A Case of Perforated Duodenal Diverticular Stone.

Nontraumatic surgical emergencies constitute a major bulk of general surgical practice. Most of the cases seen fall under routine, but now and then, a surgeon or emergency physician is faced with an unusual diagnosis or a rarer presentation of a usual diagnosis. Sharing among peers their experiences with these outliers of practice helps spread knowledge and increases the experience pool. We share our experience of a 66-year-old female who presented to our emergency with upper abdominal pain of one-day duration.

A Rare and Interesting Presentation of Diabetic Ketoacidosis Caused by Native Aortic Valve Endocarditis Complicated by Aortic Root Abscess Resulting in Multiple Septic Emboli Causing Bowel Ischemia and Splenic Infarction.

Diabetic ketoacidosis (DKA) is a serious life-threatening complication of diabetes, often precipitated by infection. Infective endocarditis (IE) is a serious precipitating factor for DKA, especially in patients with a previous cardiac surgery or valvular pathology. IE can be further complicated by life-threatening embolic events, which could be fatal if not detected and managed early and effectively. Our patient is a 54-year-old diabetic who presented with DKA precipitated by native aortic valve endocarditis complicated by an aortic root abscess, which was further complicated by septic emboli to the splenic artery and superior mesenteric artery leading to splenic infarction and bowel ischemia, respectively. To our knowledge and as per the literature reviewed, no case has been reported in a single patient who presented with DKA precipitated by IE complicated by aortic root abscess and multiple septic emboli resulting in bowel ischemia and splenic infarction.

Midwakh-Associated Acute Lung Injury (MALI) in a 14-Year-Old Male: A Case Report.

Midwakh is one of the most used alternative tobacco products (ATPs) in the UAE, particularly among adolescents. We report a 14-year-old adolescent male, who presented with acute lung injury within 24 hours following the first attempt at Midwakh smoking. A high-resolution computerized tomogram of the chest (HRCT) showed bilateral interstitial pneumonia and patchy consolidation. Flexible bronchoscopy revealed bilateral petechial haemorrhages with oedematous bronchial walls. Mechanical ventilation was required for two weeks. The criteria for moderate acute respiratory distress syndrome (ARDS) were met, and a good response was achieved to a high dose of steroids, and ultra-protective mechanical ventilation with the prone position. Significant clinical and radiological recovery was achieved at three months. As per the literature reviewed, this is the first case of Midwakh-associated acute lung injury reported to date. We emphasize that physicians should be well informed about the use of ATPs and their potential severe complications.