Snakebites are common emergencies in tropical countries, usually presenting with hematotoxic, neurotoxic, or myotoxic effects. Vascular thrombosis as a systemic complication is extremely rare. We report a case of superior mesenteric artery (SMA) thrombosis following a viper bite, leading to acute mesenteric ischemia. A 39-year-old male patient presented with abdominal pain, vomiting, loose stools, and reduced urine output following a snakebite with Daboia russelii to the right index finger. He had received 20 vials of anti-snake venom at a peripheral hospital. On examination, he was tachycardic with abdominal distension, diffuse tenderness, guarding, and rigidity. Blood investigations suggested leukocytosis, thrombocytopenia, and elevated creatinine levels. Imaging revealed dilated small bowel loops and near-complete thrombosis of the jejunal and ileal branches of the SMA. The patient underwent exploratory laparotomy, with resection of gangrenous small bowel, with double-barrel stoma. Despite emergent surgical intervention and intensive supportive care, the patient's condition deteriorated rapidly. The patient succumbed to multi-organ failure and died on postoperative day two. This case highlights the rare but lethal complication of acute mesenteric ischemia following viper envenomation. Early recognition and timely surgical intervention are critical for favorable outcomes.

We report severe Fournier's gangrene in a 69-year-old man presenting with septic shock and extensive perineal gas on computed tomography. Enterococcus faecium was identified. Fournier's gangrene may occur without classical risk factors. Early recognition, broad-spectrum antibiotics, and urgent surgical debridement are essential to improve survival and reduce mortality.

Transomental hernia is a rare cause of small bowel obstruction and may be missed before surgery, particularly in a virgin abdomen. We report a 75-year-old woman with no previous abdominal operation who presented with 4 days of abdominal pain, vomiting, distension, constipation, and reduced urine output. She had leukocytosis and acute kidney injury. Because of renal dysfunction, computed tomography was performed without intravenous contrast. It showed dilated ileal loops, a pelvic transition point, mild ascites, and twisting of mesenteric vessels at the transition point, suggestive of volvulus or closed-loop obstruction. Internal hernia was not diagnosed preoperatively. Emergency laparotomy revealed ileum strangulated through a 3 cm greater omental defect. Approximately 120 cm of gangrenous ileum was resected, the defect was excised, and single-layer extramucosal hand-sewn end-to-end anastomosis was performed. The case emphasizes that closed-loop obstruction in a virgin abdomen should prompt early consideration of internal hernia.

Gas gangrene after a Naja atra bite may be caused by Enterococcus faecalis from the snake's mouth, which is resistant to ceftriaxone. Emergency management must include early, aggressive surgical debridement and antibiotics effective against this organism (e.g., piperacillin-tazobactam) to prevent amputation.

Disseminated peritoneal nematode infestation is a rare extra-intestinal manifestation of ascariasis, typically occurring following bowel perforation. We report a case of a male in his 60s presenting with features of acute small bowel obstruction, including abdominal pain, distension, obstipation, and bilious vomiting, with a history of perforated appendicitis managed surgically six months prior. Contrast-enhanced computed tomography suggested small bowel obstruction. Intraoperative findings revealed dense adhesions, gangrenous ileum, and multiple nodular lesions over the small bowel, mesentery, and omentum. Resection of the gangrenous segment with primary anastomosis was performed. Histopathological examination confirmed nematode infestation with associated granulomatous inflammation. The findings suggest transperitoneal dissemination following prior appendicular perforation. This case highlights a rare presentation of ascariasis mimicking granulomatous disease and emphasizes the importance of considering parasitic etiologies in atypical intra-abdominal pathology, particularly in endemic regions.

A 58-year-old woman on long-term hemodialysis underwent computed tomography for diabetic foot gangrene, which revealed a mass adjacent to the gallbladder, suggesting gallbladder carcinoma. Magnetic resonance imaging also suggested a gallbladder tumor. At laparotomy, the lesion was found to originate from the right kidney, and right nephrectomy was performed. Histopathological and immunohistochemical findings (AMACR+, CD10[+], CK7-) confirmed acquired cystic disease-associated renal cell carcinoma (ACD-RCC). ACD-RCC may present with atypical imaging findings and mimic adjacent organ malignancies in patients on dialysis.

Ulcerative colitis (UC) is a chronic inflammatory condition with recognized extraintestinal manifestations, including a prothrombotic state that can result in both venous and arterial complications. While venous thromboembolism is more common, arterial and microvascular thrombosis leading to digital ischemia and gangrene are rare but severe manifestations. The presence of antineutrophil cytoplasmic antibodies (ANCA), including proteinase 3 (PR3) positivity, may further complicate the clinical picture by mimicking ANCA-associated vasculitis (AAV), posing a diagnostic challenge. We present a 21-year-old male patient with a history of UC who developed rapidly progressive bilateral digital ischemia and gangrene following a recent disease flare. Laboratory evaluation revealed markedly elevated inflammatory markers and positive c-ANCA with PR3 antibodies, raising concern for AAV. Imaging demonstrated patent large vessels. Skin and renal biopsies showed no evidence of vasculitis. Despite treatment with anticoagulation, antiplatelet therapy, vasodilators, and supportive care, ischemia progressed, ultimately requiring digital and partial foot amputations. A multidisciplinary assessment supported a diagnosis of UC-associated vasculopathy after extensive evaluation excluded other causes of thrombosis. This case highlights the importance of distinguishing UC-associated vasculopathy from AAV, particularly in the setting of ANCA positivity, which can represent a diagnostic pitfall. Early tissue biopsy is essential for accurate diagnosis and appropriate management, with a multidisciplinary approach playing a critical role in guiding care.

Ischiorectal abscess can rarely progress beyond the anorectal region to cause Fournier's gangrene, supralevator extension, and purulent peritonitis. Early recognition of disease progression, prompt imaging, aggressive surgical source control, and multidisciplinary management are critical to reducing morbidity and mortality in this life-threatening complication.