Perforated peptic ulcer - an update.

Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%.

Intra-Abdominal Hematoma Following Enoxaparin Injection.

An elderly patient, who was being treated for therapeutic enoxaparin for a couple of days due to suspected deep vein thrombosis, was admitted to hospital following a collapse and severe abdominal pain. She was in hypovolemic shock and was fluid resuscitated. Ultrasound scan and computed tomography (CT) scan showed a large pelvic hematoma.

Upper gastrointestinal bleeding: gallstone-induced auto-sphincterotomy.

A 67-year-old gentleman with no significant medical history of note presented with sudden onset of epigastric pain, coffee ground vomiting and passing black tarry stool. A series of investigations including blood tests, ultrasound scan, CT abdomen and pelvis with contrast and endoscopy failed to reveal any site of active bleeding. The mystery remained and the patient continued to have upper gastrointestinal bleeding.

An unusual presentation of migraine: temporary complete body paralysis and aphasia.

A 47-year-old gentleman with a medical history of long-standing migraine presented with temporary total body paralysis and expressive aphasia for 4 h. It was also associated with worsening severe unilateral pulsating pain, nausea, photophobia, blurred vision, hearing disturbance and neck stiffness. All these symptoms were resolving gradually after 4 h and had resolved completely after 1 day.