Introduction: Dieulafoy’s lesion (DL) is a rare but potentially life-threatening cause of upper gastrointestinal bleeding. Endoscopic therapy is the first-line treatment; however, recurrent bleeding may necessitate surgical intervention.Case Report:A 55-year-old male presented to the emergency department with hematemesis and hemodynamic instability. Initial endoscopy revealed a Dieulafoy’s lesion in the gastric fundus with active bleeding. Hemostasis was achieved with epinephrine injection, thermal coagulation, and hemoclip placement, and temporary stabilization was obtained after blood transfusion. On the third hospital day, recurrent bleeding required repeat endoscopy and an additional hemoclip application, but the patient continued to experience symptoms. On day eight, intraoperative endoscopic tattooing with methylene blue facilitated accurate localization of the lesion, and wedge resection was performed. The postoperative course was uneventful, and histopathological examination confirmed the diagnosis of DL.Conclusion:This case demonstrates that intraoperative endoscopic marking is a valuable adjunct in refractory Dieulafoy’s lesions, enabling precise localization, avoiding unnecessary radical surgery, and allowing successful limited resection.
Critical illness polyneuropathy (CIP) is characterized by muscle weakness and atrophy in intensive care patients. Although recovery may occur by addressing the underlying cause, plasmapheresis or immunoglobulin therapy may be necessary in severe cases. We present two female patients (aged 76 and 52) who developed CIP in the early phase following epileptic seizures. CIP was suspected due to difficulty in ventilator weaning, and EMG confirmed the diagnosis. Both patients underwent five sessions of plasmapheresis and were successfully weaned from the ventilator, regaining full (5/5) muscle strength in all extremities. Early diagnosis is crucial in preventing complications and increasing treatment success in CIP.
Tirofiban is a glycoprotein IIb/IIIa inhibitor and is an adjunct in the treatment of patients with acute coronary syndrome. Its main side effects are bleeding and thrombocytopenia. Severe thrombocytopenia is a rare but serious complication of tirofiban therapy, including when administered at low intracoronary doses in interventional cardiac procedures. The pathogenesis is largely immune-mediated and can result in abrupt and profound platelet count declines. Early and frequent platelet monitoring, prompt discontinuation of the drug, and supportive care remain critical to managing this adverse effect. In this case report, we present a case of severe thrombocytopenia that occurred in a 74-year-old male patient with non-ST segment elevation myocardial infarction following administration of a very low dose of tirofiban.
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, with an incidence of approximately 2%. While the majority of cases remain asymptomatic, significant clinical complications such as gastrointestinal bleeding, intestinal obstruction, perforation, and inflammation may develop in some cases. In this study, three different complications of Meckel's diverticulum that eluded preoperative diagnosis are presented: diverticular bleeding detected only during intraoperative colonoscopy in a 24-year-old male patient; intestinal ischemia due to mesodiverticular band in a 26-year-old male patient; and adhesive small bowel obstruction and ischemia resulting from diverticulitis in a 50-year-old male patient. This case report highlights the diagnostic difficulties and surgical management strategies of Meckel's diverticulum complications while also demonstrating the clinical importance of considering this entity in the differential diagnosis of patients presenting with unexplained abdominal pain. Given the diagnostic limitations of current imaging modalities, surgical exploration in suspected cases has both diagnostic and therapeutic value.
The relationship between the combination of bleomycin-etoposide-cisplatin, a chemotherapeutic treatment option used in testicular carcinomas, and acute thrombotic events has been previously described. Acute coronary syndromes associated with this treatment have been frequently reported. The differences in the underlying mechanisms that lead to coronary events suggest that the treatment options may vary in these situations. The decision regarding the right treatment option for the patient sometimes emerges after a relatively long process that requires patience. In this event, which occurs without atherosclerosis and involves vasospasm and thrombus formation, a conservative approach may be beneficial. A 42-year-old individual diagnosed with testicular cancer who did not have any cardiac risk factors was diagnosed with acute coronary syndrome. Since no atherosclerotic background is observed on coronary angiography, coronary intervention is postponed. In this case, the management of the patient will be discussed with a focus on medical treatment without any coronary intervention.
The most common cause of carbon monoxide poisoning in T & uuml;rkiye is coal stove poisoning and common symptoms include headache, dizziness, nausea, confusion and fatigue. Carbon peel laser is an aesthetic procedure performed using carbon solution. In this case report, we aimed to present a carbon monoxide poisoning related to this aesthetic procedure that has never been reported before. A 21-year-old female patient with no chronic disease, smoking history or medication history was admitted to the emergency department due to nausea, dizziness and feeling faint. Physical examination was normal. In the venous blood gas analysis; FCOHb:11.2%, was detected. 100% oxygen therapy was started via a non-rebreathing face mask. The patient's history was detailed; at the beauty center, a carbon suspension was applied to the patient's face as a mask. In addition to the laser treatment, a hot steam treatment was applied while the carbon mask was on her face, and her symptoms began afterward. The patient, who was administered 100% oxygen therapy via a non-rebreathing face mask, was discharged from the emergency department after her complaints improved. Emergency physicians should be aware of the potential for carbon monoxide poisoning due to cosmetic applications, not made by competent hands, containing carbon solution.
The relationship between the combination of bleomycin-etoposide-cisplatin, a chemotherapeutic treatment option used in testicular carcinomas, and acute thrombotic events has been previously described. Acute coronary syndromes associated with this treatment have been frequently reported. The differences in the underlying mechanisms that lead to coronary events suggest that the treatment options may vary in these situations. The decision regarding the right treatment option for the patient sometimes emerges after a relatively long process that requires patience. In this event, which occurs without atherosclerosis and involves vasospasm and thrombus formation, a conservative approach may be beneficial. A 42-year-old individual diagnosed with testicular cancer who did not have any cardiac risk factors was diagnosed with acute coronary syndrome. Since no atherosclerotic background is observed on coronary angiography, coronary intervention is postponed. In this case, the management of the patient will be discussed with a focus on medical treatment without any coronary intervention.
In children, acute scrotal pain is a common source of urological consultation in the Emergency Department (ED). The annual incidence of acute testicular torsion is low; however, missing the diagnosis has catastrophic outcomes. Color Doppler Ultrasound (CDUS) is the most effective and convenient test for diagnosing TT, with high diagnostic sensitivity and specificity. Torsion-detorsion syndrome (TDS) occurs when the testicle undergoes repeated episodes of twisting and untwisting of the spermatic cord. Unlike TT, imaging can look normal and may not be reliable for detecting, especially when the testis is detorsed at the time of scanning, which makes diagnosis challenging. The spontaneous untwisting of the spermatic cord makes surgical exploration a crucial step in confirming the diagnosis of TDS. This case report describes a patient with recurrent acute scrotal pain and normal CDUS findings, yet significant pathology was identified on surgical exploration, underscoring the risk of misdiagnosing torsion-detorsion syndrome (TDS). Clinicians should be highly vigilant in cases of recurring episodes of acute scrotal pain, despite negative imaging tests. If left untreated, TDS can progress into TT, whereby the testicular salvage is attainable only if intervention is undertaken within 6 hours of the onset of pain.
Pediatric ocular trauma represents a significant cause of preventable blindness worldwide and constitutes an important proportion of emergency department visits. Among these injuries, corneal perforation accompanied by iris prolapse is particularly vision-threatening, as it can rapidly lead to infection, anterior chamber instability, and permanent visual impairment if not promptly managed. The aim of this report is to highlight the clinical importance of iris prolapse in children and emphasize the critical role of early recognition and rapid surgical intervention. An 8-year-old boy presented to the emergency department with acute pain, redness, and decreased vision in the left eye following blunt ocular trauma caused by a stone. Ophthalmic examination revealed a full-thickness corneal perforation at the 3 o'clock limbal position, complicated by iris prolapse and fibrin reaction in the anterior chamber. The patient underwent urgent surgical intervention under general anesthesia. Using viscoelastic-assisted techniques, the prolapsed iris was gently repositioned into the anterior chamber, followed by meticulous corneal suturing and conjunctival closure. Postoperative recovery was uneventful, with restoration of anterior chamber depth, stable wound healing, and preservation of viable iris tissue. This case highlights the rarity and clinical significance of iris prolapse in pediatric ocular trauma. Rapid diagnosis, emergency referral, and modern tissue-preserving surgical techniques such as viscoelastic-assisted iris repositioning can successfully restore globe integrity and minimize long-term sequelae. Effective collaboration between emergency physicians and ophthalmologists is essential to prevent irreversible visual loss in this vulnerable population.
Horner syndrome (HS) in the emergency department (ED) is never a trivial finding. While it often signals catastrophic vascular or neoplastic disease such as carotid dissection or apical lung cancer, spinal cavernous hemangioma (SCH) is an extraordinarily rare etiology. Its recognition is critical, as missing this subtle sign may delay life-saving intervention. We describe a 21-year-old previously healthy male who presented with acute neck pain, progressive right upper limb weakness, and contralateral lower limb paresthesia. Careful examination revealed right-sided ptosis and miosis, unveiling HS. Urgent cervical MRI demonstrated a 47 & times; 11 mm intradural lesion at C6-C7, consistent with a cavernous hemangioma. The patient underwent emergent microsurgical resection, resulting in rapid neurological recovery. By two months, all deficits-including HS-had completely resolved. This case underscores that even the most subtle ocular sign can reveal life-threatening spinal pathology in the ED. HS should be approached as a clinical alarm bell which that necessitates immediate imaging and multidisciplinary coordination. Recognizing SCH as a potential-though rare-culprit expands the emergency physician's diagnostic horizon and illustrates how prompt diagnosis and timely surgery can transform an impending catastrophe into full recovery.
Critical illness polyneuropathy (CIP) is characterized by muscle weakness and atrophy in intensive care patients. Although recovery may occur by addressing the underlying cause, plasmapheresis or immunoglobulin therapy may be necessary in severe cases. We present two female patients (aged 76 and 52) who developed CIP in the early phase following epileptic seizures. CIP was suspected due to difficulty in ventilator weaning, and EMG confirmed the diagnosis. Both patients underwent five sessions of plasmapheresis and were successfully weaned from the ventilator, regaining full (5/5) muscle strength in all extremities. Early diagnosis is crucial in preventing complications and increasing treatment success in CIP.
Atrial fibrillation (AF) is a rare but clinically significant post-ictal cardiac arrhythmia that may complicate epileptic seizures and increase the risk of thromboembolic events. New-onset arrhythmias have been described after both focal and generalized tonic-clonic seizures; however, most published reports involve patients without pre-existing epilepsy, and the arrhythmias described are generally tachyarrhythmias. We report the case of a 47-year-old man with established epilepsy, treated with levetiracetam, who presented after a generalized tonic-clonic seizure and subsequently developed new-onset post-ictal atrial fibrillation on continuous cardiac monitoring and repeat electrocardiography. Baseline cardiac investigations, laboratory studies, and inflammatory markers were unremarkable. This case highlights the importance of systematic post-ictal cardiac monitoring, evaluation for reversible triggers, and consideration of anticoagulation with cardiology follow-up in selected patients. Clinicians should be aware of this uncommon association to avoid missed diagnoses and optimize management strategies.
Dieulafoy's lesion (DL) is a rare but potentially life-threatening cause of upper gastrointestinal bleeding. Endoscopic therapy is the first-line treatment; however, recurrent bleeding may necessitate surgical intervention. A 55-year-old male presented to the emergency department with hematemesis and hemodynamic instability. Initial endoscopy revealed a Dieulafoy's lesion in the gastric fundus with active bleeding. Hemostasis was achieved with epinephrine injection, thermal coagulation, and hemoclip placement, and temporary stabilization was obtained after blood transfusion. On the third hospital day, recurrent bleeding required repeat endoscopy and an additional hemoclip application, but the patient continued to experience symptoms. On day eight, intraoperative endoscopic tattooing with methylene blue facilitated accurate localization of the lesion, and wedge resection was performed. The postoperative course was uneventful, and histopathological examination confirmed the diagnosis of DL. This case demonstrates that intraoperative endoscopic marking is a valuable adjunct in refractory Dieulafoy's lesions, enabling precise localization, avoiding unnecessary radical surgery, and allowing successful limited resection.
In adolescence, personal care routines pass from parental control to the children. During this period, children develop independence in personal hygiene, clothing preferences, nutritional habits, and adhering to medical treatments. In case of lack of parental support and monitoring, it takes time for personal care habits to settle. 16-year-old female patient was diagnosed with deep neck infection and descendant mediastinitis with massive pleural effusion. The patient discontinued her prior dental abscess treatment due to progressive dysphagia. The patient underwent surgery for neck exploration, insertion of a cervical drain, tracheostomy, and chest tube. Although tests for immunodeficiency were screened, no significant result was found. The patient was discharged on the 33rd day. In adolescence, challenges arise in maintaining effective clinical relationships, especially regarding risk-taking behaviors and adherence to medical treatment in the face of illness. Parental support and healthcare providers play a vital role in facilitating this transition by educating adolescents on self-care practices and increasing parental monitoring during this developmental phase. Also developing algorithms that address biopsychosocial integrity through artificial intelligence will contribute to identifying patients who are likely to be non-compliant with treatment.
BRASH syndrome is a definition that encompasses complex causes of bradycardia. The use of atrioventricular node blockers, renal failure, hyperkalemia, bradycardia, renal hypoperfusion create a cascade that triggers each other. Additionally, hyperkalemic drugs such as angiotensin converting enzyme inhibitors may aggrevate the clinical condition. This is a clinical condition that can lead to shock and mortality if the diagnosis and mechanism are not considered or overlooked. We presented the BRASH clinic in 84-year-old female patient and discussed the approach. Finally, we created a graphical abstract summarizing this syndrome.
Foreign body impaction in the esophagus is a common emergency, particularly among children; however, unusual presentations in geriatric patients are rarely encountered. The clinical manifestation may vary depending on the type and location of the foreign body and the patient’s underlying condition. We report the case of a 79-year-old bedridden male patient with Alzheimer’s disease who presented to the emergency department with shortness of breath and audible wheezing. Initial evaluation and imaging studies revealed no acute pulmonary pathology. A lateral neck X-ray demonstrated an image consistent with a foreign body at the cervical level, which was later confirmed by computed tomography to extend along the esophagus. Under sedation with fentanyl and ketamine, the foreign body—a sock—was successfully removed using a laryngoscope and long forceps. The patient recovered uneventfully and was discharged after clinical stabilization. This case is remarkable due to the atypical presentation and the unusual nature of the ingested object. While most esophageal foreign bodies in adults are accidental or intentional, this case resulted from unconscious behavior related to Alzheimer’s disease. Emergency physicians should maintain a high index of suspicion when evaluating elderly or cognitively impaired patients presenting with atypical respiratory symptoms, as early recognition and prompt intervention can be lifesaving.
Tirofiban is a glycoprotein IIb/IIIa inhibitor and is an adjunct in the treatment of patients with acute coronary syndrome. Its main side effects are bleeding and thrombocytopenia. Severe thrombocytopenia is a rare but serious complication of tirofiban therapy, including when administered at low intracoronary doses in interventional cardiac procedures. The pathogenesis is largely immune-mediated and can result in abrupt and profound platelet count declines. Early and frequent platelet monitoring, prompt discontinuation of the drug, and supportive care remain critical to managing this adverse effect. In this case report, we present a case of severe thrombocytopenia that occurred in a 74-year-old male patient with non-ST segment elevation myocardial infarction following administration of a very low dose of tirofiban.
Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract, occurs in approximately 2% of the population and typically remains asymptomatic; however, it can lead to significant complications. This study aims to present cases of three different complications of Meckel's diverticulum that eluded preoperative diagnosis are presented: diverticular bleeding detected only during intraoperative colonoscopy, intestinal ischemia due to mesodiverticular band, and adhesive small bowel obstruction and ischemia resulting from diverticulitis. This case series highlights the diagnostic difficulties and surgical management strategies of Meckel's diverticulum complications while also demonstrating the clinical importance of considering this entity in the differential diagnosis of patients presenting with unexplained abdominal pain. Given the diagnostic limitations of current imaging modalities, surgical exploration in suspected cases has both diagnostic and therapeutic value.
