Ileal Perforation and Enteric Fever: Implications for Burden of Disease Estimation.

BACKGROUND: Ileal perforation occurs in about 1% of enteric fevers as a complication, with a case fatality risk (CFR) of 20%-30% in the early 1990s that decreased to 15.4% in 2011 in South East Asia. We report nontraumatic ileal perforations and its associated CFR from a 2-year prospective enteric fever surveillance across India. METHODS: The Surveillance for Enteric Fever in India (SEFI) project established a multitiered surveillance system for enteric fever between December 2017 and March 2020. Nontraumatic ileal perforations were surveilled at 8 tertiary care and 6 secondary care hospitals and classified according to etiology. RESULTS: Of the 158 nontraumatic ileal perforation cases identified,126 were consented and enrolled. Enteric fever (34.7%), tuberculosis (19.0%), malignancy (5.8%), and perforation of Meckel diverticulum (4.9%) were the common etiology. In those with enteric fever ileal perforation, the CFR was 7.1%. CONCLUSIONS: Enteric fever remains the most common cause of nontraumatic ileal perforation in India, followed by tuberculosis. Better modalities of establishing etiology are required to classify the illness, and frame management guidelines and preventive measures. CFR data are critical for comprehensive disease burden estimation and policymaking.

Anaplastic Rhabdomyosarcoma of Upper Lip in a 3-Year-Old Girl.

Rhabdomyosarcoma is an aggressive malignant striated muscle neoplasm commonly seen in children involving orbit, paranasal sinuses, cheek, tongue, and rarely upper lip. The anaplastic subtype is further rare and associated with poor prognosis. Herein, we report a 3-year-old female with this uncommon variant at an uncommon site.

Fibrolipomatous hamartoma of sural nerve: a new site of an unusual lesion.

Neural fibrolipomatous hamartoma is a rare benign tumour commonly involving the median nerve. Other less frequently involved nerves include the ulnar, radial, brachial plexus, superficial peroneal nerve, inferior calcaneal nerve and median plantar nerve. Involvement of sural nerve has not been reported in the available literature so far. A three-year-old female child presented with a painless swelling over the posterolateral aspect of left leg with no associated motor or sensory deficits. Radiological investigations revealed a fat density lesion with interspersed neural element in the subcutaneous plane of the left leg. Histopathological examination of the excised specimen showed features of a fibrolipomatous hamartoma of the nerve. This report describes the occurrence of fibrolipomatous hamartoma in the sural nerve for the first time in the literature. This rare tumour should be considered in the differential diagnosis of such lesions.