Background A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female. Case presentation A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications. Conclusion This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

Pylephlebitis is defined as an infective suppurative thrombosis of the portal vein and its tributaries -a rare complication of intra-abdominal infections. It is most commonly seen in patients with diverticulitis and appendicitis. Prompt diagnosis with abdominal ultrasound and computerized tomography (CT) scan along with early and aggressive treatment with broad-spectrum antibiotics is crucial because of its high mortality rates. However, this diagnosis is often missed due to the nature of its nonspecific clinical symptoms. We discuss a case of a 22-year-old male who presented with pylephlebitis as a complication of acute gangrenous appendicitis. The patient was treated successfully with appropriate surgical intervention, antibiotics, and anticoagulation.

Uterine leiomyomas are neoplasms of the smooth muscle that can cause complications such as severe bleeding and infertility in women of reproductive age. While many individuals may be asymptomatic, others may present with anemia secondary to heavy bleeding, cyclical abdominal pain, pelvic pressure, and urinary or bowel symptoms. A rare complication of uterine leiomyomas is avulsion due to blunt abdominal trauma resulting in hemoperitoneum. We present a 49-year-old female with no pertinent medical history who presented to the emergency room following a motor vehicle accident. Computed tomography scan revealed extensive hemoperitoneum and the patient was taken to the operating room where the source of bleeding was identified as multiple avulsed leiomyomas. The patient underwent an emergency hysterectomy and bilateral salpingectomy. Pathology reported a uterus weighing 6,000 g and the presence of 20 leiomyomas, with the largest measuring 29 cm. Knowledge of leiomyoma symptoms, presentation, and complications by both the patient and clinicians may help identify diagnoses and expedite intervention in the emergency setting.

The lethal triad of coagulopathy, hypothermia, and acidosis is a well-known cause of severe deterioration and poor prognosis in trauma patients. The presence of this triad complicates the surgical management of a patient suffering from penetrating injury and hemorrhage. Here, we report the case and management of a 44-year-old man with multiple high-caliber gunshot wound (GSW) injuries who became severely acidotic (pH <6.8) with hemorrhagic shock in the setting of massive hemorrhage due to penetrating chest and abdominal trauma. The patient sustained one high-caliber GSW to the left upper quadrant of the abdomen, one highcaliber GSW to the left periumbilical region of the abdomen, one high caliber GSW to the fourth intercostal space of the left chest just medial to the midclavicular line with an expanding hematoma, and one highcaliber GSW to the left shoulder with a floating left shoulder. He arrived at the Emergency Department conscious with a stable pulse but quickly became hemodynamically unstable. He required a thoracotomy and exploratory laparotomy in addition to a massive transfusion protocol. This case demonstrates the reversal of a severely acidotic patient due to massive hemorrhage to a blood pH within normal limits using damage control resuscitation surgery and massive transfusion protocols. The patient has since been discharged home in a stable condition with minimal long-term sequelae.

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