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A case of an acute abdomen secondary to a ruptured spleen managed laparoscopically is presented. Laparoscopy is currently widely used for the initial diagnosis and management of such cases as an alternative to laparotomy due to the numerous advantages of the minimal access techniques. With widespread availability and adequate training in laparoscopy, minimal access surgery is likely to play a bigger role in the initial management of patients with an acute abdomen in Kenya. It is with this realisation that we present the case of a 25 year old male who presented with an acute abdomen and thrombocytopaenia due to a ruptured spleen following severe malaria that was managed laparoscopically. The aim is to highlight and encourage conservative management of acute abdomen due to splenic rupture in a patient with malaria.

A case of intestinal tuberculosis affecting the jejunum (with perforations) and the colon is presented. The objective is to highlight the challenges medical practitioners face in making a timely diagnosis of intestinal tuberculosis. It also aims to raise awareness that chronic diarrhoea and weight loss are common symptoms of colonic tuberculosis. A 26 year old university student was admitted with a three month history of diarrhoea anorexia and weight loss having been seen and treated for typhoid in several hospitals without improvement. Colonoscopy and biopsy was non conclusive. He later developed subacute intestinal obstruction that did not respond to conservative treatment. Explorative laparotomy revealed jejunal perforations with localised absesses, peritoneal adhesions with caseous nodules and mesenteric Iymphadenopathy. Histology of resected specimens was positive for mycobacterium tuberculosis.