Intrapericardial diaphragmatic hernia (IPDH) is a rare condition that commonly occurs after trauma, in which abdominal contents herniate through the central tendon of the diaphragm into the pericardial sac. Diagnosis is frequently delayed due to nonspecific cardiopulmonary symptoms and subtle imaging findings. We performed a narrative review of cases of traumatic IPDH to identify diagnostic challenges and operative strategies and present a case of a 71-year-old woman who developed IPDH following a motor vehicle collision. Initial imaging demonstrated rib, liver, and pelvic fractures without evidence of diaphragmatic injury. After orthopedic surgery, the patient developed chest pain and dyspnea, prompting repeat imaging suggesting IPDH. Robotic-assisted repair revealed a 9-cm anterior diaphragmatic defect containing stomach and omentum, which was repaired with mesh. Postoperatively, the patient developed pericarditis confirmed by cardiac evaluation. This review highlights the diagnostic challenges of IPDH, limitations of imaging, and the importance of multimodal evaluation and timely surgical intervention.

A 74-year-old man presented with abdominal pain. Preoperative evaluation for small bowel perforation revealed a 74-mm tumour shadow obstructing the right lower lobe bronchus. Endobronchial biopsy from the truncus intermedius was diagnostic of squamous cell carcinoma (SCC). Pathological findings in the small intestine were consistent with SCC. Based on other radiological findings, the patient was diagnosed with stage IVB (cT4N3M1c) lung SCC (LUSC). Serum amylase levels were elevated at 1693 U/L (pancreatic amylase 184 U/L) prior to treatment. AMY1 (2D4) immunohistochemistry was positive, confirming amylase-producing LUSC, a rarely reported entity. Amylase levels decreased to 203 U/L following combination therapy with carboplatin, nab-paclitaxel and pembrolizumab. The patient had no symptoms or signs of pancreatic or salivary gland disease. To our knowledge, this is the first reported case of LUSC with both histological evidence of amylase production and hyperamylasemia. This case provides new evidence that LUSC can produce amylase and cause hyperamylasemia.

Adhesive small bowel obstruction (aSBO) remains one of the most common causes of surgical admission and morbidity. With advancements in imaging and the advent of water-soluble contrast, management has become increasingly non-operative. Although this is successful in a majority of patients, patients who fail this trial without operation may face worse outcomes. Delays to surgical intervention are associated with increased rates of bowel ischemia, resection, infectious complications, and mortality. Optimal management therefore depends on early risk stratification, disciplined non-operative trials, and timely escalation to operation when indicated. This review summarizes contemporary evidence regarding pathogenesis, pathophysiology, epidemiology, diagnostic evaluation, management, and outcomes of aSBO, with a focus on practical decision-making. The evaluation of each patient's obstruction consists of subjective clinical findings in combination with objective data including labs and imaging. CT with intravenous contrast remains a cornerstone of diagnosis, allowing identification of obstruction severity and features concerning for ischemic physiology that mandates immediate operative exploration. In the absence of these findings, a structured trial of non-operative management may be pursued, including nasogastric decompression, intravenous resuscitation, electrolyte correction, and inpatient admission with close oversight from a surgical team. Water-soluble contrast studies serve as both a prognostic and therapeutic adjunct, as failure of contrast to reach the colon within 24 hours is strongly predictive of unsuccessful non-operative management. Operative management should be undertaken promptly in patients with clinical deterioration, imaging evidence of ischemia, or failure of non-operative therapy. Although open laparotomy remains the standard approach, laparoscopy may be considered in carefully selected patients in experienced hands. Across management strategies, early surgical ownership and avoidance of prolonged non-operative trials in high-risk patients are critical to optimizing outcomes. aSBO is best managed through structured algorithms that prioritize early diagnosis, time-sensitive reassessment, and decisive operative intervention when indicated.

UrC is a rare malignancy with uncertain pathogenesis. The main symptoms include gross hematuria, abdominal pain, and an abdominal mass. The lack of comprehensive clinical analysis necessitates selecting an optimal therapeutic strategy for each patient. Here, we present a comprehensive review of the clinical manifestations, diagnosis, and treatment of UrC, illustrated with a case successfully managed through surgical intervention and adjuvant chemoradiotherapy. Meanwhile, the analysis of NGS detected two tumor-specific mutated genes: MYC (gene amplification, CN: 59.5) and FLT1 (missense mutation, c.1061G>A (p.R354Q), abundance: 2.1%). These findings may provide insights into tumor growth and guide therapeutic strategies.

Hepatic portal venous gas (HPVG) is a rare and potentially fatal condition. We report the case of an elderly patient with type 2 diabetes mellitus who developed HPVG. An 84-year-old woman, treated with oral hypoglycemic agents for 40 years and insulin therapy for 24 years, presented with frequent constipation due to diabetic autonomic neuropathy. She also experienced recurrent hypoglycemia resulting from blood glucose fluctuations caused by poor dietary habits. She was admitted for the management of type 2 diabetes. To prevent hypoglycemia, insulin therapy was discontinued, and treatment with dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), was initiated. Following the addition of acarbose, an alpha-glucosidase inhibitor (αGI), the patient developed abdominal pain and nausea. Abdominal computed tomography revealed HPVG without intestinal necrosis or signs of peritoneal irritation. Conservative therapy, along with the discontinuation of dulaglutide and acarbose, resulted in gradual improvement. We suspect that HPVG in this case was caused by dulaglutide-induced suppression of intestinal peristalsis combined with acarbose-induced elevation of intestinal pressure. To date, no cases of HPVG have been reported in patients receiving combination therapy with dulaglutide and acarbose. Clinicians should be vigilant regarding abdominal symptoms in patients receiving both GLP-1 RAs and αGIs.

We present a case of a 51-year-old female presenting with abdominal pain and generalized weakness, with working diagnoses of Guillain-Barré syndrome (GBS), syndrome of inappropriate antidiuretic hormone secretion (SIADH), hepatotoxicity, and posterior reversible encephalopathy syndrome (PRES) following a five-day course of ciprofloxacin for UTI. Although PRES and SIADH have been reported in relation to GBS, hepatotoxicity has never been linked to GBS in the literature. Despite the fact that each of these entities has been described in the literature as an attributable adverse effect of ciprofloxacin, this case, to the best of our knowledge, is the first to combine all these entities following its use.

Postpartum abdominal pain is frequently encountered and is most often related to obstetric causes such as uterine involution, infection, or postoperative discomfort following cesarean delivery; however, more atypical etiologies can also occur. Perforated peptic ulcer disease in the immediate postpartum period is uncommon and may be overlooked, particularly when symptoms overlap with expected postoperative findings and recent surgical history. We report a woman in her early 30s who developed severe upper abdominal pain four days after a primary cesarean delivery performed for maternal exhaustion in the setting of intraamniotic infection. Her initial postoperative course was uncomplicated, and she was discharged on scheduled ibuprofen and acetaminophen for pain control. On presentation, she was tachycardic with elevated liver enzymes, raising concerns for hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, biliary pathology, or postoperative infection. MRI and CT imaging demonstrated pneumoperitoneum and ascites, findings that were initially attributed to recent surgery. Due to persistent symptoms, a diagnostic laparoscopy was performed and revealed a 1.5 cm perforated duodenal ulcer with diffuse peritonitis. The ulcer was repaired with oversewing and a Graham patch, and the patient recovered following appropriate surgical and medical management; Helicobacter pylori testing prior to discharge was negative. This case highlights that a perforated peptic ulcer should remain in the differential diagnosis for postpartum patients presenting with persistent abdominal pain, even in the absence of classic risk factors, as recent cesarean delivery can complicate imaging interpretation and delay diagnosis, underscoring the importance of early multidisciplinary evaluation and prompt surgical intervention to reduce morbidity.

Acute intermittent porphyria (AIP) is a rare heme biosynthesis disorder in which the accumulation of neurotoxic porphyrin precursors precipitates neurovisceral attacks. Intercurrent infections, including coronavirus disease 2019 (COVID-19), may trigger or exacerbate AIP and complicate diagnosis, as clinical manifestations can resemble those of other acute neuropathies. This report describes a 16-year-old girl who developed abdominal pain, seizures, and rapidly progressive acute motor neuropathy shortly after COVID-19 and was initially misdiagnosed with Guillain-Barré syndrome (GBS). Diagnostic evaluation included electrophysiological studies, biochemical assays for porphyrin precursors, and genetic testing. AIP was suspected based on electrophysiological findings and elevated porphyrin precursors. The patient improved after initiation of a 10% dextrose infusion and a high-carbohydrate diet, with normalization of laboratory abnormalities. Subsequent genetic testing identified a heterozygous pathogenic HMBS variant (c.580C> T), confirming AIP. COVID-19 may unmask AIP and mimic a GBS-like neuropathy, increasing the risk of delayed recognition and suboptimal management. In patients with COVID-19-associated acute neuropathy-particularly when accompanied by abdominal pain, seizures, or neuropsychiatric features-clinicians should include AIP in the differential diagnosis and pursue prompt biochemical evaluation (urine PBG and ALA) to facilitate early targeted therapy and prevent complications.

Each year, millions of people experience an episode of diverticulitis, accompanied by abdominal pain, gastrointestinal symptoms, and expensive healthcare utilization. Rates of recurrence following recovery from an episode are high, ranging from 20 to 50% depending on how this is measured. A number of dietary and lifestyle factors have been found to be associated with an increased risk of developing incident diverticulitis; while these have been suggested to play a role in preventing recurrence, there is limited evidence to support this claim. Clinicians often recommend a high fiber diet after recovery from an episode of diverticulitis, however, numerous other dietary patterns have been proposed to provide benefit. Anecdotal evidence suggests that there are widespread beliefs among patients with diverticulitis about dietary triggers and modifications that are effective at reducing disease recurrence and symptom burden. We aimed to gain a better understanding of what current dietary modifications are being attempted by patients with a history of diverticulitis episode and surveyed 430 people. We found that a high fiber diet was the most common dietary change, made in 59% of survey respondents, followed by the Mediterranean diet by 26%. Among patients who adopted a Mediterranean diet, adherence was modest in 45% and strict/high in 20%. These findings suggest patients commonly make dietary changes motivated by a history of diverticulitis, and that further research in dietary interventions for this condition may be embraced by patients.

Vascular Ehlers-Danlos syndrome (vEDS) is a life-threatening connective tissue disorder that often remains undiagnosed before pregnancy and carries a markedly high risk of maternal mortality. We report the case of a 34-year-old pregnant woman who experienced sudden abdominal pain at 39 weeks of gestation and died shortly after delivery. Autopsy revealed an aortic rupture with histopathological findings suggestive of vEDS. Her family history included her father's sudden vascular death, and her personal history was notable for easy bruising and early-onset varicose veins. Next-generation sequencing-based postmortem genetic testing (PMGT) using formalin-fixed, paraffin-embedded liver tissue confirmed a pathogenic variant in COL3A1. This result facilitated genetic counseling for the family, allowing presymptomatic diagnosis and preventive management, including celiprolol therapy for at-risk relatives. This case underscores the value of PMGT in identifying the underlying cause of unexpected maternal death, particularly when conventional samples are unavailable.