Upper gastrointestinal bleeding is a rare presentation of the aortoesophageal fistula (AEF) and is usually caused by thoracic aortic aneurysms. We present the case of a 61-year-old male who presented with chest pain and hematemesis. A chest X-ray showed a widened mediastinum. The patient underwent computed tomography angiography (CTA), which showed the presence of a large aneurysm in the aorta, which caused compression of the trachea, esophagus, and left pulmonary artery. Additionally, there was evidence of an AEF. It was decided to perform an emergency surgical intervention on the patient. However, the patient had multiple episodes of hematemesis and expired.

Primary neuroendocrine carcinoma of the gallbladder (GB) is a rare, highly dismal lethal disease with a fatal prognosis. A 45-year-old female presented with right upper abdomen pain and multiple vomiting episodes. Imaging studies showed diffuse thickening of the wall of the GB with locoregional invasion into the nearby structures with extensive abdominal lymph node metastasis and arteriovenous encasements. Ultrasound-guided fine-needle aspiration was done, which was diagnostic of small cell carcinoma of the GB. The patient was planned for palliative chemotherapy. A small cell variant of neuroendocrine carcinoma of the GB is a rare entity with a moribund lethality associated with it. Patients are diagnosed in advanced stages with not many treatment modalities to offer. Usually, patients are treated with palliative chemotherapy.

The paraneoplastic leukemoid reaction is a rare haematological paraneoplastic syndrome, which is typically seen with solid tumours and squamous cell carcinomas. As an indication of bone marrow infiltration and malignancy involvement, it indicates a poor outcome and a grave prognosis. We report a woman in her 50s, who presented with an ulcer over the right forearm. Biopsy revealed squamous cell carcinoma. The patient underwent radiological investigations, which showed the presence of metastatic squamous cell carcinoma. Incidentally, the patient was found to have leucocytosis, which was attributed to a paraneoplastic leukemoid reaction, after ruling out all other causes of leukemoid reaction. Due to metastatic disease, the patient was planned for palliative radiotherapy and the best supportive care.

Primary pancreatic lymphoma (PPL) is a rare condition often confused and diagnosed as a pancreatic malignancy due to the similarity in clinical presentations of the two entities. Patients of PPL may present with features of obstructive jaundice. Here, we discuss the case of a 27-year-old male who presented to the hospital with features of obstructive jaundice, cholangitis, swelling over the scalp, and right scapular region. The patient was diagnosed to have a pancreatic head mass with radiological investigations. Endoscopic ultrasonography (EUS)-guided fine-needle aspiration cytology report was inconclusive, and the final diagnosis of PPL was made after a cervical lymph node biopsy. The patient received treatment with rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisolone regimen and went into remission.

Tension pneumoperitoneum is a vapid presentation of pneumoperitoneum, which generally refers to free air in the abdomen and can mimic abdominal compartment syndrome. A diastatic perforation in the abdomen refers to a perforation of the cecum due to a distal obstruction in the colon, manifesting as a closed-loop syndrome. We present a 46-year-old male diagnosed with obstructed left inguinal hernia who underwent hernioplasty. Postoperatively, the patient had progressive abdominal distention and abdominal pain. An abdominal x-ray and computed tomography of the abdomen showed massive air in the abdomen. The patient was diagnosed to have tension pneumoperitoneum. Needle decompression of the abdomen was done, and the patient underwent an emergency laparotomy. Intraoperatively, we found a large cecal perforation and a large amount of pneumoperitoneum. The patient underwent limited resection and ileostomy and ascending mucus fistula. Postoperatively, the patient had an uneventful course and was discharged.