Background. Bouveret syndrome and gallstone coleus are two rare subsets of gallstone ileus. Bouveret syndrome involves a gastric outlet obstruction, whereas gallstone coleus involves an obstruction of the large intestine. Both of the conditions are caused by gallstones, which migrated from the gallbladder via the fistulae. Due to its rarity, only few cases were reported for each condition. The current case describes an even rarer case of Bouveret syndrome and gallstone coleus presenting together. The case report will hopefully provide better understanding of the disease presentation and hence, lead to early diagnosis and management. Case. Ms. B is an 86-year-old woman of Italian background who presented to our emergency department with worsening symptoms of bowel obstruction. Her past clinical history included Kaposi sarcoma, hypertension, osteoarthritis, and vitamin D deficiency with surgical history including caesarean section and tonsillectomy. On her imaging, she had two large gallstones, one in the proximal duodenum and one in the distal colon. It also showed gastric dilatation and gas in the gall bladder. She was subsequently diagnosed with Bouveret syndrome with concurrent gallstone coleus. The laparotomy revealed two points of gallstone obstruction at the first part of the duodenum and at the distal sigmoid colon. Her postoperative recovery was uncomplicated. She was discharged to the care of her family and followed up in the general surgery clinic. Conclusion. The current case report describes a unique presentation of Bouveret syndrome where an additional gallstone was found simultaneously in the sigmoid colon causing the obstruction. By introducing this novel case of having two different subsets of gallstone ileus simultaneously, there will be a better understanding of both conditions and hopefully improve our scope of practice.

Dual surgical pathology at emergency laparotomy is an uncommon finding outside of trauma scenarios. There is a scarcity of case reports of concomitant small bowel obstruction and appendicitis at laparotomy, likely in part because of advancements in investigative tools, diagnostic processes and the ready availability of medical care, which is demonstrated by harrowing statistics from developing nations where these factors are lacking. However, despite these advancements, initial diagnosis of dual pathology can be difficult. We report a case of concurrent small bowel obstruction and occult appendicitis discovered at emergency laparotomy in a previously well female with a virgin abdomen.

Pericardiocentesis is a generally safe procedure that provides effective resolution of cardiac tamponade. Emergency pericardiocentesis may be a life-saving intervention. Encountering an intra-abdominal organ in the path of the needle is predicted to be a potential complication in emergency subxiphoid approaches. Despite predictions of intraabdominal injuries, only few instances are recorded. In this case study, a patient recovering from percutaneous cardiac intervention required an emergency pericardiocentesis that was complicated by a liver injury, diaphragmatic penetration and pneumo-haemoperitoneum requiring surgical intervention to remove the drain. The case discusses options for performing the procedure, patient factors that can complicate the procedure and radiological and surgical diagnosis and treatment of this rare event.

The report presents a case of a 70-year-old male with a known mesenteric neuroendocrine tumour and metastases to the liver diagnosed with acute cholecystitis. During surgery, the patient developed a carcinoid crisis with mixed distributive and cardiogenic shock involving systemic vasodilation and arrhythmia. During surgical procedures, carcinoid crisis can be precipitated by tumours that secrete a pathological shower of vasoactive mediators. Somatostatin analogues are utilized to control carcinoid syndrome and are routinely used peri-operatively. However, no standard infusion regimen exists. The case raises the suggestion that metastatic liver neuroendocrine disease may confound the diagnosis of cholecystitis, complicates the management of acute surgical presentations and highlights the need for agreement on octreotide therapy for surgical patients with carcinoid tumours.

Hiatus hernia is defined as a trans-diaphragmatic protrusion of the intra-abdominal contents through the oesophageal hiatus into the mediastinum. Surgical repair is indicated in symptomatic patients, with some patients presenting emergently with strangulation and ischaemia of hernial contents. In this situation, emergent decompression and surgical repair is indicated. Although it has been suggested previously that kyphoscoliosis may contribute to development and progression of hiatus hernia, there are no published reports of obstruction being caused by severe spinal deformity. A 67-year-old male patient with spina bifida and severe scoliosis who presented with an obstructed hiatus hernia is discussed here. Because of his obstruction, laparoscopic hiatus hernia repair and fundoplication was undertaken. The patient had an uncomplicated recovery following this. This case highlights the importance of providing definitive management to patients with difficult anatomy, which has caused their obstruction, as conservative management is unlikely to lead to an optimal outcome.