Systemic lupus erythematosus presenting with pneumoperitoneum without evidence of pneumatosis cystoides intestinalis-when not to operate-a case report.

Pneumoperitoneum in patients with systemic lupus erythematosus is commonly recognized as a surgical emergency that requires exploration. However, it may not be associated with bowel perforation and may be a benign disease manifestation. We present a case of a young patient who developed spontaneous pneumoperitoneum after pulse steroid therapy for lupus enteritis and was successfully managed conservatively. Patients with connective tissue disease may present with pneumoperitoneum, with or without pneumatosis cystoides intestinalis. Therefore, a detailed clinical history, thorough clinical examination, and laboratory parameters should be evaluated before proceeding with surgical intervention. A conservative approach may be attempted in patients with spontaneous pneumoperitoneum, and surgery should only be considered if clinical deterioration occurs.

Managing Splenic Artery Pseudoaneurysms-An Experience from a Developing Country. A Retrospective Review.

Objectives: Splenic artery pseudoaneurysm is a rare but potentially fatal condition. Early diagnosis and intervention are the key steps in the management of this condition. We have reviewed our institution's 4-year data regarding the presentation and management of this condition. Methods: We conducted a prospective review of the records of 10 patients who presented to our institute from January 2018 to December 2021 with a splenic artery pseudoaneurysm. We found one patient with a true aneurysm, whom we excluded from the study. Results: This study included seven male and two female patients with a mean age of 47.7 years. Six patients presented to the emergency department with bleeding secondary to rupture aneurysm, which is the most common reason for admission. Pancreatitis was found to be the most common cause for splenic artery pseudoaneurysm (five patients). Computed tomography angiogram remained the modality of choice for diagnosing splenic artery pseudoaneurysm. All patients were successfully managed with endovascular intervention. Conclusion: Splenic artery pseudoaneurysm is usually a rare complication of pancreatitis, which is associated with high morbidity and mortality. Timely diagnosis and intervention are the keys to successful management. Endovascular embolization should be the first-line therapy in splenic artery pseudoaneurysm.

Gastrointestinal anastomosis (GIA) stapler as a safe and efficacious damage control tool for high-grade liver injury in hemodynamically unstable patient- A case report.

INTRODUCTION: Liver injury occurs in approximately 5% of all trauma admissions. There are many traditional ways of controlling hemorrhage from the liver and here we report a case in which a GIA 75 stapler was successfully used to manage Grade IV liver injury in a hemodynamically unstable patient. PRESENTATION OF CASE: 45 years old policeman presented in the emergency, after sustaining a gunshot injury to his abdomen. At presentation, he was hemodynamically unstable and had a single entry wound in the epigastrium. He was rushed to the operating room (OR) for exploratory laparotomy which revealed a shattered left lobe of the liver. Gastrointestinal anastomosis 75 stapler device was used for non-anatomical left segmentectomy (segments I and II). Perihepatic packing was done and the patient shifted to the surgical intensive care unit (SICU). He was re-explored within 24 h. No active bleeding was seen after the packs were removed and the abdomen was closed. The next day he was moved out of SICU and was discharged on the 10th day of admission. DISCUSSION: The concept of damage control surgery rests on quick control of life-threatening bleeding and a GIA stapler can be effectively used for rapid non-anatomical resection of the liver in trauma. This can prevent the depletion of physiological reserves and the life-threatening death triad. CONCLUSION: GIA stapler device is an effective, safe, and rapidly deployable tool for managing high-grade liver injury in a hemodynamically unstable patient.