Bullet embolization from the right subclavian artery to the right common femoral artery.

Bullet embolization from a gunshot wound is a rare entity in trauma patients. We report a case of a 37-year-old female patient who was brought to the trauma unit after sustaining multiple gunshots to the chest and abdomen. Followed by embolization of the bullet from the right subclavian artery to the right common femoral artery. Had successful retrieval of the bullet via a transverse arteriotomy.

Outcomes of emergency colorectal surgery in elderly population.

OBJECTIVES: To assess the outcomes of emergency colorectal surgeries in elderly patients over the age of 65 years. METHODS: This is a retrospective chart review study. We studied 99 patients over the age of 65 years and 142 patients younger than 65 years who underwent emergency colorectal surgery at our institute. In this study, patient demographics, operative results, length of hospital stay, and survival were analyzed. RESULTS: Emergency colorectal surgery was performed on a total of 145 men and 96 women. Patients over the age of 65 years were found to have a significantly greater proportion of pulmonary, cardiac, and endocrine comorbidities (27.3%, 84.8%, and 65.7%, respectively). The mean length of hospital stay was 26.0±32.1 days in the group of elderly patients and 17.8±22.0 days in the group of patients under the age of 65. The length of postoperative hospital stay was significantly greater in the group of elderly patients with a p-value (0.00). The length of hospital stay in the intensive care unit was 8.86±17.1 days, which was longer in the group of elderly patients, while it was 3.65±11.4 days for the group of younger patients. However, after logistic regression, the difference in the length of post-operative hospital and intensive care unit stays between elderly and non-elderly patients was not statistically significant in elderly patients. CONCLUSION: Our study suggests that the elderly population are associated with longer hospital stay and higher rates of postoperative pulmonary and cardiovascular complications compared to those under the age of 65. However, after logistic regression, age by itself was not found to be an independent risk factor for worse outcome indicating that patient comorbidities as a whole increase the risk of worse outcomes. Therefore, the care of elderly patients undergoing emergency colorectal surgery should be individualized based on several factors rather than age alone.

A Case of a Gastric Stent Complication Presenting With a Gastrojujenal Fistula.

Laparoscopic sleeve gastrectomy (SG) is a widely performed bariatric procedure known for its safety and efficacy, yet complications, particularly postoperative leaks, remain a concern. Endoscopic stenting is one of the approaches for leak management that has some complications such as the rare fistula with adjacent organs. Here, we present a unique case of a 56-year-old diabetic female who developed a gastroenteric fistula following endoscopic stent placement for a post-SG leak. The patient had a delayed stent removal, and three weeks later she presented with dysphagia and vomiting in a follow-up appointment. Esophagogastroduodenoscopy (EGD) showed an esophageal stricture and a large gastroenteric fistula that was confirmed by imaging to be a fistula between the pylorus and proximal small bowel. The patient's symptoms improved gradually with conservative management, and imaging showed the resolution of the fistula and associated esophageal stricture. This case highlights the importance of timely stent removal (ideally within 6-8 weeks) and close follow-up with EGD and CT to detect and manage potential complications, while emphasizing the need for further research on optimal stent placement duration.

The role of laparoscopy in emergency colorectal surgery.

OBJECTIVES: To assess the outcomes of the laparoscopic approach compared to those of the open approach in emergency colorectal surgery. METHODS: This retrospective cohort study included all patients aged >15 years who underwent emergency colorectal surgery from 2016-2021 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients were divided based on the surgical approach into laparoscopic and open groups. RESULTS: A total of 241 patients (182 open resections, 59 laparoscopic approaches) were included in this study. The length of stay in the intensive care unit was shorter in the laparoscopic than in the open group (1±3 days vs. 7±16 days). After multivariable logistic regression, patients undergoing laparoscopic resection had a 70% lower risk of surgical site infection than those undergoing open surgery (adjusted odds ratio=0.33, 95% confidence interval: [0.06-1.67]), a difference that was not significant (p=0.18). Lastly, patients who underwent open surgery had a high proportion of 30-day mortality (n=26; 14.3%), compared to those who underwent laparoscopic resection (n=2; 3.4%, p=0.023). CONCLUSION: Laparoscopy in emergency colorectal surgery is safe and feasible, with a trend toward better outcomes. Colorectal surgery specialization is an independent predictor of an increased likelihood of undergoing laparoscopy in emergency colorectal surgery.

A Mixed Neuroendocrine/Non-Neuroendocrine Neoplasm Arising in the Background of Ulcerative Colitis: A Case Report and Review of the Literature.

BACKGROUND Inflammatory bowel disease (IBD) is a chronic, potentially life-long, disorder, including ulcerative colitis (UC) and Crohn's disease (CD). Ulcerative colitis (UC) is an idiopathic chronic inflammatory disorder affecting the mucosa of the colon; it starts at the rectum and continues proximally in a continuous pattern to include up to the entire colon, called pancolitis. Patients with ulcerative colitis are at particularly higher risk of developing colorectal cancer (CRC) than the general population. Adenocarcinoma is the most common type of colorectal malignancy reported in the general population and IBD patients. One of the rarest types reported are the neuroendocrine neoplasms (NENs), which account for only 1% of all colorectal cancers, and it is very infrequent in IBD patients. Moreover, mixed neuroendocrine/non-neuroendocrine neoplasm (MiNEN) is a rare aggressive subtype of NENs that involves the colon in the background of an underlying chronic inflammatory process. CASE REPORT A 57-year-old woman, known to have long-term cirrhosis and ulcerative colitis, came to the Emergency Department with a suspected large-bowel obstruction. Imaging (CT scan of the abdomen) showed an obstructive transverse colon mass along with multiple descending colon masses. Biopsy of the transverse tumor confirmed the diagnosis of mixed neuroendocrine/non-neuroendocrine neoplasm (MiNEN). CONCLUSIONS Although neuroendocrine tumors are rare, strong association exist between MiNENs and ulcerative colitis. Further studies and reports can help better understand the pathogenesis, diagnosis, management, and prognosis of these cases.

Dual Bowel Obstruction: A Rare Case of Gallstone Ileus and Colonic Adenocarcinoma.

Bowel obstruction is a surgical emergency that leads to a high rate of admissions. Twenty percent of patients with acute abdominal pain will be diagnosed with bowel obstruction; eighty percent of them are of small origin. It is classified based on etiology to either mechanical or functional. Mechanical obstruction is a physical barrier that obstructs the passage of bowel content; it could be caused by adhesion, tumors, volvulus, hernias, strictures, and gallstone ileus. Functional obstruction is usually due to impaired peristalsis or metabolic disorders. In this article, we report a case of an 80-year-old gentleman with no previous surgical history who was found to have a bowel obstruction. Diagnostic imaging and colonoscopy showed that his clinical presentation was due to gallstone ileus with cholecysto-enteric fistula and sigmoid mass. He underwent exploratory laparotomy with small bowel resection and sigmoidectomy with primary anastomosis and diverting ileostomy. The final pathology showed early moderately differentiated polyp adenocarcinoma T1N0 and was kept on surveillance. The novelty of this case is the presentation of two different abdominal pathologies, which lead to large and small bowel obstruction. Thus, the management decision was challenging, and a thorough workup is advisable in such cases.

A Large Retroperitoneal Ganglioneuroma Presenting With an Abdominal Pain: A Case Report.

Ganglioneuromas are rare benign neoplasms arising from neural crest tissue. They are a subtype of neurogenic tumors with ganglion cell origin. They are most commonly found in the retroperitoneum and posterior mediastinum. Most ganglioneuromas are found incidentally; most patients are asymptomatic, and it rarely causes symptoms, which are often induced by compression. Here we present a case of a 24-year-old lady, who was investigated for right lower abdominal pain and found to have a right retroperitoneal solid mass at the level of L5-S1, which was displacing the major vessels. The patient underwent open excision of the mass.