An early BAL protocol identified trauma patients with early pneumonia, a separate entity from ventilator-associated pneumonia. Patients were treated based on clinical signs. There was no difference in clinical outcomes but reported VAP rate decreased by 28%.

Small bowel is a well-described site of malignant melanoma; however, it is a rare cause of intussusception. A patient presented with malignant melanoma causing jejunojejunal intussusception 11 years after resection of melanoma-in-situ. The patient was managed with exploration and resection. Despite complete resection of melanoma-in-situ and limited literature about its metastatic potential, malignant melanoma as a lead point for intussusception should be on the differential for any patient with pertinent history. To our knowledge, this appears to be the first case of melanoma-in-situ causing small bowel intussusception.

Preduodenal portal vein (PDPV) is a rare congenital anomaly in which the portal vein lies anterior to the duodenum rather than its normal posterior position. It is a known rare cause of duodenal obstruction and can be associated with other anomalies such as malrotation with or without jejunal atresia. Presented is an incidentally found PDPV causing partial duodenal obstruction during exploration for the resection of a gastric mass and placement of open gastrostomy tube for feeding. This was managed with duodenoduodenostomy, re-creating normal anatomy with portal.