Postoperative abdominal pain after gastric surgery requires thorough evaluation in the ED. Portomesenteric venous thrombosis (PMVT) is a rare complication after laparoscopic sleeve gastrectomy, which requires prompt evaluation and diagnosis. Patients require admission with prompt anticoagulation and broadspectrum antibiotics due to the risk of decompensation from intestinal ischemia and sepsis from bowel translocation. This report describes the case of a 36-year-old male who presented to the ED one week after laparoscopic sleeve gastrectomy with tachycardia and gradual onset, severe, sharp epigastric abdominal pain associated with anorexia and fatigue. He subsequently developed hypotension requiring vasopressor support, acute kidney injury, thrombocytopenia, and septic shock suspected due to secondary to bowel translocation. He was transferred to another facility for consideration for thrombolysis and went on to recover. This case report describes a rare case of PMVT after laparoscopic sleeve gastrectomy. Surgical risk factors include obesity and multiple components of Virchow's triad. These include inherited/acquired thrombophilic states, iatrogenic endothelial injury of portal vein/mesenteric vessels via direct manipulation, and increased intraabdominal pressure decreasing portal venous flow. Providers should carefully consider evaluation for genetic hypercoagulability requiring lifelong anticoagulation. On hospital discharge, anticoagulation should continue for at least six months, with repeat CT with IV contrast or USG in three to six months to evaluate for recanalization of the venous system. Knowledge of the appropriate evaluation and treatment of this rare complication after laparoscopic sleeve gastrectomy is vital to avoid unnecessary patient morbidity and mortality.

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51-year-old male presented to the emergency department with left flank pain after a near fall on steps. Computed tomography of the abdomen and pelvis with contrast showed a non-enhancing left kidney, secondary to suspected acute traumatic dissection of the left renal artery.Renal artery dissection is typically affiliated with blunt abdominal trauma, though it can also occur spontaneously. The diagnosis of a renal artery dissection after minor trauma can often go unrecognized due to a lack of initial severe symptoms. Management will vary upon the age of the injury, the preservation of the kidney, and the extent of associated injuries. Ultimately, management should be dictated by discussion with trauma surgery, vascular surgery, urology, or interventional radiology consultants. Knowing the mechanism of injury and patient risk factors can help guide your ability to successfully identify and treat the patient, limiting delays in care and potentially lowering the incidence of organ injury.

Acute pharyngitis is a common complaint in emergency department (ED), urgent care, and primary care settings. Most cases are due to bacterial or viral infections easily treated with antibiotics or supportive care. However, serious pathologies in the pharyngitis differential include Ludwig's angina, peritonsillar abscess, retropharyngeal abscess, and bacterial tracheitis. Rarely, oncologic conditions such as leukemia may initially present as pharyngitis in an acute care setting. We present a case of pharyngitis in a 32-year-old male ED patient with a final diagnosis of acute myelogenous leukemia (AML). Knowledge of the appropriate ED evaluation of AML is key for accurate diagnosis and prompt referral to avoid unnecessary patient morbidity and mortality.