Air in gallbladder: Emphysematous cholecystitis or else?

Gas in gallstones represents a rare but well described radiological finding. Other causes of gas in gallbladder include biliary-enteric fistula, sphincterotomy, gas forming organisms cholangitis. However, gas in gallbladder raises suspicion of emphysematous cholecystitis which necessitates prompt diagnosis and management due to its rapid clinical course and high mortality rate.

Non-worrisome scenario of acute abdomen.

Differential diagnosis between benign and life-threatening pneumatosis intestinalis poses a great dianostic dilemma.

A case of right inguinal necrotizing skin and soft-tissue infection.

Mesh infection is the most common complication after elective hernia repair with an increasing incidence with time.

Intractable low back pain during acute exacerbation of systemic lupus erythematosus.

Diagnosis of acute low back emergencies during a systemic lupus erythematosus flare necessitates high clinical suspicion and early CT.

Large papillary thyroid cancer bed recurrence causing overlying skin ulceration and bleeding.

Salvage surgery is an acceptable option for palliative treatment of thyroid bed recurrence in metastatic papillary thyroid carcinoma when other non-invasive options fail to control local skin complications.

Undifferentiated shock in a cirrhotic patient: Ascites matters.

In cirrhotic patients with undifferentiated shock, early CT with emphasis in ascitic fluid density should be performed to exclude rare causes of shock such as secondary peritonitis or hemoperitoneum.

Difficult diagnosis of an air-containing, abscess-like, and mass-like pancreatic head lesion.

Duodenal diverticulosis can be a difficult CT diagnosis and should be considered in the differential diagnosis when a periduodenal mass-like structure that may contain air, air-fluid level, or oral contrast material is depicted.

An unusual case of obstructive uropathy.

Although inguinal bladder hernia associated with obstructive uropathy is an extremely rare entity, it should be suspected in elderly patients with bladder outlet obstruction presented with inguinal hernia and lower urinary tract symptoms.

Procedure of choice in a patient initially operated for a suspected epithelial appendiceal neoplasm.

In patients operated for a suspected appendiceal neoplasm, radical appendectomy is the procedure of choice because it provides definitive treatment in most of appendiceal neoplasms, except from mucinous or colonic-type adenocarcinoma and NET>2 cm.

Mystery of the lost gallstone-Part 2.

If gallbladder perforation occurs during cholecystectomy, every spilled gallstone should be retrieved to minimize possible late gallstone-related complications.

Aorto-cutaneous fistula from an infected ascending aorta graft resulting in massive hemorrhage after a Valsalva maneuver for a heavy weight lift.

In the setting of an infected prosthetic ascending thoracic aorta, prompt and definitive surgical treatment is mandatory to avoid catastrophic bleeding complications.

Mystery of the lost gallstone-Part 1.

If gallbladder perforation occurs during laparoscopic cholecystectomy, every spilled gallstone should be retrieved to minimize possible late gallstone-related septic complications.

A case of massive primary tumor growth in the immediate postoperative period.

Major surgical trauma along with discontinuation of antiangiogenic treatment can exacerbate primary tumor growth even in the immediate postoperative period.

Preoperative endoscopic tattooing for colonic polyp localization: From blue to black.

When surgical polypectomy and not segmental resection is planned, preoperative endoscopic tattooing with high-volume undiluted methylene blue should be avoided as it can result in colon perforation.

A misdiagnosed cause of early postoperative bowel obstruction.

In the setting of altered anatomy, diagnosis of superior mesenteric artery syndrome requires high clinical and imaging suspicion as the defined imaging criteria cannot be applied.

Meckel's Diverticulum in Adults: Surgical Concerns.

Since Meckel's diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Treatment of symptomatic MD is definitive surgery, including diverticulectomy, wedge, and segmental resection. The type of procedure depends on: (a) the integrity of diverticulum base and adjacent ileum; (b) the presence and location of ectopic tissue within MD. The presence of ectopic tissue cannot be accurately predicted intraoperatively by palpation and macroscopic appearance. When present, its location can be predicted based on height-to-diameter ratio. Long diverticula (height-to-diameter ratio >2) have ectopic tissue located at the body and tip, whereas short diverticula have wide distribution of ectopic tissue including the base. When indication of surgery is simple diverticulitis, diverticulectomy should be performed for long and wedge resection for short MD. When indication of surgery is complicated diverticulitis with perforated base, complicated intestinal obstruction and tumor, wedge, or segmental resection should be performed. When the indication of surgery is bleeding, wedge and segmental resection are the preferred methods for resection. Regarding management of incidentally discovered MD, routine resection is not indicated. The decision making should be based on risk factors for developing future complications, such as: (1) patient age younger than 50 years; (2) male sex; (3) diverticulum length >2 cm; and (4) ectopic or abnormal features within a diverticulum. In this case, diverticulectomy should be performed for long and wedge resection for short MD.