Appendiceal endometriosis is a rare form of extragenital endometriosis that can mimic acute appendicitis. This reports presents the case of a 19-year-old woman with no significant medical history who presented with right-sided abdominal pain, nausea, and lightheadedness. Physical examination revealed right lower quadrant tenderness and a positive Rovsing sign. Laboratory studies showed no leukocytosis, and her modified Alvarado score was 4. Computed tomography of the abdomen and pelvis demonstrated mild fluid and inflammatory changes near the base of the cecum extending toward the right adnexa, raising concern for acute appendicitis versus a ruptured ovarian cyst. Pelvic ultrasound identified a complex cystic structure in the right ovary with adjacent free fluid, while appendicitis could not be excluded. Due to persistent symptoms and diagnostic uncertainty, laparoscopic appendectomy was performed. Intraoperative findings included hemoperitoneum, endometriotic lesions, and possible rupture of a right ovarian follicle. Histopathological examination revealed appendiceal serosal endometriosis. This case underscores the diagnostic challenge of appendiceal endometriosis and the importance of considering gynecologic etiologies in young women presenting with right lower quadrant pain.

Multisystem thromboembolism is a rare but potentially fatal phenomenon that can develop in patients with underlying hypercoagulability and rapidly progress to multiorgan failure if not promptly identified. Concurrent arterial and venous embolic events should raise suspicion for paradoxical embolism, particularly in patients with a patent foramen ovale (PFO).

Acute kidney injury (AKI) in the intensive care unit (ICU) is a heterogeneous syndrome characterized by kidney stress, structural injury, functional decline, requirement for extracorporeal organ support, and incomplete recovery, rather than a single creatinine-defined event. Current critical care practice increasingly integrates conventional Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic criteria with urine output trajectories, cystatin C measurement when serum creatinine is unreliable, structural damage biomarkers when results will change management, hemodynamic phenotyping, venous congestion assessment, nephrotoxin stewardship, fluid stewardship, and recovery planning. This narrative review summarizes recent advances relevant to adult ICU care, including evolving definitions of AKI and acute kidney disease, sepsis-associated microcirculatory and cellular injury, systemic venous congestion, point-of-care ultrasound-assisted congestion assessment, biomarker-triggered prevention bundles, individualized renal replacement therapy (RRT), continuous renal replacement therapy (CRRT), and post-ICU recovery pathways. Key recommendations include avoiding automatic fluid loading in response to oliguria; interpreting mean arterial pressure together with cardiac output, central venous pressure, right ventricular function, and intra-abdominal pressure; using biomarkers only within an actionable response pathway; and initiating RRT according to urgent or trajectory-based indications rather than serum creatinine alone. Precision ICU nephrology is best conceptualized as the timely alignment of phenotype, risk, trajectory, and organ support objectives.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy by improving survival across multiple malignancies by enhancing antitumor immune responses. However, increasing use of ICIs has been accompanied by a growing spectrum of immune-related adverse events (irAEs). Gastrointestinal irAEs most commonly include colitis and hepatitis, whereas biliary complications remain rare and poorly characterized. ICI-associated cholecystitis is an uncommon entity affecting patients treated with ICIs. It often presents as an acalculous disease and occurs months after therapy initiation. This report describes a case of a 64-year-old woman with lung adenocarcinoma receiving adjuvant pembrolizumab after surgical resection and chemotherapy who developed acute right upper quadrant pain and fatigue during her ninth treatment cycle. Imaging revealed significant gallbladder distension and wall thickening in the absence of gallstones, consistent with acute cholecystitis. Given high operative risk from concurrent ICI-induced adrenal insufficiency and absence of severe inflammatory findings, she was managed conservatively with intravenous fluids, antibiotics, and stress-dose corticosteroids, resulting in clinical improvement. Pembrolizumab was discontinued because of suspected immune-mediated toxicity, and she was discharged with plans for elective cholecystectomy and oncologic surveillance. This case highlights the importance of maintaining a high index of suspicion for biliary irAEs in patients receiving ICIs who present with abdominal symptoms and underscores the need for multidisciplinary management and further studies to guide optimal treatment strategies.

The primary cause of acute appendicitis is obstruction of the proximal lumen of the appendix, although the underlying etiology remains unclear in many cases. Trauma is a rare but documented cause of appendicitis. We present the case of a 38-year-old man who developed right lower quadrant abdominal pain four days after jumping from the second floor of a department store. He reported no prior episode of lower abdominal pain. Abdominal computer tomography (CT) confirmed the diagnosis of acute appendicitis, and the patient subsequently underwent an emergency appendectomy. This case report and literature review highlight the importance of promptly considering appendicitis in patients presenting with acute abdominal pain following abdominal trauma and underscore the need for timely evaluation and appropriate management.

Chronic mesenteric ischemia (CMI) with multivessel occlusive disease remains challenging when endovascular therapy fails. We describe sequential antegrade reconstruction of the superior mesenteric artery (SMA) and celiac artery using a single 8-mm Dacron conduit originating from the supraceliac aorta. A 59-year-old man with severe malnutrition presented with progressive postprandial abdominal pain and substantial weight loss. Computed tomography angiography revealed flush occlusion of the celiac trunk, heavily calcified chronic total occlusion of the proximal SMA, patent distal target vessels, and limited collateralization through a diminutive inferior mesenteric artery. After two unsuccessful endovascular attempts, open revascularization was performed. The distal SMA was selected beyond the occluded segment, and the celiac trunk was reimplanted onto the same graft to preserve antegrade physiologic inflow while avoiding additional conduits. The patient recovered uneventfully and remained asymptomatic with patent graft at 3 months. This report outlines considerations for conduit configuration in CMI after failed endovascular therapy.

Pelvic desmoid fibromatosis is a rare locally aggressive benign neoplasm, typically presenting in the reproductive age group with lower abdominal pain. Extra-abdominal occurrence being predominant, the pelvic origin of the tumour makes the clinical management a multidisciplinary challenge. Previous surgeries, current or previous pregnancies, and familial adenomatous polyposis have been documented as associated risk factors. Our patient was a young woman with three previous caesarean sections, admitted with a large infiltrative lesion extending into the left pelvic sidewall up to the pelvic bone, causing ipsilateral severe hydroureteronephrosis. Malignancy was suspected due to the infiltrating nature of the lesion on imaging. Due to its proximity to the pelvic veins, preoperative embolisation of the feeding vessel was done. An exploratory laparotomy was performed by a multidisciplinary team. For this deep-seated disease, mass excision was performed along with total hysterectomy, left salpingo-oophorectomy and left ureteroneocystostomy. A part of the lesion infiltrating the presacral fascia was not removed during the primary surgery. Within 24 hours of surgery, she developed critical limb ischaemia in the left limb due to thrombosis in the ipsilateral external iliac artery. An emergency thrombo-embolectomy was performed by the vascular surgeons and thromboprophylaxis continued. Final histopathology confirmed desmoid fibromatosis. For the residual disease, the patient has been under close follow-up and is receiving targeted therapy with oral sorafenib to prevent local progression. Her follow-up imaging showed a decrease in the size of the residual disease and she is asymptomatic currently.

Actinomycosis is a rare, slow-progressing infection mimicking malignancies by penetrating mucosal barriers and spreading across anatomical planes. While typically affecting the cervicofacial area, it can also involve the thorax and abdomen, with simultaneous hepatic and pulmonary involvement being particularly rare.

Cat scratch disease is a zoonotic infection caused by Bartonella henselae and typically presents with regional lymphadenopathy and mild systemic symptoms in immunocompetent children. Atypical disseminated disease with visceral involvement is uncommon and may occur without classic clinical findings, leading to delayed diagnosis, particularly in patients with altered immune responses. We describe the case of an 11-year-old girl with type 1 diabetes mellitus who presented with persistent fever and progressive abdominal pain. Initial evaluation suggested streptococcal pharyngitis, and she was treated with appropriate antibiotics without improvement. Subsequent imaging revealed multiple hepatic lesions concerning for malignancy or infection. The patient had significant cat exposure but lacked lymphadenopathy or cutaneous lesions. Laboratory studies demonstrated anemia and elevated inflammatory markers with normal liver enzymes. Magnetic resonance imaging confirmed multifocal hepatic involvement. Based on imaging findings and exposure history, disseminated Bartonella henselae infection was suspected, and empiric antimicrobial therapy was initiated. The patient improved clinically, and serologic testing later confirmed the diagnosis. This case highlights an atypical presentation of disseminated cat scratch disease with isolated hepatic involvement in a child with diabetes mellitus. Recognition of hepatic lesions on imaging and careful exposure history were critical for diagnosis. Clinicians should maintain a high index of suspicion for Bartonella henselae in pediatric patients with prolonged fever and abdominal pain, especially those with metabolic or immunologic risk factors, even in the absence of classic features.