Management of an undetectable Diverticular Bleed: A Case Report and Literature review.

Diverticular bleeding is the most common cause of lower gastrointestinal bleeding and accounts for 20.8%-41.6% of cases in the Western world. Management involves initial resuscitation followed by diagnostic assessment. Colonoscopy is the investigation of choice as it localizes the bleed and has the potential to effectively deliver therapeutic interventions. Other diagnostic modalities include flexible sigmoidoscopy, a tagged red blood cell scan, or angiography. In cases where the bleeding source cannot be identified, intraoperative enteroscopy has emerged as a valuable tool for investigating obscure gastroenterology bleeds in specific patients. In this case report, we describe the management of a 77-year-old male with recently diagnosed pan-colonic diverticulosis who presented with multiple episodes of rectal bleeding and syncope. Due to his declining hemodynamic status and failed endoscopy and embolization, he was taken to surgery for a colectomy. Intraoperative colonoscopy was utilized to facilitate accurate identification of the pathology, assessment of anastomotic patency, and detection of surgical complications. This case report attempts to portray how the incorporation of endo-videoscopy into surgical planning has the potential to enhance patient outcomes and represent a significant advancement in the field of minimally invasive surgery.

Trifoliate gallbladder: A rare congenital anomaly masquerading as acute cholecystitis.

Key Clinical Message: Triple gallbladder, an extremely rare congenital anomaly, can mimic more common biliary conditions. Accurate diagnosis through imaging and a multidisciplinary approach is essential for timely surgical management, preventing complications, and ensuring better patient outcomes. Abstract: The multiplication of the gallbladder is a congenital malformation with a rare incidence of 1 in 4000 patients, among which the trifoliate gallbladder, even rarer, is included. Gallbladder anomalies are typically discovered incidentally while investigating conditions like gallstones, sedimentation, gallbladder inflammation, or malignancy. The clinical presentation of trifoliate gallbladder disease varies, and it may require a variety of imaging modalities to obtain a preoperative diagnosis. Recommended therapeutics for this anomaly are open or laparoscopic cholecystectomy, depending on the patient's condition. Early diagnosis of gallbladder multiplications is vital to improve prognosis and mitigate the risk of complications like cholelithiasis, cholecystitis, metaplasia, and adenocarcinoma. In our case, we present a 30-year-old male with the diagnosis of acute cholecystitis with triple gallbladder. A confirmatory diagnosis was made with magnetic resonance cholangiopancreatography (MRCP). The patient responded well to the therapy given and was discharged for follow-up.

Acute pancreatitis associated with the antibiotic levofloxacin: A rare case report.

Drug-induced acute pancreatitis is a potentially ignored diagnosis that must be precisely valued. Drug-induced acute pancreatitis can be considered the third common cause of acute pancreatitis after ruling out alcohol and gallstones. Levofloxacin belongs to a class of fluoroquinolone antibiotics used for treating various infections. Besides photosensitivity and liver toxicity, levofloxacin can induce acute pancreatitis, although rarely described. We highlight a case of acute pancreatitis in a female induced by levofloxacin. She presented with typical signs and symptoms of acute pancreatitis and had been taking levofloxacin for urinary tract infections for the last 3 days. After ruling out all other possible causes, her clinical picture, laboratory results, and imaging findings confirmed acute pancreatitis induced by levofloxacin.

Gastric adenocarcinoma complicated by an intra-abdominal abscess: A case report.

Perforated gastric adenocarcinoma is a rare and challenging complication of gastric cancer, which can lead to intra-abdominal abscesses and other complications. Management of perforated gastric adenocarcinoma with an intra-abdominal abscess requires a multidisciplinary approach, including empiric antibiotic therapy and fluid resuscitation, partial gastrectomy with Roux-en-Y reconstruction, and image-guided drainage. This case report highlights the complex and challenging nature of managing perforated gastric adenocarcinoma with intra-abdominal abscesses. Prompt recognition and timely intervention are essential for favorable outcomes. Postoperative care and close follow-up are also important.

Intussusception in an elderly female and its management: A case report and literature review.

Intussusception is the telescoping or invagination of the proximal part of the gastrointestinal tract into an adjacent section. It is rare in adults, accounting for 1% of adult bowel obstruction. Adult presentation of intussusception is variable, with nonspecific, vague symptoms like abdominal pain, nausea, vomiting, and rectal bleeding. Abdominal computed tomography (CT) scans have the highest sensitivity in the diagnosis of intussusception. The classical findings of intussusception are the target sign and mesenteric vessels lined within the bowel lumen. An abdominal CT scan can reveal a cloverleaf figuration, fluid-filled ileal loops, superior mesenteric venous (SMV) occlusion, and concerns about ongoing sealed perforation or fistulization. Our patient is an 86-year-old female who was diagnosed with a jejunal-jejunal long-segment intussusception, gastro-enteric fistula, and SMV occlusion with distal reconstitution. The patient responded well to conservative treatment and was discharged for follow-up.