5 While the boy presented with persistent seizure as a sign of neurotoxicity, constipation was the common symptom between our case and the previous report. Mantadakis and colleagues,6 reported a young adult, who received Vincristine and Posaconazole as prophylaxis. The

authors also reported severe peripheral neuropathy as a side effect of such combined treatment. The unique features of Posaconazole toxicity in our patient were jaw pain and ultrasonographic signs of pancreatitis. Pancreatitis has been reported as a drug Inhibitors,research,lifescience,medical reaction in the official drug information of Posaconazole; nevertheless, it has been reported in consequence of the other azole member, Itraconazole.7 Another interesting point about our patient was the occurrence of these symptoms just after he had received one single dose of Vincristine; this has not been reported in the previous few reports. Peripheral neuropathy manifesting as constipation and abdominal pain can present in patients receiving combined Vincristine and Posaconazole. Early diagnosis and conservative management are the only Inhibitors,research,lifescience,medical required managements needed in patients with ALL receiving both drugs. Not only should clinicians administering chemotherapy take heed of the interaction profile of

Posaconazole with Vincristine but they should also closely monitor their patients for possible neurotoxicity. Conflict of Interest: None declared.
A Richter’s hernia is a type Inhibitors,research,lifescience,medical of hernia in which only a part of the circumference of the bowel is entrapped and strangulated in the ABT-737 solubility dmso hernial orifice, leading to ischemia, gangrene, and perforation of the hollow viscus.1 The portion

of the bowel which is usually involved is the distal ileum; however, any part of the intestinal tract, from the stomach to Inhibitors,research,lifescience,medical the colon, may become incarcerated. A Richter’s hernia occurs when the size of the hernial orifice is large enough to entrap the partial circumference of the bowel Inhibitors,research,lifescience,medical wall, but it should be small enough to prevent protrusion of a loop of the intestine, and there should be a firm margin of the hernial ring. A Richter’s hernia progresses more rapidly to gangrene due to compromised blood supply. This may be explained by the firm constricting ring that exerts direct pressure on the bowel wall. When less than two thirds of the circumference of the bowel wall is involved, the signs and symptoms of intestinal obstruction are absent. This not leads to late diagnosis or even misdiagnosis, and thus it allows bowel necrosis to develop. The common sites of Richter’s hernias are the femoral ring and at trocar sites after laparoscopic procedures.2 The trocar site is closed routinely nowadays to prevent the development of hernia. Unusual occurrences are at the insertion site of the drainage tube following open abdominal surgery, as a Spigelian’s hernia, through the sacral foramen. A spontaneous fecal fistula is an extremely rare complication in a long standing abdominal wall hernia.