HighlightsThis case report reviews complicated appendicitis that failed non-operative management, underwent appendectomy, and did well post-operatively.In the present case, the patient’s clinical picture was substantially worse on presentation four weeks post-diagnosis when compared to his prior hospitalizations, indicating failed non-operative treatment.This case report provides an opportunity to review the management of complicated perforated appendicitis.This case report could help to increase the awareness of medical professionals who manage similar cases and outline best treatment options such as early surgical intervention.

HighlightsThis case is a rare presentation of C. sordellii toxic shock syndrome resulting from a Caesarian section.This is the only obstetric case of C. sordellii to have survived.Extreme levels of a leukocytosis and hypotension without fevers raises suspiscion for this severe infection.Broad spectrum antibiotics, including coverage for anaerobic organisms, and surgical intervention is the standard of care.At the moment, no early detection or antitoxins are commercially available.

Introduction:Traumatic intracranial hemorrhages (ICHs) are high priority injuries. Traumatic brain bleeds can be categorized as traumatic subarachnoid hemorrhage (SAH) versus non-SAH-ICH. Non-SAH-ICH includes subdural, epidural, and intraventricular hematomas and brain contusions. We hypothesize that awake patients with SAH will have lower mortality and needless interventions than awake patients with non-SAH-ICHs.Study Design and Methods:A review of data collected from our Level I trauma center was conducted. Awake was defined as an initial Glasgow coma score (GCS) 13–15. Patients were divided into two cohorts: awake SAH and awake non-SAH-ICH. Chi-square and t-test analyses were used with statistical significance defined as P < 0.05.Results:A total of 12,482 trauma patients were admitted during the study period, of which 225 had a SAH and GCS of 13–15 while 826 had a non-SAH-ICH with a GCS of 13–15. There was no significant difference in demographics between the two groups. Predicted survival between the two groups was similar (97.3 vs. 95.7%, P > 0.05). Mortality rates were, however, significantly lower in SAH patients compared to the non-SAH-ICH (4/225 [1.78%] vs. 22/826 [2.66%], P < 0.05). The need for neurosurgical intervention was significantly different comparing the SAH group versus non-SAH-ICH (2/225 [0.89%] vs. 100/826 [12.1%], P < 0.05).Conclusion:Despite similar predicted mortality rates, awake patients with a SAH are associated with a significantly lower risk of death and need for neurosurgical intervention when compared to other types of awake patients with a traumatic brain bleed.

Highlights This is a case report of a rare adrenal tumor that manifested as acute coronary syndrome. Adrenalectomy for pheochromocytoma presents a risk for intraoperative hemodynamic instability. Preoperative medical care is essential to reduce intraoperative complications. This case exemplifies the importance of the various symptoms that are prevalent with excessive circulating adreno-receptor agents.

HighlightsWe present a case of massive pelvic abscess complicated by sepsis and necrotizing fasciitis successfully treated with surgical drainage.There was complete resolution of sepsis following open surgical drainage of a massive pelvic abscess complicated by necrotizing fasciitis.Larger multi-loculated abscesses or when associated with necrotizing infections may be better approached surgically.