Concealing drugs inside the body to transport them covertly, known as 'body packing', can be fatal. Intestinal occlusion and poisoning are common; fatal gastric perforation is unusual. We present a rare case involving a 54-year-old female 'drug mule' (body packer) who died from peritonitis resulting from gastric perforation. The deceased (from Sweden) was discovered dead in her hotel room. A forensic autopsy revealed diffuse peritonitis due to a 2 cm hole in the superior part of the gastric lesser curvature. There were 70 rigid plastic capsules, about 6 cm long and weighing between 3 and 4 g each, inside the stomach, intestines and in the subphrenic space. This case serves as a stark reminder of a rare but serious complication associated with body packing; the volume of the capsules may have exerted enough strain to cause stomach wall ischaemia and rupture. Drug mules are more commonly young men who present with acute signs of poisoning, so the type and site of complication, the victim's sex and relatively older age make this report stand out as unusual. In conclusion, we need to recognise that gastric perforation poses a serious, life-threatening danger in cases of body packing, particularly if a 'mule' swallows large, stiff packets and it is crucial that forensic pathologists and doctors keep this possibility in mind and involve multiple disciplines when dealing with these very high-risk situations. Interdisciplinary policies should be created to manage the care of body packers and to prevent a recurrence.

Acute gastric distension (AGD) is a rare but life-threatening acute abdominal condition. Despite the rich blood supply to the stomach, extreme distension can lead to ischemic necrosis, perforation, and gas accumulation in the portal vein, with a mortality rate as high as 80-100%. We report the case of a 15-year-old male patient who presented with severe abdominal pain, bloating, and vomiting following a binge-eating episode. Physical examination revealed signs of diffuse peritonitis and shock (heart rate 154 beats per minute). Laboratory results showed severe metabolic acidosis (pH 7.265) and hyperlactatemia (11.3 mmol/L). An abdominal CT scan confirmed massive gastric distension and gas accumulation in the portal vein, biliary tract, and esophageal wall. The patient underwent emergency laparotomy within 2 hours of admission. Intraoperatively, the stomach was found to be distended into the pelvic cavity, with two areas of hemorrhagic necrosis: one on the lesser curvature (4 cm × 5 cm) and another on the posterior wall of the greater curvature (3 cm × 4 cm). Gastric decompression, debridement of the necrotic areas, and creation of a gastrostomy were performed. After 5 days of intensive care unit (ICU) monitoring (for treatment of septic shock), the patient recovered well and was discharged on the 14th postoperative day; follow-up revealed no recurrence. This case demonstrates that even healthy individuals without eating disorders may develop AGD due to acute binge eating. Portal air is a critical warning sign of mucosal necrosis. Early diagnosis via CT and prompt surgical decompression are key to saving the lives of patients with ischemia and shock.

Background and Clinical Significance: Torsion of the vermiform appendix is a rare condition with a clinical presentation closely resembling acute appendicitis, while preoperative investigations are of limited value in distinguishing between the two entities. In most cases, the definitive diagnosis is made incidentally during surgery. Case Presentation: The authors present the case of an 18-day-old female neonate who presented with marked abdominal distension, diffuse spontaneous and palpation-induced abdominal pain, guarding, and signs of peritoneal irritation. The clinical manifestations and paraclinical findings mimicked a neonatal intestinal obstruction; however, intraoperative exploration revealed a gangrenous vermiform appendix twisted 240° anticlockwise, associated with a fibrinous pseudomembrane and multiple enlarged mesenteric lymph nodes. Although the initial therapeutic strategy was to perform a laparoscopy, severe abdominal distension caused by marked aerocolia necessitated conversion to a supra- and infraumbilical midline laparotomy. We thus describe, to the best of our knowledge, one of the youngest neonatal cases of appendiceal torsion reported in the literature. Conclusions: Although rare, appendiceal torsion should be considered in the differential diagnosis of neonatal acute abdomen, and timely surgical exploration is key to achieving a favorable outcome.

We report an 11-year-old boy with chronic kidney disease (CKD) stage 3 due to right multicystic dysplastic kidney and contralateral dysplasia who developed poststreptococcal acute glomerulonephritis (PSAGN) that rapidly progressed to kidney failure despite intensive immunosuppressive treatment. He presented with oliguria, macrohematuria, heavy proteinuria, hypocomplementemia, and an elevated antistreptolysin O titer. Initial kidney biopsy revealed diffuse endocapillary proliferation with prominent C3 deposition, subepithelial humps, and positive staining for nephritis-associated plasmin receptor (NAPlr), consistent with PSAGN. Kidney dysfunction persisted despite the administration of methylprednisolone pulse therapy, prednisolone, cyclosporine, and mycophenolate mofetil. A second biopsy at 4 months revealed focal segmental glomerulosclerosis, diffuse foot process effacement, and negative staining for NAPlr, suggesting transition from a glomerular inflammatory process to a hyperfiltration-driven structural injury. Comprehensive genetic analysis did not identify any pathogenic variants associated with bilateral dysplastic kidney. Peritoneal dialysis was initiated on day 182, and living donor kidney transplantation was performed 10 months after nephritis onset, with favorable early outcomes. This case highlights that PSAGN superimposed on CKD with reduced nephron mass may result in rapid kidney function deterioration despite aggressive treatment.

Acute abdomen in elderly postmenopausal women requires prompt evaluation to exclude life-threatening conditions such as bowel perforation, intra-abdominal sepsis, and malignancy. Advanced gynecological malignancies may involve the gastrointestinal tract, commonly through peritoneal dissemination or direct invasion. However, presentation as bowel perforation is rare and associated with significant morbidity. A 61-year-old postmenopausal woman presented with diffuse abdominal pain and altered bowel habits. She was hemodynamically unstable with clinical features of sepsis. Imaging revealed a pelvic mass with suspected bowel involvement, pneumoperitoneum, and a hepatic lesion suggestive of metastasis. Emergency exploratory laparotomy demonstrated purulent peritoneal contamination and a sloughed ileal segment near the ileocecal junction, forming a mass with adjacent pelvic structures and a hepatic lesion suggestive of metastasis. Ileal resection with end ileostomy was performed. Histopathological examination of the bowel segment and liver lesion biopsy revealed metastatic carcinomatous deposits. Immunohistochemistry showed CK7+, PAX8+, WT1+, CK20-, and SATB2-, favoring a Müllerian origin. Further imaging demonstrated advanced disease with hepatic and vertebral metastases. The patient received combination chemotherapy with gemcitabine, carboplatin, and bevacizumab, achieving a near-complete metabolic response. Bowel perforation as an initial presentation of pelvic malignancy is rare. This case highlights the importance of clinical judgment in managing an acute abdomen, especially when imaging findings are inconclusive. Immunohistochemistry plays a crucial role in identifying the primary tumor origin. Management requires a staged approach with emergency surgical intervention followed by multidisciplinary oncological treatment for optimal outcomes.

Ileal diverticulitis is an uncommon cause of acute abdomen, and perforation is a rare but serious complication that may lead to secondary peritonitis. Its clinical presentation is often nonspecific and may mimic more common intra-abdominal emergencies, making computed tomography (CT) essential for diagnosis. We report the case of a 79-year-old man who presented with a three-day history of diffuse abdominal pain, nausea, vomiting, inability to tolerate oral intake, and absence of bowel movements and passage of flatus. Physical examination revealed abdominal distension, diffuse tenderness, guarding, and signs of peritoneal irritation. Laboratory studies showed mild leukocytosis and markedly elevated C-reactive protein. Contrast-enhanced CT demonstrated multiple ileal diverticula, segmental bowel wall thickening, inflammatory changes, pneumoperitoneum, and an adjacent fluid collection, consistent with perforated ileal diverticulitis and secondary peritonitis. Exploratory laparotomy revealed multiple ileal diverticula involving approximately 50 cm of the distal ileum, purulent and enteric contamination, and a perforated ileal diverticulum measuring approximately 5 mm. Segmental ileal resection with creation of an end ileostomy was performed. Histopathological examination confirmed acute diverticulitis with diverticular perforation and no evidence of malignancy. The patient had a favorable postoperative course and was discharged on postoperative day 7. This case highlights the importance of considering ileal diverticulitis in elderly patients with acute peritonitis and emphasizes the role of CT and timely surgical management in complicated cases.

Pneumoperitoneum due to lower gastrointestinal perforation is an acute clinical situation requiring rapid dia-gnosis and treatment. This condition is often the result of dis-eases such as diverticulitis, malignant tumors, Crohn's dis-ease, or complications of endoscopic examination methods and surgical procedures. If this condition is not treated promptly, it can lead to life-threatening complications. Dia-gnosis relies mainly on imaging techniques such as X-ray, ultrasound, and CT, which allow the detection of free gas in the peritoneal cavity and the localization of the perforation. Treatment is usually surgical and its success depends on the speed of intervention and the general condition of the patient. This article discusses the etiology, dia-gnostic approaches, treatment strategies, and prognostic factors associated with pneumoperitoneum from lower gastrointestinal perforation, with emphasis on current clinical practices and recommendations.

Gastrointestinal candidiasis is typically encountered in immunocompromised individuals. Small bowel perforation presenting in association with pancolitis in an immunocompetent patient is exceedingly rare. We report the case of a 67-year-old immunocompetent male patient who presented with acute abdomen and generalized peritonitis. Emergency exploratory laparotomy revealed a jejunal perforation 10 cm distal to the duodenojejunal flexure, which was managed with primary repair and an omental patch. The postoperative course was initially uneventful; however, the patient was readmitted with diarrhea and abdominal pain. Imaging revealed diffuse pancolitis with terminal ileal involvement. Histopathological examination of the jejunal perforation edge biopsy demonstrated fungal elements in the form of pseudohyphae and budding yeast forms consistent with Candida species, without evidence of malignancy or granulomatous disease. The patient responded favorably to systemic antifungal therapy with fluconazole. This case highlights a rare presentation of Candida-associated jejunal perforation with pancolitis in an immunocompetent patient and underscores the importance of routine histopathological evaluation in hollow viscus perforation and early consideration of fungal etiology in atypical postoperative gastrointestinal presentations.

Small bowel obstruction due to ingested fruit pits is rare and often underrecognized. In exceptional cases, these foreign bodies may mimic the clinical and imaging features of gallstone ileus, a complication of cholelithiasis involving biliary-enteric fistula formation and gallstone migration into the intestinal lumen. Such presentations may lead to misdiagnosis and inappropriate management. This case highlights an uncommon but clinically relevant diagnostic pitfall: a pseudo-gallstone ileus caused by an impacted apricot pit in a patient with a prior ileocolic anastomosis. An Italian Caucasian 49-year-old woman presented with acute abdominal pain and vomiting. Her medical history included a remote ileocolic resection for intestinal ischemia. Physical examination revealed a diffusely tender abdomen without signs of peritonitis. Biochemical investigations showed mild hepatopancreatic enzyme elevation and a low-grade inflammatory response. Plain abdominal radiography demonstrated radiopaque intraluminal structures in the right iliac fossa and features of small bowel obstruction. Contrast-enhanced computed tomography confirmed mechanical obstruction above a prior ileocolic anastomosis, with three hyperdense intraluminal masses in the distal ileum and calcified gallstones in the gallbladder. Although no aerobilia or biliary-enteric fistula was detected, imaging raised suspicion of gallstone ileus. Colonoscopy revealed a stenotic ileocolic anastomosis and three hard, stone-like masses in the terminal ileum. Two were endoscopically mobilized into the colon; the third resisted lithotripsy. Magnetic resonance cholangiopancreatography showed no evidence of biliary-enteric fistula. On repeat endoscopy, after balloon dilation of the anastomosis, the remaining object was retrieved and identified as an apricot pit. Upon questioning, the patient recalled recent ingestion of stone fruits. The final diagnosis was mechanical small bowel obstruction from an impacted fruit pit mimicking gallstone ileus. The patient recovered fully and was discharged with dietary recommendations. This case underscores the importance of considering alternative diagnoses when imaging suggests gallstone ileus, especially in the absence of a biliary-enteric fistula. Radiologists and clinicians should be aware that ingested fruit pits may resemble calcified biliary calculi on cross-sectional imaging. A high index of suspicion and multidisciplinary collaboration are essential to avoid misdiagnosis and unnecessary surgical intervention.