The Friend Turned Foe: A Rare Presentation of Bilateral Empyema Secondary to the Perforated Appendix.

Acute appendicitis is one of the most common surgical emergencies encountered. Although studies have reported a rise in the number of cases over the past decade in Western countries, appendicitis is comparatively lower in Asian countries, mainly due to the prevailing dietary habits. Acute appendicitis can further complicate as either appendicular abscess or an appendicular lump or culminate into peritonitis following gangrene/rupture. Almost one-third of the patients with appendicitis present to the hospital with a ruptured appendix. Management of complicated appendicitis is complex, and the diagnosis itself becomes tricky when it presents unusually. Here, we describe the management of one such rare manifestation in a middle-aged female who had concomitant gangrenous appendicitis and bilateral pyothorax. This case report emphasizes that abdominal pathology can lead to bilateral intrathoracic collection without any preexisting thoracic pathology.

Left Paraduodenal Hernia Presenting as Closed Loop Jejunal Obstruction in a Young Female: An Enigmatic and Perilous Differential of Acute Abdomen.

Internal hernia is a rare cause of intestinal obstruction, accounting for <2% of cases with paraduodenal type being the most common. An internal hernia, mostly acquired, develops due to protuberance of the intestine through a gap in the peritoneum or mesentery formed as a result of an antecedent abdominal operation such as gastric bypass or liver transplant, ischemic injury, peritonitis, or trauma. Paraduodenal hernias (PDHs) are congenital anomalies, secondary to a failed fusion of mesentery with parietal peritoneum along with rotational midgut errors, causing the evolution of potential space for herniation within the left paraduodenal fossa. Primary internal hernias can have a varied clinical presentation and cause significant mortality and morbidity if left untreated. We report the case of a 20-year-old female with chronic pain in abdomen and intestinal obstruction due to left PDH (LPDH). The prompt diagnosis led to timely exploration and reduction of entrapped jejunum, with prudent closure of the hiatus, while circumventing any injury to the adjacent mesenteric circulation. No postoperative ileus arose, and recovery was uneventful.