Introduction Hundreds of thousands of cholecystectomies and appendectomies are performed in the United States annually. Due to the prevalence of cholecystitis and appendicitis, a subset of patients will require both operations. The limited literature describing these patients supports a laparoscopic approach over open surgery; consistent with the advantages of laparotomy over open surgery in the treatment of each condition individually. Case presentation We report two cases where a patient presented with cholecystitis and appendicitis simultaneously. An abdominal computer tomography (CT) scan revealed the presence of the two diagnoses, which was then confirmed by an abdominal ultrasound. A four-access port was utilized for simultaneous appendectomy and cholecystectomy. Discussion A review of the literature indicates that simultaneous infection with appendicitis and cholecystitis is rare, and thus clinical presentation, lab work, and imaging studies are all needed to support such a diagnosis. Potential findings on imaging in these patients may include distended gallbladder with thickened wall and fluid-filled dilated appendix with mural enhancement. In the event that both clinical presentation and further work-up indicate both pathologies, laparoscopic intervention is suitable. A four-access port is deemed the conservative approach to dealing with such cases. Conclusion Finding a single diagnosis responsible for a patient's illness is a high priority in an acute care setting, a concept known as diagnostic parsimony. However, it is inevitable that very common illnesses will be comorbid in a subset of patients, and physicians should be prepared to consider contemporaneous illness in the isolated circumstances it is warranted.

Kikuchi-Fujimoto disease (KFD) is a rare lymphohistiocytic disorder with an unknown etiopathogenesis. Due to its non-specific lymphadenopathy presentation, treatment is complicated by the frequency by which it is misdiagnosed—for example up to one-third of cases are misdiagnosed as malignant lymphoma, leading to expensive clinical testing and overtreatment of this typically self-limiting illness. KFD has a strong association with SLE, although its transience and rarity make it difficult to investigate. We present a case of KFD to illustrate the variance in presentation and typical outcome of KFD. We want to increase awareness and shed some light on some typical and atypical clinical presentations of KFD to reduce the incidence of misdiagnosis.

A saddle pulmonary embolism is defined as a large thromboembolus lodged at the bifurcation of the pulmonary artery. It would be expected for a patient with a saddle pulmonary embolism to present with symptoms such as dyspnea or pleuritic pain. However, more often than not, saddle pulmonary embolisms may present asymptomatically and are not associated with the typical symptoms. We present a case of an incidental finding of saddle pulmonary embolism in an 89-year-old patient with a past medical history significant of gastrointestinal adenocarcinoma that was treated with capecitabine. The saddle pulmonary embolism was found incidentally on computer tomography (CT) with the contrast of the abdomen and subsequently confirmed with CT of the chest with contrast. It is crucial to be mindful of a possible pulmonary embolism in a patient with similar past medical history.

Disposal of fetal remains as a biohazard material after spontaneous abortion has been the standard practice in many states across the United States of America. In certain states, when a patient requests the fetal remains, it raises a controversy. A proper funeral and burial may be beneficial for patients who suffered from a miscarriage. A patient who is informed of the options available to her after a miscarriage can then decide the most suitable path to deal with such a tragedy. However, the return of the fetal remains to the patient still remains a controversy in certain locations.

Background/Objective: Obesity (body mass index > 30 kg/m2) complicates maternal and neonatal pregnancy outcomes. Bariatric surgery (BS) is an option for weight reduction in reproductive-aged women. However, there is a lack of data regarding the ideal time interval between BS and pregnancy. Methods:We report the case of a 43-year-old Hispanic female who underwent an initial Roux-en-Y gastric bypass (RYGB) in 2011 followed by a revision eight years later in 2019. The revision occurred 16 months prior to conception of her second pregnancy. Results: Despite advanced maternal age and nutritional challenges following BS, she delivered a healthy male baby and sustained a net weight loss compared to her preoperative weight. Factors leading to this positive outcome included the patient’s adherence to dietary recommendations following the procedure and the use of phentermine to promote post-procedure weight loss. Conclusion: An interval of sixteen months between RYGB revision and conception can lead to positive pregnancy outcomes, even in women of advanced maternal age. Adherence to post-procedure nutrition and weight gain protocols are crucial to this outcome. Further studies are needed to explore the time interval that ensures a healthy pregnancy, as well as the use of medications as weight loss adjuncts following BS.