ABSTRACT
Background: Untreated constipation can lead to fecaloma loading in colon, stercoral colonic perforation and subsequently stercoral peritonitis. Stercolar peritonitis is relatively uncommon presentation with a grave prognosis. Case Presentation: We recently managed a 46-year-old lady known HIV- infected who had a long standing history of constipation. She presented to us with history of acute generalized abdominal pain, fever, vomiting and signs of peritonism for four days. Abdominal radiography showed colonic fecal loading and pneumoperitoneum while abdominal ultrasound demonstrated free fluid in the peritoneal cavity. She underwent emergency exploratory laparotomy in which, we found a perforation at rectosigmoid junction with protruded fecaloma and significant feco-purulent peritoneal fluid. Evacuation of fecolomas, resection of perforated bowel and Hartmann’s procedure was done. The patient was sent to a high dependent unit with standard post-operative orders. She unfortunately demised on day 2 post-operatively due to intractable sepsis. Conclusion: Fecal impactions should be promptly treated to avoid fatal complications like stercoral peritonitis. Judicious selection of patients with underlying risk conditions like HIV/AIDS for referral and expert definitive management can warrant relatively favorable surgical outcome.

ABSTRACT
Pharyngeal malignancies are primary tumors arise in the head and neck. These tumors involves part of nasopharynx, oropharynx and hypopharynx Method. All patients with histologically proven malignant lesions in the head and neck region attended the Otorhinolaryngology and dental department of MNH between 1st April 2015 and 31st December 2015 were enrolled. Special designed questionnaire was used. Results: A total 438 patients with head and neck malignancies were recruited. Ones with the pharyngeal malignancies were 114. Male were 79 (69.3%) and ratio of Male to female was 2.3 to 1. Majority of the patients presented at 61yrs and above with mean age of 55.7. Tobacco use alone were 16(14%); Male were 75%. Alcohol alone was consumed by16.7% of the patients consumption was equal among the sexes. The patients did both smoking and alcohol consumption were 49(43%). On combine the risk factors alcohol, tobacco or both (alcohol and tobacco) were 84(73.7%). This was noted to be high in relation to other risk factors. The ones nether smoked nor take alcohol were 30 (26.3%). Leading involved area with malignant was oropharynx by 55.3%, hypopharynx 27.2% and nasopharynx 17.5%. Histological leading type was the squamous cell carcinoma by 77.2%, kaposis sarcoma 7.9%, lymphoma 5.3%, undifferentiated carcinoma 5.3%. Conclusion: This study shows that the prevalence of the pharyngeal malignancies among head and neck malignancies was 26%. Squmous cell carcinoma been the predominant histological diagnosis in both sexes and age.

ABSTRACT
Iliopsoas abscess (IPA) has been deemed a rare clinical entity. Traditionally, IPA has been classified as primary if no adjacent anatomic structure could be identified as the source of infection. Primary abscesses were thought to arise from hematogenous seeding of a bruised muscle and were more frequent in younger, active, male patients. Abscesses classified as secondary occur by direct spread from adjacent structures. The most frequent cause of secondary IPA listed in medical literature continues to be intra-abdominal disease, while new cases series implicating that most cases are related to skeletal infections. We report a case of a 40-year-old man complaining of recurrent fever and lumbar dermal sinuses. He was diagnosed as primary iliopaoas abscess and received surgical debridement. However, the symptom was not improved. He kept on received several debridements in the next 4 years with no recovery. Gradually, server dynamic pain and local lumbar kyphosis were developed by abscess induced spine spondylodiscitis. He received no more surgical intervention except conservative antibiotic treatment of meropenem for 6 weeks. Then, the symptoms were significantly improved. He had no more sinuses or fever recurrence. 2 years later, the patient complains nothing except some numbness at lower limbs numbness. Orthosis is suggested while walking or sitting.