Cushing's syndrome is a rare endocrine disorder characterized by an insidious course and multisystem manifestations, often leading to delayed diagnosis due to its nonspecific presentation. A 52-year-old woman with a history of type 2 diabetes mellitus and hypertension was followed in primary care for persistent musculoskeletal pain and worsening metabolic control, initially attributed to poor treatment adherence. Her condition progressively led to significant functional impairment, requiring the use of crutches for ambulation and ultimately resulting in medical retirement due to disability. After presenting with abdominal pain, a computed tomography scan incidentally revealed a 35 mm left adrenal mass suggestive of an adenoma. In light of the clinical context, further evaluation confirmed adrenocorticotropic hormone (ACTH)-independent hypercortisolism. The patient underwent left adrenalectomy and remains under clinical follow-up, with progressive improvement in metabolic parameters and functional status. This case highlights the importance of reassessing persistent symptoms and appropriately evaluating incidental findings in primary care, as well as the potential for significant functional decline in undiagnosed cases. Early recognition of atypical presentations may facilitate the diagnosis of rare endocrine disorders.

Introduction Irritable bowel syndrome (IBS) is a chronic medical condition that presents with abdominal pain, abdominal bloating, diarrhea, among others. Understanding the knowledge, awareness, and practice of IBS is crucial for the early recognition of symptoms, treatment, and management of the condition. Methods This was a cross-sectional, questionnaire-based study that utilized data from a sample of 421 participants drawn from the general adult population in the Al-Baha region of Saudi Arabia. Data were cleaned, coded, and then analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, NY, USA), to derive key insights. Results The study found that 85 (20.2%) had high knowledge, the majority 299 (71.0%) had medium knowledge, while only 37 participants (8.8%) had low knowledge about IBS. Participants aged 20-39 years (p < 0.001), those with postgraduate studies (p = 0.039), and those employed (p = 0.002) demonstrated considerably good knowledge about the condition compared to other groups. The most frequently reported symptom of IBS was abdominal bloating (368, 87.4%); psychological stress (388, 92.2%) was the most commonly reported factor that worsens IBS. The most common source of information about the condition was social media (214, 50.8%). Being employed was positively associated with high knowledge about IBS (AOR = 1.96; 95% CI = 1.048-3.665; p = 0.035). Conclusion The study found the level of knowledge about IBS to be inadequate among the population, with significant gaps in understanding the potential health risks posed by the condition. The most common source of information about IBS was social media. Being employed was significantly associated with high knowledge of the condition. The study highlights the need for targeted health education and awareness campaigns to increase awareness of the condition, ultimately improving treatment outcomes.

Perforated duodenal ulcers represent a surgical emergency requiring prompt operative intervention. The Graham omental patch is the most commonly performed procedure for emergent repair; however, postoperative findings suggestive of leakage remain a serious concern and are associated with significant morbidity and mortality. Traditionally, suspected postoperative leaks have prompted early surgical re-exploration due to the risk of peritonitis and sepsis. However, select patients with concerning postoperative findings may be managed successfully with appropriate drainage, decompression, and nutritional support. We present the case of a 79-year-old male patient who was brought to the emergency department with progressive altered mental status and generalized abdominal pain. Imaging revealed findings consistent with a perforated duodenal ulcer, and the patient underwent emergent exploratory laparotomy with Graham patch repair and placement of a Jackson-Pratt drain. During the postoperative period, bilious output from the drain raised concern for a possible duodenal leak. A contrast-enhanced CT scan with enteric (oral) contrast demonstrated contrast entering the drain, prompting surgical re-exploration. Intraoperatively, the previous repair was found to be intact without evidence of active leakage; instead, a retroperitoneal abscess extending along the duodenal sweep was identified and drained. With continued supportive management, including nasogastric decompression, antibiotics, proton-pump inhibitor therapy, and nutritional support via gastrostomy tube, the patient demonstrated progressive clinical improvement. Drain output gradually diminished and ceased, consistent with resolution of the postoperative process. This case highlights that postoperative findings suggestive of duodenal leak may not represent true failure of the primary repair and underscores the importance of correlating radiologic, intraoperative, and clinical findings. Careful assessment and appropriate supportive management may allow for favorable outcomes in selected hemodynamically stable patients following Graham patch repair.

Abdominoplasty is a commonly performed body-contouring procedure with a predictable postoperative course. Early abdominal pain is typically attributed to surgical site discomfort, edema, rectus plication, or common complications such as seroma or hematoma. However, intra-abdominal pathology may present with overlapping or nonspecific symptoms, increasing the risk of diagnostic delay. We report two cases of postoperative abdominal pain following abdominoplasty in which intra-abdominal etiologies were identified or strongly considered. In Case 1, a 71-year-old woman with prior Roux-en-Y gastric bypass developed progressive abdominal pain and obstructive symptoms on postoperative day 1. Imaging revealed small bowel obstruction, and diagnostic laparoscopy confirmed an internal hernia through a Petersen's defect requiring surgical intervention. In Case 2, a 34-year-old woman presented with progressive right lower quadrant pain and swelling after a combined reduction mammaplasty and abdominoplasty. Imaging demonstrated an incidental ovarian hemorrhagic cyst, and she was managed conservatively with resolution of symptoms. In both cases, the abdominal wall and surgical sites were clinically benign. These cases highlight that postoperative abdominal pain after abdominoplasty is not always attributable to the abdominal wall or operative field. Overlapping symptoms may contribute to diagnostic anchoring and delayed recognition of intra-abdominal pathology. Maintaining a broad differential diagnosis, particularly in patients with prior abdominal surgery or atypical symptom progression, is essential. Prompt evaluation and multidisciplinary collaboration can reduce morbidity and prevent delays in care.

[This corrects the article DOI: 10.1093/jcag/gwaf042.257.].

Semaglutide is a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1 RA), primarily used for the treatment of type 2 diabetes mellitus and obesity. Common adverse drug reactions (ADRs) include nausea, vomiting, diarrhea, abdominal pain, and constipation, whereas liver function-related ADRs are relatively rare. We report a rare and severe case of semaglutide-induced acute-on-chronic liver failure (ACLF) in a 47-year-old male patient who was successfully treated. The patient was admitted to the Department of Infectious Disease at the Second Xiangya Hospital of Central South University on December 1, 2023. He had a history of chronic hepatitis B and had discontinued antiviral therapy for more than two years without medical supervision. Due to weight loss requirements, he initiated subcutaneous semaglutide therapy. Approximately three months after treatment initiation, he developed severe liver dysfunction, which rapidly progressed to profound jaundice, coagulopathy, and hepatic encephalopathy. Drug-induced liver injury (DILI) was considered the primary precipitating factor of liver failure, and the final diagnosis was ACLF. Following confirmation of the diagnosis, semaglutide was discontinued, and comprehensive management, including hepatoprotective therapy, artificial liver support, plasma exchange, and liver transplantation, was implemented. The patient's clinical symptoms and liver function parameters improved significantly. This report describes the successful management of semaglutide-induced ACLF and reviews the relevant literature. For individuals with underlying chronic liver disease (e.g., chronic viral hepatitis), thorough baseline liver assessment should be performed prior to initiating semaglutide or similar agents. Close monitoring during treatment is essential to identify potential severe drug-induced liver injury at an early stage.