Emphysematous gastritis is a rare disease with gastric inflammation and intramural gas formation due to gas-forming microorganisms. It is diagnosed based on clinical presentation and imaging findings of gas in the gastric wall. Computed tomography is the preferred imaging modality. Early diagnosis and management are important since emphysematous gastritis is associated with high rates of morbidity and mortality. We present a case of emphysematous gastritis, which was successfully managed conservatively through early diagnosis and prompt treatment.

Biliary-enteric fistula is a rare complication of cholelithiasis that can lead to gallstone ileus. Gallstone impaction in the duodenum and pylorus is extremely rare and can lead to gastric outlet obstruction, a condition known as Bouveret syndrome. Bouveret syndrome needs to be diagnosed and managed in a timely fashion, as it has a high mortality rate. We describe a case of an elderly patient who presented with Bouveret syndrome secondary to impaction of the biliary calculus in the first part of duodenum.

Ectopic varices account for 1%–5% of all variceal bleeding episodes. The most common presentation of cecal varices is an acute episode of a massive lower gastrointestinal hemorrhage. However, cecal varices can be found incidentally and can be silent for a prolonged period of time before presenting with a massive gastrointestinal hemorrhage. Through this case of a 63-year-old woman, we would like to highlight the paucity of literature in the treatment of nonbleeding cecal varices.

Coronoviraus disease 2019 (COVID-19) has infected over two million people worldwide and the number keeps growing every day. While the pulmonary complications of COVID-19 are obvious, the effect of the virus on the other organs and the chronicity of the organ dysfunction remain unknown. The virus causes a debilitating infection with multiorgan injury and has a high mortality rate estimated to be around 3.70%. Several hypotheses are formulated to explain the liver dysfunction in COVID-19 patients which include collateral damage from cytokine storm, drug-induced liver injury, viral-induced hepatitis and hypoxia-induced damage. Through this case series, we would like to highlight that liver enzyme abnormalities are often seen in COVID-19 patients and would like to highlight that physicians need to serially monitor biochemical testing until the liver enzymes return to baseline. Physicians also need to be vigilant of liver enzyme abnormalities in these patients, especially before starting new medications.

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A 35-year-old male, farmer also engaged in raising cattle, from rural part of northern Karnataka, India, presented to the emergency room with acute onset altered speech and sensorium, right upper limb and facial weakness since two days with a background of intermittent moderate grade fever with weight loss and fatigue since nine months. He never had any medical ailments or hospital admissions prior to this. He lived in a kutcha house with his wife and two children who were all in good health.At presentation his Glasgow Coma Scale (GCS) was 14 and had minimal confusion. He was a moderately built and well nourished middle aged man. General physical examination revealed grade 3 clubbing, enlarged (2X2 cm) mobile left upper cervical superficial lymph node and moderate degree pallor. A bounding irregular pulse with a blood pressure recording of 130/40 mmHg was noted. Neurologic examination revealed Broca's aphasia, right upper limb monoparesis and right side upper motor neuron facial palsy. Cardiovascular system examination revealed a laterally displaced hyperdynamic apex beat with precordial pulsations. A high pitched early diastolic murmur with an ejection systolic component was heard in Aortic area on auscultation. Other systemic examination did not reveal any abnormality. Routine haemogram revealed mild anaemia (Hb of 10.6 gm%) and normal total leukocyte count (5600cells/µl). CECT brain showed infarcts in the left frontal lobe [Table/ Fig-1-3] and left corona radiata. An ill defined intra-axial hypodensity involving the left insular lobe with suspicious increased meningeal enhancement along the high left fronto-parietal sulci suggestive of meningoencephalitis [Table/ Fig-4] was also noticed. Our potential differentials based on Pyrexia of Unknown Origin (PUO) and neurological manifestations included meningoecephalitis, systemic lupus erythematosus, retroviral illness, syphilis, infective endocarditis with systemic emboli. He was started on empirical intravenous antibiotics; Ceftriaxone (2 gm I.V. as single daily dose) while we were investigating further for the cause of his symptoms and signs. Improvement was noted in the patient's condition as he attained near normal power the very next day without any other specific treatment. Blood and bone marrow cultures did not grow any organisms. Liver and renal function tests were normal. Scrub typhus antibodies and Weil-felix test were negative (these tests were done as Rickettsial diseases are common in this part of India). CSF analysis was done which was with in normal limits. Internal Medicine SectionAn ABSTRACTBrucella endocarditis is a rare but a severe complication of brucellosis, observed in less than 2% of cases. It is the main cause responsible for up to 80% of deaths in brucellosis. Herein, we present a case of brucella endocarditis that developed on a native aortic valve, but presented to us with fever for several months and acute neurological symptoms. This case report signifies the importance of considering brucella endocarditis as one of the differentials ...

A 91-year-old male presented to the emergency room with hemodynamically significant upper gastrointestinal bleeding. The patient underwent an esophagogastroduodenoscopy (EGD), which showed frank blood in the duodenum interfering with the visualization. Hence, the patient underwent urgent interventional radiology (IR)-guided arteriogram and embolization. An EGD done 48 hours later showed a giant, non-bleeding, cratered duodenal ulcer with a visible vessel and vascular coils partially protruding into the duodenal bulb lumen. The patient had no evidence of bleeding post embolization. The patient presented three months later with abdominal pain. Computed tomography (CT) abdomen showed multiple liver abscesses. IRguided drainage of abscesses was performed, and the culture grew Streptococcus intermedius. Magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and barium enema were unremarkable. The patient was treated with a prolonged course of intravenous (IV) antibiotics and recovered without any further issues. IR guided arterial embolization can be lifesaving in cases where GI bleeding cannot be controlled endoscopically, however, it can lead to serious complications, including endovascular coil migration into the gastrointestinal (GI) lumen causing infection and rebleeding. Endovascular coil migration can occur immediately or several years later, which can result in fatal bleeding and infection. The best approach to prevent and manage migrated endovascular coils in the GI lumen remains unclear.