Iatrogenic bladder injury is an uncommon but recognized complication of gynecologic laparoscopy, most often occurring during trocar placement or pelvic dissection. While the majority of injuries are identified intraoperatively, missed injuries may present postoperatively with nonspecific findings such as abdominal distension, oliguria, and elevated serum creatinine due to intraperitoneal urinary leakage. Reabsorption of urinary solutes across the peritoneum can result in pseudo-acute kidney injury (pseudo-AKI), a reversible condition that mimics intrinsic renal dysfunction and may delay appropriate diagnosis. A 29-year-old woman underwent laparoscopic right salpingectomy for a ruptured ectopic pregnancy with hemoperitoneum. Although the initial procedure was uncomplicated, she developed progressive abdominal distension, inability to void, leukocytosis, and a rapid rise in serum creatinine on postoperative day 2. Abdominal imaging demonstrated intraperitoneal bladder rupture with urinary ascites. The patient subsequently underwent laparoscopic bladder repair with placement of a drain and a Foley catheter, resulting in rapid normalization of renal function and clinical improvement. This case demonstrates how a ruptured ectopic pregnancy with hemoperitoneum may create a high-risk operative environment for unrecognized bladder injury due to distorted pelvic anatomy and limited visualization. It further highlights pseudo-AKI as an important diagnostic consideration in patients presenting postoperatively with abdominal distension, oliguria, and elevated serum creatinine following gynecologic laparoscopy. Early recognition of urinary tract injury and prompt imaging are critical in patients with unexplained postoperative abdominal distension and rising creatinine following gynecologic laparoscopy. Awareness of pseudo-AKI and timely minimally invasive repair can lead to rapid clinical recovery and favorable outcomes.
Penetrating abdominal stab wounds are among the most common causes of abdominal trauma worldwide. Historically, omental evisceration mandated exploratory laparotomy. However, advances in clinical assessment, imaging modalities, and close patient monitoring have enabled selective non-operative management (SNOM) in carefully selected patients. This case report highlights the role of non-laparotomy management in hemodynamically stable patients presenting with penetrating abdominal stab wounds associated with isolated omental evisceration. Avoiding non-therapeutic laparotomy may reduce morbidity, mortality, hospital stay, and healthcare costs. We report two adult male patients with penetrating abdominal stab wounds complicated by omental evisceration. Both patients were hemodynamically stable, had no signs of peritonitis, and underwent thorough clinical evaluation and contrast-enhanced computed tomography, which demonstrated no intra-abdominal visceral injury. Both were successfully managed conservatively with local wound care, omental reduction, fascial closure, antibiotics, and close serial clinical monitoring without laparotomy. The successful non-operative management of these two patients with isolated omental evisceration suggests that SNOM is feasible in hemodynamically stable patients. SNOM offers the benefits of avoiding unnecessary laparotomy, a reduced hospital stay, and lower healthcare costs and must be supported by frequent serial abdominal examinations, extended observation periods, thorough patient education regarding warning signs, and a low threshold for surgical exploration when any clinical doubt exists. SNOM of penetrating abdominal stab wounds with isolated omental evisceration can be feasible and safe in carefully selected, hemodynamically stable patients with close observation.
Cutaneous metastasis from gastric cancer is a rare clinical event, typically signifying advanced disease. Carcinoma erysipeloides (CE) is a subtype of inflammatory cutaneous metastasis that often presents similarly to infectious lesions, such as cellulitis. Delayed-onset CE in highly atypical locations, such as the genital region, is exceptionally uncommon and poses a significant diagnostic challenge. A 70-year-old woman who underwent laparoscopic distal gastrectomy for Stage IB gastric cancer 6 years prior presented with a 3-month history of painful, dark-red swelling in the genital region. She was initially treated for suspected cellulitis with antibiotics; however, the lesions were refractory to therapy. Computed tomography revealed increased subcutaneous fat density in the genital region and an umbilical mass. A skin biopsy confirmed metastatic signet-ring cell carcinoma consistent with the patient’s primary gastric cancer. She was diagnosed with cutaneous metastasis following surgery for gastric cancer and received 14 cycles of modified folinic acid, fluorouracil, and oxaliplatin 6 chemotherapy, achieving marked clinical improvement. The patient remains in complete remission 22 months after completing treatment. This case is notable for its unusually long 6-year disease-free interval and rare metastatic involvement of the genital region. While CE usually involves the trunk or neck, our literature review suggests this may be the first documented case of erysipelas-like metastasis to the genital region from gastric cancer. During follow-up after surgery for gastric cancer, clinicians should consider this metastatic pattern and promptly perform a biopsy of inflammatory skin lesions that are resistant to treatment.
Bronchial mucoepidermoid carcinoma (MEC) is a rare pediatric pulmonary malignancy that is easily overlooked or misdiagnosed as a carcinoid tumor on limited biopsy material, with direct implications for surgical planning. A 16-year-old male’s symptoms began with a dry cough in January 2025 and progressed to recurrent pneumonia and a persistent productive cough. Imaging and bronchoscopy identified a 15 × 11 mm endobronchial mass in the left main bronchus. Initial biopsy favored carcinoid tumor; immunohistochemistry (IHC) (pan-cytokeratin and MAML2-related protein–positive, neuroendocrine markers–negative) established a diagnosis of low-grade MEC. Parenchymal-sparing wedge resection of the left main bronchus with bronchobronchial anastomosis was performed, achieving R0 resection and pN0 status while preserving the ipsilateral lung. At 1-month follow-up, the patient was asymptomatic with a patent anastomosis; at approximately 9 months postoperatively, he remained clinically well without respiratory symptoms. IHC was essential, not merely confirmatory, in distinguishing MEC from a carcinoid tumor, and parenchymal-sparing resection offered oncologic clearance without sacrificing lung parenchyma in a low-grade, node-negative tumor. Recurrent or persistent focal obstructive respiratory disease in an adolescent should prompt consideration of an endobronchial neoplasm, and IHC should be applied routinely to avoid misdiagnosing MEC as a carcinoid tumor. When localized low-grade MEC is confined to the bronchial wall without nodal or distant disease, parenchymal-sparing bronchial resection can achieve complete oncologic clearance while preserving lung parenchyma.
Nutcracker syndrome refers to a condition in which the left renal vein is anatomically entrapped. A rare variant of this syndrome, posterior nutcracker syndrome, occurs when the retroaortic renal vein is compressed between the aorta and the vertebral body. A 22-year-old woman from a rural town in Ethiopia presented with left flank abdominal pain that had persisted for 4 months. Her vital signs were normal, though she had a slightly low body mass index of 18.75 kg/m 2 . During the physical examination, mild tenderness was noted over the left flank. Urinalysis revealed hematuria, and a computed tomography angiogram of the abdomen and pelvis confirmed left renal vein compression between the aorta and the vertebral column. The patient subsequently underwent left ovarian (Gonadal) vein transposition and an end-to-side anastomosis to the inferior vena cava. She experienced a smooth postoperative recovery and was discharged. Posterior nutcracker syndrome is a rare cause of hematuria and chronic flank pain. Computed tomography angiography plays a central role in diagnosis by demonstrating left renal vein compression and collateral venous pathways. Surgical intervention is indicated in symptomatic patients with persistent or disabling symptoms. Gonadal vein transposition is effective in decompressing the left renal venous system. Posterior nutcracker syndrome is a rare vascular condition that may present with unexplained hematuria and chronic flank pain. Gonadal vein transposition is a potential treatment for selected patients with persistent symptoms, but longer follow-up and objective postoperative imaging are needed to determine long-term outcomes.
