Short-term patency of iliofemoral to tibial bypass with vascular allografts in a minority population: A retrospective analysis of a single center acute care facility.

OBJECTIVE: The aim of this study was to examine the short-term patency rates and associated factors of open lower limb, iliofemoral to tibial bypass using cryopreserved saphenous vein (CSV) in a minority population at an acute care hospital in New York City. METHODS: A retrospective analysis of patients undergoing infra-inguinal bypass from iliofemoral vessels to tibial arteries with CSV between March 2020-April 2022 at an acute care facility (Harlem Hospital Center, Harlem, New York) was performed. Data including patient demographics, comorbidities, type of operation, follow-up surveillance, and salvage procedures were collected. Results were presented in patency line graphs and a life table. Target limb revascularization (TLR) and amputation free survival (AFS) were also calculated. RESULTS: Eleven bypass procedures were included in the analysis. Patients were followed for a mean of 10.8 months. Cumulative primary patency rates at 1, 6, and 12 months were 72.7%, 54.5%, and 40.9%, respectively. TLR was 36.4% and the AFS was 66.67% at the mean 10.8-month follow-up. CONCLUSIONS: The patency rates of minority patients undergoing bypass with CSV were analyzed with creation of a life table and calculation of patency rates, TLR and AFS. The short-term primary patency rates and post-operative outcomes were found to be comparable to larger studies in non-minority cohorts. These results suggest that larger studies as well as prospective analyses and randomized controlled trials in this patient cohort and demographic are needed, as well as optimal selection of patients to determine true clinical implications.

Strangulated Gastric Hernia Following a Missed Traumatic Diaphragmatic Injury: A Case Report.

Traumatic diaphragmatic injuries (TDIs) are rare and can be life-threatening, depending on the size of the injury and the contents herniating through it. They usually result from blunt or penetrating trauma to the thoracoabdominal area, with an incidence of 0.8-5% and up to 30% presenting late. A high index of suspicion should be maintained when evaluating patients with a history of trauma (severe blunt or thoracoabdominal penetrating trauma) and upper abdominal symptoms. We present a case of a missed TDI after a left posterior thoracoabdominal stab injury, which was evaluated with a diagnostic laparoscopy at an outside hospital. He presented to our emergency department (ED) with sudden onset left-sided chest pain and uncontrollable vomiting. A CT scan was obtained and showed a distended stomach herniating through a defect in the left hemidiaphragm. The patient was immediately taken for laparoscopic exploration and repair. There was a 5 cm defect in the left posterolateral diaphragm containing a strangulated stomach (approximately ⅔) and necrotic omentum. Complete reduction was achieved and the diaphragmatic defect was repaired primarily. His postoperative course was uncomplicated. This case illustrates the importance of maintaining a high index of suspicion for TDI, despite reports of previous exploration. Missed TDI can present with herniated intra-abdominal organs, which can become strangulated and increase morbidity and mortality.

A Rare Cause of Popliteal Artery and Vein Transection: A Case Report and Literature Review.

We present a rare occurrence of popliteal vascular injury due to blunt trauma. The patient had an isolated blunt lower extremity trauma. The patient subsequently experienced moderate tenderness and non-expanding hematoma at the popliteal fossa, reduced range of motion at the knee, and diminished distal pulses. X-rays showed a patella dislocation and tibial plateau non-displaced fracture but no knee dislocation. CT angiography showed an abrupt non-opacification of the distal portion of the popliteal artery with an overlying large hematoma. Surgical exploration was performed which revealed a concomitant transection of the popliteal artery and vein with a 5 cm defect. It was repaired with an interposition graft, and a fasciotomy was also performed. Literature has noted that although the overall incidence of popliteal injuries is low, when present due to blunt trauma there is increased morbidity. A high index of suspicion is recommended for vascular injuries in all patients with blunt trauma to the lower extremities. Minimizing time to diagnosis and intervention for limb salvage and improved outcomes.

An Unusual Case of Cecal Perforation: Accidental Ingestion of a Tooth in an Elderly Trauma Patient.

Foreign body ingestion is a common occurrence in the United States, with the majority passing asymptomatically. In cases where complications occur, such as intestinal perforation, it may present as an acute abdomen with diagnostic challenges regarding the etiology. A 70-year-old male was brought to the emergency department (ED) after he jumped from the second floor of a burning building, sustaining 10% second-degree burns to his forearms. He was intubated for concerns of inhalational injury and resuscitated. His intensive care unit (ICU) course included the management of respiratory failure, sepsis, and acute kidney injury. On hospital day 28, imaging showed moderate pneumoperitoneum with ascites. He was taken for abdominal exploration, during which it was noted that there was gross fecal contamination and a 1 cm cecal perforation. After resection of the ileocecum, it was left in discontinuity due to hemodynamic instability and contamination. He was brought for a second-look laparotomy in 48 hours, and an incisor tooth was found in the right pelvis, and an ileocolic (ileum-ascending colon) anastomosis was performed. His post-operative course was complicated by an anastomotic leak and an intra-abdominal collection. Despite attempts at source control with percutaneous drainage, the patient remained septic with a poor prognosis. Goals of care were discussed, and the decision was made to de-escalate care. Although there is literature on foreign body ingestion resulting in intestinal perforation, there is a paucity of literature highlighting the importance of dental exams in elderly trauma patients, the incidence of perforation due to tooth ingestion, and maintaining a high index of suspicion for an acute abdomen in unusual presentations of sepsis.

Traumatic Rupture of Cystic Left Retroperitoneal Mass: An Atypical Presentation of Diffuse Large B-Cell Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Though the presentation is diverse, patients typically have a history of "B" symptoms and lymphadenopathy in areas such as the neck, mediastinum, or abdomen. However, a growing body of evidence suggests DLBCL can present as a cystic mass in diverse tissues. We present the case of a large cystic left retroperitoneal mass of unknown origin in a patient subsequently diagnosed with DLBCL. The diagnosis was obtained via percutaneous biopsy of the cystic mass in preparation for surgical excision. Upon diagnosis, surgical intervention was aborted, and the patient was started on chemotherapy treatment. However, four weeks into her treatment, she slipped and fell while in the bathroom and presented to the emergency department in shock with a computed tomography (CT) scan suggestive of splenic rupture. She underwent emergent splenectomy and resection of the cystic mass. She was discharged on postoperative day 7 and is currently continuing with outpatient chemotherapy. The presentation of DLBCL is notoriously diverse, however, this patient represents a unique presentation that adds to a growing body of literature suggesting DLBCL can present as a cystic mass. Pathological diagnosis should be obtained in all patients with cystic lesions of unknown origin before any surgical intervention to avoid unnecessary surgery and provide an optimal management plan.

E-scooter and E-bike injury pattern profile in an inner-city trauma center in upper Manhattan.

BACKGROUND: Electric bikes and scooters are becoming popular means of short-distance transportation in major cities. Regulations for safe riding established by ride-sharing companies and local governments have not been effectively implemented. Inner-city hospitals are at the frontline of receiving traumas related to e-bikes and e-scooters and are receiving an increasing number of injuries. The works of literature reporting these injuries are limited. METHOD: This study reviewed all the trauma activations at a major trauma center in NYC from 04/2019 to 08/2021. Patients with e-bike and e-scooter injuries were included in the study. Socio-demographics of riders, passengers, injury patterns, and outcomes were reviewed. Logistics regression was used to analyze the factors associated with Injury Severity Scale. RESULTS: We reviewed 1979 patient charts of trauma activation in the Emergency Department. We included 88 scooters, 24 E-bike, and 5 nonrider scooter injuries. 91% were male and 9% were Female victims. The majority were African American patients (34%) and Hispanic patients (46%). 87% belonged to the 18-50 years age group, and 13% were above 50 years and below 18 years were excluded from the study. 36% of victims were under the influence of drugs or alcohol and only 25% of riders wore helmets. 58% of patients were discharged from the ED, 42% required hospital admission, and 14% required ICU care. Odds of non-mild injury (moderate to critical injury) in comparison to mild injury were significantly greater with increasing age. CONCLUSIONS: The use of e-bikes and e-scooters is increasing as a means of affordable short-distance transportation but with evidence of significant injuries with varying severity. These findings suggest a need to review public policy regarding e-bike and electric scooter use regulations for the safety of riders and pedestrians; Driving While Intoxicated (DWI) law enforcement, mandatory helmet, education, speed control, creation of special lanes, and no car zones.

Right Hepatic Artery Pseudoaneurysm Presenting As Upper Gastrointestinal Bleed: A Deadly Hit and Run Following Blunt Trauma.

Hepatic artery pseudoaneurysm (HAA) is a rare complication of blunt trauma, occurring in only 1% of patients. It is life-threatening with abysmal and atrocious outcomes if not recognized early and managed promptly. Other etiologies include transjugular-intrahepatic portosystemic shunt (TIPS), pancreatitis, cholecystectomy, and liver transplantation. We report a near-miss case in a 38-year-old woman following a motor vehicle accident. She sustained Grade III/IV liver laceration (>50% subcapsular hematoma), presenting with upper gastrointestinal bleeding (UGIB). Our patient was managed emergently intra-operatively, with hemostasis promptly achieved; however, she continued to bleed postoperatively, becoming hemodynamically unstable and unresponsive to both massive blood transfusions and high-dose proton pump inhibitors. Further imaging demonstrated HAA for which coil embolization was carried out by interventional radiology (IR).

Type 2 Necrotizing Soft Tissue Infection: A Disastrous Diagnosis Not To Be Missed.

Necrotizing soft tissue infections (NSTIs) are severe, life-threatening forms of infection. Tissues from the epidermis to the deep musculature may be affected. This includes necrotizing forms of cellulitis, myositis, and fasciitis. Delayed diagnosis can lead to widespread tissue loss, limb loss, and mortality, representing a group of infectious surgical emergencies requiring time-sensitive aggressive debridement. This article presents a unique case with a particularly ambiguous and vague presentation of type 2, group A streptococcal NSTI in an intravenous drug abuser. This rapidly spreading infection subjected her to profound morbidity, with loss of all four extremities. Type 2 NSTIs are particularly challenging to diagnose as they often present without classic signs of skin changes, subcutaneous air, and crepitus. They also spread more rapidly and, as such, have a higher morbidity and mortality rate than type 1 NSTIs. We are striving to increase physician awareness of such cases, with the aim of earlier recognition and earlier limb and life-saving interventions.

Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19.

INTRODUCTION: There is paucity of data regarding C reactive protein/Albumin (CRP/Alb) ratio in patients with SARS-CoV-2 infection. We aimed to evaluate the significance of CRP/Alb ratio in COVID-19 patients. METHODOLOGY: Patients hospitalized between March - April 2020 with COVID-19, who had CRP and Albumin levels documented within 24 hours from admission were retrospectively analyzed. Unpaired Student's t-test was used for continuous and Pearson Chi-square (χ²) test for categorical variables. Univariate and multivariate logistic regression models were developed to assess the relationship between CRP/Alb and mortality. Nonparametric correlations were calculated using Spearman's Rho correlation coefficient. RESULTS: 75 patients were included. Mean age was 62.92, 26 females (34.67%) and 49 males (65.33%), mean Body Mass Index (BMI) 29.86, mean body temperature 101.3 and mean length of stay (LOS) was 14.80 days. 24 (32%) patients required invasive mechanical ventilation and 51 (68%) did not, mean CRP/Alb ratio was 6.89 and 4.7 respectively (p = 0.036). 15 (20%) patients died, 60 (80%) survived and the mean CRP/Alb difference between these groups was also statistically significant (7.74 vs 4.83, p = 0.02). LOS (OR 0.71, 95% CI 0.57.-0.88, p < 0.001) and BUN (OR 1.04, 95% CI 1.01.-1.07, p = 0.006) were independent predictors of mortality by multivariate logistic regression, whereas CRP/Alb (OR 1.21, 95% CI 0.96.-1.51, p = 0.06) was not. CONCLUSIONS: CRP/Alb ratio could be useful as a prognostic indicator of disease severity in COVID-19, but we could not corroborate its potential to predict mortality. The work was conducted at Columbia University College of Physicians and Surgeons at Harlem Hospital.

Transgender surgery - Knowledge gap among physicians impacting patient care.

Transgender surgeries are increasingly performed across the globe and in the United States. Although comprehensive centers exist, which are well equipped to cater and tailor to the needs of this population subset, quite often their resultant complications are handled at a different institution owing to the acuity of the condition. However, interestingly the psychosocial needs, medical pathophysiology, available surgical procedures, and their resultant complications are still not a part of the regular medical curriculum. This translates into inadequate care when physicians from vast majority of institutions that do not routinely perform transgender surgery encounter these patients with complications from gender-affirming surgeries. We present a case of a patient who underwent complex multiple gender-affirming surgeries, presenting to our emergency department with an acute abdomen; this resulted in a diagnostic and management dilemma and review of brief pertinent literature. We recommend that transgender medicine and its basics needs should be exposed to currently practicing physicians by continuing medical education, trainees and medical students alike via incorporation into their curriculum, to decrease health disparities among the lesbian, gay, bisexual, transgender, and queer community.

Role of neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios as predictors of disease severity in COVID-19 patients.

Direct viral damage and uncontrolled inflammation contribute to disease severity in SARS-CoV-2 infection. The aim of this study was to investigate the prognostic significance of neutrophil-to-lymphocyte [NLR], lymphocyte-to-monocyte [LMR] and platelet-to-lymphocyte [PLR] ratios in COVID-19 patients. All 184 COVID-19 patients hospitalized in our institution between March - April 2020 were retrospectively analyzed. The patients were grouped into intubated and non-intubated, and subgrouped into survived and deceased. An unpaired Student's t-test was used for continuous variables, and the Pearson Chi-square (χ2) test for categorical. Univariate and multivariate logistic regression models were developed to assess the independent relationship between NLR, LMR and PLR and unfavorable outcomes. Non-parametric correlations were calculated using Spearman's Rho correlation coefficient. The mean age of the patients was 64.7; mean BMI was 29.10; 73 (39.67%) were female and 111 male (60.33%). No statistical difference between groups was identified with regard to NLR (mean 8.29, standard deviation [SD] 7.86). On multivariate regression analysis, only PLR and LMR were shown to influence the ratio and it was positively correlated with PLR, lactate and C-reactive protein [CRP]. LMR for non-intubated survived [NI-S] (mean 2.29, SD 1.31) and non-intubated deceased [NI-D] (mean 1.79, SD 0.81) groups were statistically significant (p=0.03). LMR was influenced only by NLR on regression analysis. A positive correlation of LMR with body mass index [BMI] was ascertained. No statistical significance was found between groups for PLR (mean 269.85, SD 207.98) and the ratio was influenced by age and NLR on regression analysis, and positively correlated with NLR. To conclude, previously reported findings of a prognostic role of NLR, LMR and PLR in COVID-19 were not validated in our cohort and we would caution against using the ratios in question as independent markers for disease severity.

Gastrointestinal manifestations in American minority population with COVID-19.

BACKGROUND: The spectrum of gastrointestinal (GI) injuries by the SARS-CoV-2 remain largely unknown. Ethnicity data is missing or unspecified. We analyzed GI involvement in American minority patients with COVID-19 infection. METHODS: Retrospective study of hospitalized patients with confirmed COVID-19 in March-April 2020. RESULTS: 183 patients included: 114 (62.30%) African-Americans, 58 (31.69%) Hispanics and 11 (6.01%) Asians. 73 females, 110 males; mean age 64.77, mean BMI 29.03 (50.82%); GI manifestations upon presentation: anorexia (29.51%), diarrhea (22.40%), nausea/vomiting (18.03%), abdominal pain (9.84%). No difference observed between three ethnical groups for GI symptoms and liver function tests. C Reactive Protein (CPR) (P=0.008), Lactate (P=0.03) and Prothrombin Time (PT) (P=0.03) were significantly elevated in patients without GI symptoms. No difference was observed for other laboratory tests. Patients with severe disease course/intubated had higher levels of Aspartate Transaminase (AST) (109.17 vs 53.97, P=0.018), Alanine Transaminase (ALT) (79.53 vs 40.03, P=0.02) and total bilirubin (0.82 vs 0.60, P=0.03) vs non-intubated patents as well as body temperature (101.38 vs 100.70, p=0.0006), CRP (24.06 v 15.96, P=0.019) and lactate (3.28 vs 2.13, P=0.009). There was no correlation between severity of the disease and GI symptoms, PT, platelets and albumin. However, CRP and lactate were markedly elevated in deceased vs survived patients: (27.09 vs 16.39, P=0.008) and (3.33 vs 2.10 P=0.005) respectively. CONCLUSIONS: ~ 50% of patients presented with GI symptoms and they had lower levels of inflammatory markers, better liver synthetic function, indicating less overall inflammatory response and direct viral damage. Our results suggest that SARS-CoV-2 virus targets GI tract along with the lung tissue, and the degree of hepatocyte damage correlated well with more severe disease.

Successful Laparoscopic Repair of Posttraumatic Diaphragmatic Injury.

Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.

Waist Training Corset: An Unusual Cause of Acute Lower Limb Ischemia.

Acute limb ischemia (ALI) can occur due to many causes. This article illustrates a novel case of a very rare presentation and etiology of acute lower extremity ischemia. This case involves a middle-aged female with a history of smoking and obesity who presented with right lower extremity (RLE) pain. The patient had undergone a liposuction procedure a few days prior to her presentation and had been wearing a waist training corset. The patient was found to have multivessel thrombotic occlusive plaques starting from the right common iliac to the right tibial arteries. She was fully worked up and no other etiologies of her presentation was found. Thus, we concluded that her presentation was very likely precipitated by wearing the training corset, leading to right iliac artery thrombosis or perhaps a formal iliac atherosclerotic plaque destabilization and ipsilateral limb showering with athero-thrombi.

New York Inner City Hospital COVID-19 Experience and Current Data: Retrospective Analysis at the Epicenter of the American Coronavirus Outbreak.

BACKGROUND: In the midst of the coronavirus disease pandemic, emerging clinical data across the world has equipped frontline health care workers, policy makers, and researchers to better understand and combat the illness. OBJECTIVE: The aim of this study is to report the correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and the mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We did a review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and nonintubated, and subgrouped to alive and deceased. A comprehensive analysis using the following parameters were performed: age, sex, ethnicity, BMI, comorbidities, inflammatory markers, laboratory values, cardiac and renal function, electrocardiogram (EKG), chest x-ray findings, temperature, treatment groups, and hospital-acquired patients with SARS-CoV-2. RESULTS: A total of 184 patients were included in our study with ages ranging from 28-97 years (mean 64.72 years) and including 73 females (39.67%) and 111 males (60.33%) with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), and 1 Caucasian (0.54%), with a mean of 1.70 comorbidities. Overall, the mortality rate was 17.39% (n=32), 16.30% (n=30) of our patients required mechanical ventilation, and 11.41% (n=21) had hospital-acquired SARS-CoV-2 infection. Pertinent and statistically significant results were found in the intubated versus nonintubated patients with confirmed SARS-CoV-2 for the following parameters: age (P=.01), BMI (P=.07), African American ethnicity (P<.001), Hispanic ethnicity (P=.02), diabetes mellitus (P=.001), creatinine (P=.29), blood urea nitrogen (BUN; P=.001), procalcitonin (P=.03), C-reactive protein (CRP; P=.007), lactate dehydrogenase (LDH; P=.001), glucose (P=.01), temperature (P=.004), bilateral pulmonary infiltrates in chest x-rays (P<.001), and bilateral patchy opacity (P=.02). The results between the living and deceased subgroups of patients with confirmed SARS-CoV-2 (linking to or against mortality) were BMI (P=.04), length of stay (P<.001), hypertension (P=.02), multiple comorbidity (P=.045), BUN (P=.04), and EKG findings with arrhythmias or blocks (P=.02). CONCLUSIONS: We arrived at the following conclusions based on a comprehensive review of our study group, data collection, and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature, EKG findings with sinus tachycardia, and bilateral diffuse pulmonary infiltrates on the chest x-rays. Those intubated exhibited increased disease severity with significantly elevated levels of serum procalcitonin, CRP, LDH, mean glucose, creatinine, and BUN. Mortality was strongly correlated with BMI, African American ethnicity, hypertension, presence of multiple comorbidities (with a mean of 2.32), worsening renal function with acute kidney injury or acute chronic kidney injury, and EKG findings of arrhythmias and heart blocks.

Effective Management of Femur Fracture Using Damage Control Orthopedics Following Fat Embolism Syndrome.

Fat embolism syndrome (FES) is a rare event following a traumatic injury, and its pathophysiologic mechanism continues to be elusive. Fat embolism syndrome generally occurs when a bone marrow fat enters the bloodstream resulting in a cascade of inflammatory response, hyper-coagulation, and an array of symptoms that generally begin within 24-48 hours. FES early symptoms include petechial rash, shortness of breath, altered mental status, seizures, fever, and may result in decreased urine output. The common etiologies of a fat embolism include long bone fractures, mainly femoral and pelvic fractures.  There are multiple management methods described in the literature to help prevent FES and other long bone fracture complications from occurring. Although not universally adopted, the damage control orthopedics (DCO) has been the major management option for patients with a long bone fracture. DCO is entertained by provisional immobilization of patients with long bone fractures and those who are considered severely traumatized patients (STP). Thus, immobilization can help minimize the traumatic effect and the subsequent second hit by performing non-life saving surgical procedures. In this case, a patient with a transverse femur fracture suffered disconcerting symptoms of fat embolism prior to definitive femur repair. Hence, damage control orthopedics was entertained with a postponement of his femur repair to facilitate stabilization. The use of damage control orthopedics was successful in this patient with no long term complications.

Identification and Surgical Management of Upper Arm and Forearm Compartment Syndrome.

Extremity muscles are grouped and divided by strong fascial membranes into compartments. Multiple pathological processes can result in an increase in the pressure within a muscle compartment. An increase in the compartment pressure beyond the adequate perfusion pressure has the potential to cause extremity compartment syndrome. There are multiple sites where compartment syndrome can occur. In this article, an arm and forearm compartment syndrome ensued secondary to a minor crushing injury that lead to supracondylar and medial epicondylar non-displaced fractures. A pure motor radial and ulnar nerve deficits noted on presentation, worsened with progression of the compartment syndrome. Ultimately, a surgical fasciotomy was carried out to release all compartments of the right upper arm and forearm.

Warfarin induced mesenteric and intestinal hematoma requiring surgical resection to relieve small bowel obstruction: A case report.

INTRODUCTION: Mesenteric and Intramural Hematoma leading to small bowel obstruction is a rare, but a fatal complication of anticoagulant therapy. PRESENTATION OF CASE: We present this unique case of 61 year old male with non traumatic mesenteric and intramural hematoma secondary to warfarin leading to small bowel obstruction requiring surgical resection. DISCUSSION: Although there have been few cases reported in literature about intramural small bowel hematoma, however, associated with small bowel obstruction secondary to warfarin therapy are less frequently seen. Diagnosis of intramural hematoma can be made with Computed Tomography (CT) of abdomen. The most effective treatment approach is conservative management after excluding any signs of small bowel obstructions, peritonitis and bowel necrosis. CONCLUSION: Therefore, early diagnosis is vitally essential to avoid morbidity in patients with these symptoms. Physician should have a higher index of suspicion to recognize and diagnose this complication is essential for early treatment intervention to prevent morbidity.

Duodenal Diverticular Perforation after Small Bowel Obstruction: A Case Report.

INTRODUCTION: Duodenal diverticulum is a rare disease that can be easily missed. The incidence of duodenal diverticulum diagnosed by upper GI study is approximately 5%. Autopsy results show that 22% of the population have duodenum diverticulum. Most patients with duodenal diverticulum are asymptomatic. However, complications like inflammation, perforation with retroperitoneal abscess, sepsis, pancreatitis, bile duct obstruction, and bleeding can occur. Approximately 162 cases of perforated duodenal diverticulum have been reported in the literature. CASE PRESENTATION: We present a rare case of an 82-year-old female with perforation of a duodenal diverticulum caused by small bowel obstruction; in addition to this, there was a synchronous colonic tumor. CONCLUSION: Diagnosis and management of this rare disorder are controversial. Nonoperative management is advocated in some cases. Some of the cases require early aggressive surgical intervention. The mortality rate remains approximately 45% in all these patients.

Abdominal Drains Retrieved Laparoscopically 15 Years Post Laparotomy.

A retained intra-abdominal foreign body is a common occurrence that is frequently underreported due to its medicolegal implications. Sponges, gauzes, surgical instruments, abdominal drains, etc. have been reported in the literature. The most common presentation for a retained intra-abdominal foreign body is postoperative abdominal infections or bleeding, frequently seen in the immediate postoperative period. Most of these foreign bodies are removed by exploratory laparotomy owing to recent abdominal surgeries or presentation as complicated abdominal masses. Here, we report a case with retained intra-abdominal drains for 15 years with minimal symptoms presenting as an intermittent abdominal pain; the drains were removed using laparoscopic intervention.