: Snakebite is a common type of animal bite injury worldwide. The local effect can manifest as an abscess followed by cellulitis and compartment syndrome which could cause ischemic tissue damage. CASE PRESENTATION: A case of a 40-year male with a history of a snake bite 4 days back complained of swelling, throbbing pain, bluish discoloration of the skin and blackish discoloration of the little finger. Incision and drainage were done initially with disarticulation of the gangrenous little finger and finally treated with a split-thickness graft. CLINICAL DISCUSSION: Snakebite can lead to only the bite mark without clinical features, local manifestations around the bite site, systemic toxicity due to redistribution of venom and signs and symptoms due to traditional treatment. Delayed presentation and improper treatment can lead to wound infection, abscess, compartment syndrome, necrotizing fasciitis and gangrene. CONCLUSION: Snakebite is common in rural areas around the tropical world. Complications like compartment syndrome, necrotizing fasciitis and gangrene could develop following snake bite for which immediate surgical intervention is required to prevent loss of limb and life.