Acute gastric dilatation is the radiological finding of a massively enlarged stomach as seen on plain film X-ray or a computerized tomography scan of the abdomen. It is a rare entity with high mortality if not treated promptly and is often not reported due to a lack of physician awareness. It can occur due to both mechanical obstruction of the gastric outflow tract, or due to nonmechanical causes, such as eating disorders and gastroparesis. Acute hyperglycemia without diagnosed gastroparesis, such as in patients with diabetic ketoacidosis, may also predispose to acute gastric dilatation. Prompt placement of a nasogastric tube can help deter its serious complications of gastric emphysema, ischemia, and/or perforation. We present our experience of 2 patients who presented with severe hyperglycemia and were found to have acute gastric dilation on imaging. Only one of the patients was treated with nasogastric tube placement for decompression and eventually made a full recovery.

Diarrhea is the principal cause of the majority of healthcare utilization. When diarrhea lasts longer than four weeks, it is considered chronic diarrhea. There are several causes of chronic diarrhea, but here we focus on one of the rare causes, known as McKittrick-Wheelock syndrome (MWS). We here present the case of a patient in his seventies with chronic diarrhea, found to have tubulovillous adenoma and diagnosed with McKittrick-Wheelock syndrome. We also discuss the clinical presentation, pathophysiology, and management of MWS.

Celiac disease is emerging as an autoimmune disorder with increasing prevalence and incidence. The mean age of presentation is also increasing with the passage of time. The delay in diagnosis is partly attributable to the asymptomatic state in which most patients present. The diagnosis of the disease is primarily based on biopsy, but serology can also be included for possible screening purposes. Although the primary management strategy is to eliminate gluten from the diet of such patients; however, compliance with the diet and follow-up to detect healing might be difficult to maintain. Therefore, there is a need to investigate further management therapies that can be easily administered and monitored. The aim of the review is to discuss the epidemiology, clinical presentation, and novel therapies being investigated for celiac disease.

We report a case of a 79-year-old male presenting to a South Bronx hospital with complaints of fever, shortness of breath, severe thrombocytopenia, hematuria, elevated liver enzymes, and acute renal failure. The patient rapidly progressed to acute hypoxic respiratory failure requiring mechanical ventilation. Treatment was delayed for six days because the tick-borne disease was not considered in the differential. Empirical treatment of tick-borne illnesses should be considered in the proper clinical setting, and travel history should be relevant in any patient presenting with fever. Delay in appropriate treatment results in the onset of more severe illness.

Medullary thyroid cancer (MTC) is a neuroendocrine tumor of the parafollicular cells of the thyroid gland. The prognosis is very poor in patients with advanced MTC. Vandetanib was approved for advanced MTC after randomized control trials showed that it had therapeutic efficacy and considerably prolonged progression-free survival. Vandetanib therapy is associated with serious cardiovascular side effects including hypertensive crisis and arrhythmias due to prolonged QTc. We present a case of an 83-year-old female with advanced metastatic MTC who is under treatment with vandetanib 300 mg/day and developed medication-related hyponatremia, QTc prolongation, ventricular fibrillation (VF), and torsades de pointes (TdP). Her vandetanib therapy was held. Subsequently, she did not show recurrences of TdP. This is the second such case report in the literature.

There are many methods for closing the perforated peptic ulcer. The technique of closure of perforation by figure of 8 stitch method has been found to be very effective in managing patients with this common problem. MATERIAL AND METHOD: The present study was conducted in Unit III of Department of General Surgery, Government Medical College and Dr. Susheela Tiwari Government Hospital Haldwani, from January 2012 to December 2013 on the cases of peptic ulcer perforation peritonitis. All patients with clinical and radiological features and intraoperative findings suggestive of perforated peptic ulcer were included in the study. RESULTS: A total of 153 patients were included in the study. Out of these, 128 patients (84%) were males and 25 patients (16%) were females. In 120 patients (78%) there was duodenal perforation and in 33 patients (22 %) gastric perforation was present. Out of these 33 patients, 6 patients had posterior gastric perforation. 140 patients were managed with midline laparotomy and 13 with laparoscopic method, with one converted to open due to presence of posterior gastric perforation. The average time of patient reporting to the emergency was3-4 days, with earliest reporting time of 2-3 hours and late reporting up to 7-8 days. Age ranged from 15 years to 90 years (average 35 -45 years). In the postoperative period, 3 patients had leakage from repair site, 7 patients died, rest showed good outcome. CONCLUSION: Figure of 8 stitch method showed very good and acceptable result. Therefore, in our opinion this method should be promoted for surgery of perforated peptic ulcer.

Acute compartment syndrome develops when intracompartmental pressure increases either due to intrinsic or extrinsic causes. Increase in compartment pressure eventually can lead to impaired tissue perfusion followed by tissue death if no urgent intervention is performed. Patients with acute compartment syndrome usually present with pain out of proportion to apparent injury. It can cause rhabdomyolysis, myoglobinuria, and eventually acute renal failure. The definite treatment is fasciotomy in a timely manner. We here report a very interesting case of acute compartment syndrome in a young patient cause by pressure over his axilla by an iPad.

INTRODUCTION: Gastroparesis in diabetics can be worsened by hyperglycemia. Acute elevations in blood glucose suppress the frequency and contraction amplitude of antral pressure waves while stimulating phasic pyloric pressure waves, which can result in Acute Gastric Dilatation (AGD). Though an unusual occurrence, it requires a high degree of suspicion to avoid its rare but life-threatening complications. We present our experience of two patients with AGD. CASE DESCRIPTION/METHODS: Case 1: A 30-year-old male presented to the ER with nausea, vomiting and abdominal pain. His comorbidities included type 1 diabetes and end-stage renal disease. On examination, his abdomen was notably distended and bowel sounds were sluggish. No guarding or rigidity was appreciated. He was hypotensive (76/49 mmHg) and hypoxic. Lab values were significant for blood glucose of 1155 mg/dL and a pH of 6.97. He was emergently intubated and started on IV insulin and Epinephrine. An abdominal plain film x-ray showed acute gaseous distention of the stomach. An NG tube was passed which drained 500cc of brownish gastric content. A repeat x-ray 4 hrs later revealed resolution of gastric dilatation which was confirmed by CT-abdomen. Patient's abdominal symptoms improved thereafter and he made a full recovery in time. Case 2: 59-year-old male was brought to the ER with an altered mental status. As per EMS, he had “very high” blood sugar levels. His comorbidities included diabetes mellitus and chronic hepatitis C. His abdomen was distended with decreased bowels sounds. His vital signs were stable. Lab values were significant for hyperglycemia (649 mg/dL), and a blood pH of 7.29. He underwent an abdominal x-ray which showed marked distention of the stomach. A follow-up CT abdomen confirmed the finding, with no mechanical cause of obstruction identified. He was started on IV Insulin, IV antibiotics and was planned for endoscopic workup, however, his conditioned rapidly deteriorated and he required pressors with mechanical ventilation. The patient eventually suffered a cardiac arrest and was unable to be revived. DISCUSSION: AGD presents with nausea, vomiting, succussion splash, and abdominal distension. Acute hyperglycemia in uncontrolled diabetics is the precipitating factor. If intragastric pressures exceed 20 cmH20 (lower limit of gastric venous pressure), it can cause mucosal ischemia and necrosis. This may be followed by perforation, which has a high mortality rate. Emergency decompression with NG tube seems to be the treatment of choice.