Massive Gastroepiploic Artery Pseudoaneurysm Presenting as Arterial Enteric Fistula.

A 63-year-old male presented to the Emergency Department with weakness and hematochezia. He was found to have a massive gastroepiploic artery pseudoaneurysm that had eroded into the transverse colon. He underwent open en bloc resection of the aneurysm, a portion of the stomach, and a portion of the transverse colon.

Is pneumatosis cystoides intestinalis a lymphatic pathology?: A case of small bowel lymphangioma and subsequent development of pneumatosis cystoides intestinalis in a 57-year-old female.

The etiology of pneumatosis cystoides intestinalis (PCI) is multifactorial and its corresponding treatment is similarly complex. One causation of PCI, is lymphatic disruption. This association is discussed in this case report involving an incident of abdominal lymphangioma and subsequent development of PCI in a 57-year-old female.

An unusual case of intra-peritoneal bladder rupture.

•Urologists and health care professionals alike need to recognize the risks and complications that come with clot formation in urine and the use of CBI, especially subsequent bladder rupture.•Prior history of chronic, prolonged BPH has implications and complications that need to be considered when hematuria with blood clots arise and urologic procedures are performed.•This case is presented to highlight the importance of surveillance of hematuria with presence of clots, as well as the importance of regulated control of CBI.

Jejunal lymphangioma causing intussusception in an adult: An unusual case with review of the literature.

Introduction: Adult intussusception is rare, and 90% are due to a lead point secondary to a pathologic condition. Lymphangioma is an uncommon tumor of the lymphatic system and is rarely found within the small bowel. Small bowel lymphangioma causing intussuception in an adult is a rare occurrence, with three very distinct rare pathologies occurring simultaneously.

Synchronous primary malignancies of the appendix and ovary causing carcinomatosis in one patient.

Associated tumors of the ovary and the appendix are commonly found in cases of pseudomyxoma peritonei (PP); the origin of these tumors are a continually debated topic. Outside of the setting of PP, this finding is exceedingly rare and there are no documented reports of two primary processes causing carcinomatosis in the absence of PP. Here, we present a patient who underwent cytoreductive surgery for peritoneal carcinomatosis presumptively secondary to ovarian carcinoma and who on pathological examination was found to have synchronous primary malignant processes of both the appendix and the ovary.

Ultrasound-guided excision of nonpalpable malignant soft tissue tumors of the abdomen.

The use of intraoperative ultrasound to guide the excision of sonographically visible but nonpalpable lesions is a newer modality. Its use in intraoperative localization of recurrent malignant soft tissue tumors has not been reported. This report describes a technique of intraoperative localization by ultrasound to guide the excision of recurrent nonpalpable malignant soft tissue tumors of the abdominal wall in two patients.

Tracheostomy in ventilator dependent trauma patients: a prospective, randomized intention-to-treat study.

Background: Tracheostomy is a commonly performed procedure in ventilator dependent patients. Many critical care practitioners believe that performing a tracheostomy early in the postinjury period decreases the length of ventilator dependence as well as having other benefits such as better patient tolerance and lower respiratory dead space. We conducted a randomized, prospective, single institution study comparing the length ventilator dependence in critically ill multiple trauma patients who were randomized to two different strategies for performance of a tracheostomy.

Splanchnic perfusion during delayed, hypotensive, or aggressive fluid resuscitation from uncontrolled hemorrhage.

The purpose of this study was to determine the effect of three different fluid resuscitation strategies on splanchnic perfusion in a clinically relevant model of uncontrolled hemorrhage after liver trauma. Anesthetized swine were instrumented with a gastric near-infrared spectroscopy probe (GStO2), a jejunal tonometer (PrCO2), a portal vein catheter (SpvO2, lactate), and an ultrasonic blood flow probe on the superior mesenteric artery. The liver was lacerated to produce uncontrolled hemorrhage and a shock state characterized by a 40-60% decrease in cardiac output and a decrease in mean arterial pressure (MAP) to 42 +/- 1 mmHg.