Ileosigmoidal knotting: a case report and literature review of a rare cause of acute abdomen in children.

Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels. Intraoperatively, gangrenous ileum loops were entangled around the sigmoid, and resection of the gangrenous ileum and sigmoid was performed. An end-to-end colo-colic anastomosis from the descending colon to the remaining sigmoid with a double-loop ileostomy was performed. Pediatric ISK is a rare fatal form of intestinal obstruction that progresses quickly to gangrene. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging.

Auto-Craniotomy With Leaves Implantation on the Surface of the Brain Following a Road Traffic Accident.

The development of modern vehicles that are not compatible with the roads, the rising burden of vehicles on narrow roads, and the recklessness of the vehicle's driver and pedestrians have resulted in an increase in uncommon and severe forms of head injury. We present a case of non-fatal autocraniotomy with leaf implantation inside the cranium. Foreign body implantation merit certain management adaptation from other traumatic head injuries. This case highlights the detachment of the frontal bone of the skull on the left side with a Superior Sagittal Sinus tear and leaf implanted inside the cranium. Early assessment of the patient with computed tomography (CT) of the head to identify surgically removable foreign bodies and thorough washing of the brain and scalp is recommended.