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A 60-year-old male was admitted to our major level 1 trauma centre following a fall from the fourth storey of a car park and landing initially on his feet on concrete. The primary survey was unremarkable apart from abdominal pain and localised peritonism in the right upper quadrant and lower lumbar midline pain. The secondary survey revealed bilateral complex calcaneal fractures, multiple vertebral fractures and sternal fracture. A trauma CT scan showed pericholecystic fluid and described by the radiology team either as cholecystitis picture or possible disruption of the gallbladder wall. Based on the patient's stable presentation, the decision was made for a diagnostic laparoscopy to explore possible gallbladder injury and other concomitant injuries.  Operative findings showed free bile in the right upper quadrant and right paracolic gutter and small amount of blood. The gallbladder did not have an obvious site of perforation but had a necrotic appearance. No further injuries identified laparoscopically after checking small and large bowel, and since no obvious perforation was identified, the decision was made to convert to laparotomy and duodenal exploration. On laparotomy, there was no evidence of duodenal or pancreatic injury on Kocher's manoeuvre and ligament of Trietz mobilisation. The gall bladder wall was stained and leaking bile, therefore a standard retrograde cholecystectomy was performed. No further intra-abdominal injuries were identified during the laparotomy. The patient made an unremarkable recovery. He was discharged home with physiotherapy for rehabilitation. We recommend a diagnostic laparoscopy and cholecystectomy for such injuries with a low threshold for duodenal exploration (Kocherization) if the perforation site is not obvious based on the high incidence of concomitant duodenal injuries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Abouelazayem et al.)

Mucosal Schwann cell hamartoma (M-SCH) of the intestinal mucosa is a rare entity and incidental finding in histological examination. Histological characteristics are Schwannonian cell proliferation in lamina propria with S100-positivity. M-SCH-like lesion in the gall bladder is even rarer and is a recently reported entity. We report this extremely rare lesion in a cholecystectomy specimen of a 4-year-old boy, which makes it the youngest patient to be having M-SCH-like lesion in the gall bladder., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Indian Association of Pediatric Surgeons.)

Gall bladder perforation (GBP) is a rare and life-threatening complication of acute cholecystitis that requires immediate intervention. The diagnosis itself poses a diagnostic challenge, if the patient presents after the perforation of the gall bladder, especially if the initial imaging techniques such as ultrasonogram (US), computed tomography (CT) scan, hepatobiliary iminodiacetic acid (HIDA) scan and magnetic resonance cholangiopancreatography (MRCP) are inconclusive. Subtle clues such as free fluid around gall bladder and contracted gall bladder should warrant the clinician as these might be the only clues suggestive of gall bladder perforation. Here we describe a case of GBP successfully diagnosed by peritoneal drainage and analysis and subsequently managed by endoscopic retrograde cholangiopancreatography (ERCP) and open cholecystectomy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Pata et al.)

Gallstone ileus is an uncommon cause of intestinal obstruction in Ghana. A patient with gallstone ileus that was diagnosed intra-operatively after being treated conservatively as adhesive small bowel obstruction for ten days is reported to highlight the importance of the clinical information in this condition. A 60-year-old Chinese male with recurrent intestinal obstruction who was initially being managed at a primary healthcare facility was subsequently referred to a tertiary hospital on account of computer tomography diagnosis of an intraluminal object obstructing the bowel. He had hypokalaemia that was corrected before surgery. Intra-operatively, a 4.5cm in diameter gallstone was removed from the terminal ileum. Gallstone ileus is rare in Ghana. A high index of suspicion is required to avoid a delay in diagnosis due to the low incidence of cholelithiasis in Ghana., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Introduction: Paragonimiasis or lung fluke disease is a typical food-borne parasitic zoonosis caused by infection with Paragonimus species . The Paragonimus is a trematode that mainly infects the lungs of humans after eating an infected raw or undercooked crab or crayfish., Case Presentation: Herein we report a case of peritoneal Paragonimiasis in the gallbladder of a 58-year-old female from Rukum district of Nepal. It was an incidental diagnosis following routine histopathological examination of the cholecystectomy specimen. She presented with the symptoms of abdominal pain, fever, cough, and had a history of consumption of partially cooked river crabs. She responded well to praziquantel and improved thereafter., Clinical Discussion: Ectopic paragonimiasis is a rare disease and it presents with few clinical symptoms so it is significantly difficult to make a diagnosis and treat the patients. Even if a sputum test and biopsy are performed, the ova or body of Paragonimus parasites may not be detectable due to insufficient amount of specimens. Therefore, thorough history taking should be given importance. The dietary history of partially cooked crab or crayfish should indicate towards a high suspicion of Paragonimiasis. Any such indication should be immediately confirmed, which in our case was done by routine histopathological examination of the cholecystectomy specimen., Conclusion: We report the case of a patient with peritoneal paragonimiasis in the gallbladder. Ectopic paragonimiasis is hard to diagnose due to an ignorance of, misdiagnosis, and the rarity of this disease. Thus, thorough history-taking and clinical suspicion of parasitic infection is essential., Competing Interests: None., (© 2021 The Authors.)