An incisional hernia containing a gangrenous gallbladder: a case report and review of the literature.

We present a 76-year-old male who presented to the emergency department with 24 hours of sudden onset, severe abdominal pain. Physical exam and laboratory analysis indicated acute cholecystitis, and a CT scan demonstrated a ventral hernia containing an inflamed gallbladder. This patient was managed operatively with an open cholecystectomy. The ventral hernia was not repaired at the index operation in the setting of frank gallbladder necrosis. The patient recovered well after a short post-operative stay. This report is intended to illustrate an unusual presentation of acute, gangrenous cholecystitis with herniation through the ventral abdominal wall.

Does altitude increase the risk of traumatic aortic injuries? A retrospective cohort study among six level I trauma centers in the United States.

BACKGROUND: Traumatic aortic injuries (TAIs) are rare but are associated with a high mortality. Prior studies have shown skiers and pilots, whose injuries occur at high altitudes, are at an increased risk for a TAI. The purpose of this study was to examine the effect of altitude on the incidence of TAIs across all causes of injury. METHODS: This retrospective cohort study at six Level I trauma centers (8/1/2016-1/1/2020) included adult blunt trauma patients with a chest or abdomen injury. High altitude injuries (> 5000 ft.) were compared to low altitude injuries (≤ 5000 ft.). The primary outcome was incidence of TAI. RESULTS: There were 8562 patients, 37% were at high altitude and 63% at low altitude. High altitude patients were older (p < 0.01), more often Caucasian (p < 0.01) and had a higher ISS (p < 0.01). There was a significantly greater incidence of TAI at high altitude than low altitude (1.5% vs. 1.1%, p = 0.01). The median altitude was significantly higher for patients with a TAI than for patients without a TAI (5100 ft. vs. 1400 ft., p = 0.01). After adjustment, high altitude patients had 2-fold [OR: 2.4 (1.6, 3.7)] greater odds of having a TAI than low altitude patients. CONCLUSION: TAIs were more prevalent among high altitude injuries. Providers should be aware of the increased incidence of TAIs at high altitudes particularly when there is a delay in diagnosis and transfer to a trauma center with appropriate resources to manage these critical injuries. TAI screening at high altitude trauma centers may improve survival rates.