Tuberculosis is known as “the great mimicker.” Extrapulmonary tuberculosis accounts for approximately 20% of all cases, with about 10% of these involving the intestines. The ileocecal region is the most common site due to its high density of lymphoid tissue, slowed intestinal transit, and low bile acid concentration. We report the case of a 16-year-old male student who presented with symptoms consistent with an acute abdomen and required emergency laparotomy; subsequent histological examination confirmed tuberculosis. Diagnosis is challenging because of nonspecific symptoms that mimic other common conditions such as appendicitis. Imaging studies lack specificity, while positive Ziehl-Neelsen staining and the presence of Langerhans-type giant cell granulomas on histologic analysis are among the most sensitive and rapid diagnostic indicators. Intestinal tuberculosis carries a poor prognosis, particularly when associated with complications such as obstruction, perforation, or intestinal stenosis. Medical management follows the same antibiotic regimen used for pulmonary tuberculosis, whereas surgical intervention is reserved for acute abdominal complications.

This case describes a rare but serious complication of endoscopic procedures, highlighting the importance of vigilance in acute care. A 79-year-old man who underwent simultaneous esophagogastroduodenoscopy and colonoscopy developed hemoperitoneum caused by injury to the short gastric artery, a branch of the splenic artery. Emergency angiography demonstrated hypervascularity, and successful hemostasis was achieved using gelfoam embolization. The patient remained stable, with no recurrent bleeding, and was discharged without complications. This case underscores the importance of meticulous procedural technique, comprehensive preprocedural evaluation, and prompt recognition of vascular injury to optimize outcomes in acute care and emergency settings. It also emphasizes the need for continued education and vigilant monitoring to reduce the risk of rare but potentially life-threatening complications in endoscopic practice, in line with the journal’s mission to advance clinical care in trauma and emergency surgery.

We report a rare case of pneumoretroperitoneum caused by a vaginal wall laceration following sexual intercourse, including anal intercourse, in a 19-year-old woman. The patient presented with abdominal pain and syncope. Abdominal computed tomography revealed free air in the retroperitoneal space, initially raising suspicion for rectal perforation. However, intraoperative colonoscopy confirmed the rectum was intact. A subsequent gynecological examination identified a 4-cm laceration in the lateral fornix that directly communicated with the retroperitoneal space. The injury was surgically repaired, and the patient achieved a full recovery without complications. This case underscores the importance of considering vaginal trauma in the differential diagnosis of pneumoretroperitoneum, particularly in sexually active young women. A prompt gynecological evaluation can prevent misdiagnosis and unnecessary interventions. In stable patients without signs of infection or peritonitis, conservative management following surgical repair may suffice. To our knowledge, this is the first reported case of pneumoretroperitoneum following sexual intercourse in the absence of rectal injury.

Splenic abscess is a rare entity encountered during clinical practice, with a high mortality rate. Formation of gas in splenic abscess is usually localized to the left upper quadrant of the abdomen. Here we report a case where the splenic abscess ruptured and presented with generalized peritonitis. The erect chest radiograph showed free air under the right dome of the diaphragm, thus masquerading a hollow viscera perforation (most common cause of pneumoperitoneum).

Citations

• Pneumoperitoneum Caused by a Ruptured Splenic Abscess Mimicking Gastrointestinal Perforation: A Case Report
  Naoki Kawahara, Mitsuaki Kojima, Koji Morishita
  Surgical Case Reports.2025; 11(1): n/a.     CrossRef
• Ruptura espontânea de abscesso esplênico simulando perfuração de víscera oca: relato de caso e revisão da literatura
  Marcos Duarte Guimarães, Priscylla Pereira Medeiros Leite, Priscila Ribeiro de Amorim Martins, Daniel Maxwell dos Santos Souza
  Journal Archives of Health.2025; 6(5): e3641.     CrossRef

Bladder injury is uncommon in blunt abdominal trauma. The injury can be life-threatening if not treated properly. Thus, timely and accurate diagnosis is critical. Traumatic intraperitoneal bladder rupture (TIBR) can be managed laparoscopically in patients who are hemodynamically stable. In this case series, we present 3 patients who underwent laparoscopic repair of TIBR performed by a single surgeon. In addition, we address useful technical tips that would facilitate the generalized use of laparoscopy for treating TIBR.

Citations

• Bladder trauma: a guideline of the guidelines
  Deshin Reddy, Abdullah E. Laher, Maeyane Moeng, Ahmed Adam
  BJU International.2024; 133(4): 365.     CrossRef

Explosions in the abdomen during surgery are rare. This article reports a case of an intra-abdominal explosion caused by flammable gas ignited by electrocautery during a laparotomy. The patient’s small intestine, left colon, and peritoneum were burned superficially, but recovered without any specific symptoms. Despite the rarity of this phenomenon, surgeons should be aware of the possibility of an explosion due to intra-abdominal gas, and consider the use a scalpel rather than electrocautery when opening the peritoneum of patients with pneumoperitoneum.

Purpose
To describe the experience of patients over a 7-year period who have had open abdomen (OA) surgery, at a tertiary university hospital.
Methods
The medical records of 59 patients, who were managed with OA after a laparotomy between March 2009 and December 2015, were reviewed retrospectively. The data collected included demographics, indication for OA, abdominal closure methods, abdominal closure rate, the intensive care unit stay duration, mechanical ventilation duration, hospital stay duration, and complications.
Results
Forty-seven patients (37 males, 78.7%) with a mean age of 52.2 ± 16.7 years were reviewed in the study. The indications for OA were traumatic intra-abdominal bleeding in 23 patients (48.9%), nontraumatic bowel perforation in 10 (21.3%), non-traumatic bleeding in 7 (14.9%), and bowel infarction in 6 (12.8%). The abdominal wall was closed in 38 patients (80.9%). Primary closures and fascial closure using an artificial mesh were performed on 21 (44.7%) and 12 patients (25.5%), respectively. The median number of dressing changes was 0 (interquartile range 0 - 1). The median duration of the intensive care unit and hospital stays were 12.0 and 32.0 days, respectively. The median interval to abdominal closure was 4 days (interquartile range 2 - 10.3 days). Twenty-seven patients developed complications, including uncontrolled sepsis (21.3%), entero-atmospheric fistula (19.1%), ventral hernia (8.5%), bleeding (4.3%), and lateralization (4.3%). The mortality rate was 44.7% with sepsis being the main cause of death (61.9%).
Conclusion
Traumatic intra-abdominal bleeding was a common indication for OA. Primary closure was performed in most patients, and frequent complications resulted in poor patient outcomes.

Citations

• The mortality rate of patients with open abdomen and contributing factors – a three-year audit in a major academic trauma unit
  E van der Merwe, MS Moeng, M Joubert, M Nel
  South African Journal of Surgery.2023; 61(3): 21.     CrossRef

Citations

• Pneumoperitoneum without significant bowel perforation in patients with blunt trauma: a systematic review and meta-analysis
  Emad Masuadi, Yasir Ahmed Mohammed Elhadi, Osman S. Abdelhamed, Zainab M. Alkharas, Linda Östlundh, Gamila Ahmed, Ashraf F. Hefny
  World Journal of Emergency Surgery.2026;[Epub]     CrossRef