Neutropenia is an adverse effect of various pharmacological therapies, including antipsychotics. Among the second-generation antipsychotic (SGA) medications, clozapine is most notable for neutropenic adverse effect. Risperidone, another SGA drug, is linked mainly with metabolic adverse effects, but rarely, blood dyscrasia adverse reactions have been reported. Hence, we report the case of a 56-year-old African American woman who developed severe neutropenia following two weeks of oral risperidone treatment. Her neutrophil levels returned to normal limits following discontinuation of risperidone and switching to haloperidol.

GIST tumors are unusual in the young and middle-aged and a high index of suspicion is needed for its possible diagnosis in young patients who present with upper gastrointestinal bleeding. Appropriate imaging such as a computed tomographic scan (CT scan) may identify this tumor that may easily be misdiagnosed as a bleeding peptic ulcer disease. We present a case of a healthy 38-year-old man with no alcohol use who presented with epigastric pain and melena and subsequent torrential bleeding uncontrolled during endoscopy necessitating an emergency exploratory laparotomy by the general surgery team. The bleeding intraluminal component of the tumor with gross splenic and pancreatic involvement was identified and surgical management consisted of a wedge resection of the greater curvature of the stomach incorporating the tumor and the spleen with successful dissection of the tumor off the tail of the pancreas. Histology was positive for C-KIT and DOG-1 markers. The postoperative course was uneventful, and he is presently on Imatinib mesylate.

Small bowel obstruction secondary to intussusception following a roux-en-Y gastric bypass (RYGB) for morbid obesity is an unusual surgical condition that has gained increased prominence with increased utilization of RYGB for the management of morbid obesity worldwide. We present a 34 year old female who presented at the Emergency Room of our facility with complaints of abdominal pain and a history of ante-colic and ante-gastric laparoscopic Roux-en-Y gastric bypass surgery at another facility a year prior to presentation. On account of unremitting abdominal pain, a lactate level of 5.4mg/dl and Abdominal Computed Tomographic Scan which showed evidence of small bowel obstruction with intussusception, an emergency open surgical exploration was performed which revealed intussusception of the biliopancreatic and common limb into the distal aspect of the roux limb. Surgical intervention entailed resection of both the proximal common channel and distal roux and biliopancreatic limbs and surgical reconstruction of the jejunojejunal anastomosis. She is alive and well two years post surgery without any recurrence.

An unusual complication of gallbladder empyema is its rupture into the liver forming a pyogenic abscess. This condition is rapidly fatal in diabetic and Immuno-compromised patients. We present a 79-year-old african american woman with diabetes mellitus who presented at the ED with constitutional symptoms and abdominal pain of a week duration. She was tender in the upper right quadrant, had a positive murphy's sign on clinical examination, tachycardia and a low-grade fever and laboratory findings of leukocytosis, and metabolic acidosis, lactic academia and elevated ketones with moderately deranged hepatic function tests and negative tumor markers. Management consisted of broad spectrum antibiotics, an open cholecystectomy and drainage of two multiloculated hepatic abscesses. A repeat ultrasonogram showed a remnant collection that was drained by interventional radiology and drains left in-situ. She was discharged after four weeks of parenteral antibiotics with repeat sonogram showing complete resolution of hepatic abscess. Appropriate antibiotic management, laparoscopic or open cholecystectomy or radiology guided cholecystostomy and drainage of hepatic abscesses is the hallmark of management.

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