Giant splenic artery aneurysms, although rare, should be considered in patients presenting with left upper abdomen pulsatile masses. Clinical suspicion followed by emergent management is necessary to prevent potentially life threatening complications.

A 21-year-old woman was admitted to our hospital with complaints of abdominal pain and vomiting for 10 days. The pain was colicky in nature, and was located on the left-hand side of the center of the abdomen. She had multiple episodes of similar pain during the past 1 year that had resolved spontaneously. Her abdominal examination showed a vague mobile lump in the left side of her abdomen. All of her laboratory blood test results were normal. An abdomen contrast-enhanced computed tomography scan showed clumping of the small-bowel loops with a membrane surrounding it (Figure A). The duodenum was dilated and colonic loops were collapsed (Figure B). Laparotomy showed a thick fibrotic peritoneal wrapping of the small bowel, suggestive of an abdominal cocoon (Figure C). Excision of the fibrous capsule and release of adhesions between the loops were performed. The patient had an uneventful postoperative period, and she remained well during the early follow-up evaluation. Pathologic examination of the membrane showed a dense fibrocollagenous tissue with no neoplastic or granulomatous change (Figure D). Based on clinical, radiologic, surgical, and histopathologic findings a diagnosis of primary sclerosing encapsulating peritonitis (PSEP) was made. PSEP is an extremely rare idiopathic condition presenting as an intestinal obstruction. It typically is characterized by total or partial encasement of the small bowel by a thick fibrotic membrane. 1 PSEP classically Conflicts of interest The authors disclose no conflicts.

ObjectivesWorldwide, an estimated 10 million adults annually experience significant myocardial injury after non-cardiac surgery. Our aim is to assess whether preoperative and postoperative serum B-type natriuretic peptides levels (BNP) could be used as a predictor of postoperative complications in hypertensive and diabetic patients post non-cardiac surgery.DesignProspective observational study.SettingSingle tertiary-care centre in northern India.ParticipantsThis study included 260 adult participants with known hypertension and diabetes who were planned for elective non-cardiac surgery.InterventionsA preoperative BNP level (baseline BNP) was measured within 24 hours of surgery and another postoperative BNP level was measured within 24 hours of surgery.Main outcome measuresThe primary outcome was the change in BNP levels (delta BNP) between the postoperative and the preoperative BNP levels (baseline BNP) with respect to the baseline BNP and the development of postoperative complications within 30 days of surgery.ResultsThe study established a correlation between delta BNP and baseline BNP (Pearson’s correlation coefficient=0.60; p=0.01). Our study found an increased serum BNP both in the preoperative period and the postoperative period in the patient group that developed complications, respectively (152.02 pg/mL±106.56 vs 44.90 pg/mL±44.22; t=4.120; p≤0.001); (313.99 pg/mL±121.29 vs 83.95 pg/mL±70.19; t=7.73; p≤0.001).ConclusionsWe found that an increased serum baseline and postoperative BNP is potentially important predictor for the development of postoperative complications. Serum BNP has the potential to emerge as a cost-effective test for risk-stratification for postoperative complications in patients undergoing non-cardiac surgery. It has promising prognostic advantages including modification of surgical procedures, deferral of surgery and the ability to tailor therapy postoperatively.