Granulicatella adiacens, a nutritionally variant streptococcus, is part of the normal oral, gastrointestinal, and urogenital flora. It is associated with bacteremia, infectious endocarditis, and, rarely, bone and joint infections. G. adiacens infections also tend to have high mortality due to diagnostic challenges and antibiotic resistance. Few case reports have documented its role in abscess formation. Here, we report the first known case of G. adiacens causing a gallbladder abscess in a patient with gallbladder carcinoma (GBC), a rare but aggressive cancer. Enhanced awareness and improved diagnostic methods are needed to manage such infections and understand their underlying mechanisms, particularly in immunocompromised patients with malignancies.

Remnant cholecystitis is a rare complication following subtotal cholecystectomy (STC), particularly when the reconstituting technique is used, which leaves a portion of the gallbladder behind. This remnant can become inflamed due to recurrent or retained gallstones. We present the case of a 39-year-old female who required a completion cholecystectomy 11 years after her initial STC due to severe recurrent right upper quadrant (RUQ) pain, nausea, and vomiting with an ultrasound that revealed cholelithiasis. This case highlights the need for increased awareness of remnant cholecystitis, better diagnostic approaches, and standardized management guidelines to prevent long-term complications. Further research is necessary to improve the treatment of this rare condition and optimize patient outcomes.

Medullary carcinoma (MC) is a rare subtype of colorectal cancer, which presents with poorly differentiated histology and is often confused with conventional adenocarcinoma of the colon. While this form of colorectal cancer is rare, it often does not meet the high-risk criteria to qualify for adjuvant chemotherapy even with a favorable prognosis. Diagnosis of MC is a proven difficulty because of the lack of immunohistochemical stains on pathology seen in adenocarcinoma of the colon. Unlike adenocarcinoma of the colon, distant metastasis is rare. Patients diagnosed with MC have one- and two-year survival rates of 93% and 74%, respectively. The patient was a 75-year-old female diagnosed with MC of the sigmoid colon and a large uterine fibroid. In this case report, we discuss the high-risk indications of colorectal cancer and the recommended treatment of patients with stage II MC of the colon.

Introduction: Appendicitis is a very common diagnosis that surgeons manage daily. Some surgeons are still giving antibiotics to patients suffering from uncomplicated appendicitis in the postoperative setting, despite an abundance of evidence to support a single preoperative dose of antibiotics. In this paper, we will describe the management of post -operative antibiotics at our institutions following uncomplicated appendicitis with regard to the use of antibiotics in the post -operative setting. Methods: A retrospective chart review was performed analyzing post -operative antibiotic use and postoperative complications in 179 patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. We retrospectively examined the patients to change our future practices as we perform appendectomies routinely, and there is practice variation at our centers. Current Procedural Terminology (CPT) codes for 'laparoscopic appendectomy' were used to identify the patients within our inclusion criteria. Twenty-four patients were excluded from the analysis as they had complicated appendicitis or met other exclusion criteria. We only studied the patient with uncomplicated appendicitis, as those with complicated appendicitis have a different clinical course that involves post -operative antibiotic administration or prolonged antibiotic administration with or without drain placement. Both arms of the study were homogeneous regarding patient characteristics. An independent test of the development of wound infection for those patients receiving post -operative antibiotics versus those not receiving post -operative antibiotics was conducted using the SPC XL 2010 Microsoft Excel (Redmond, USA) add -in. A p -value of <0.05 was considered statistically significant. This included the odds ratio for the development of complications. Results: There was no difference in the risk of infection rate in patients given post -operative antibiotics; however, given the odds ratio of 6.53, there is an association between an increased wound infection rate and patients who received post -operative antibiotics. Discussion: An appendectomy is a standard surgical procedure for acute appendicitis. The guidelines for using pre -operative antibiotics in uncomplicated appendicitis are well established; however, there is no specific recommendation on whether to continue antibiotics post -operatively. However, there is significant provider variability on this topic. Antibiotic use post -operatively in clean -contaminated cases, such as uncomplicated acute appendicitis, has been associated with higher risks of surgical site infections. Conclusion: The use of antibiotics post -operatively may not be indicated for uncomplicated laparoscopic appendectomy and may increase wound infections. A large-scale study including a larger population and extending it to other hospitals may increase statistical significance and help guide physician management.

Objective: Rare disease Background: Ureteroinguinal hernias are exceptionally rare and are seldom diagnosed in the preoperative setting. There are 2 classifications of this type of hernia: paraperitoneal and extraperitoneal. Case Report: We report a case of a 67-year-old man who presented with urinary symptoms and a reducible right inguinal hernia. A computed tomography (CT) scan of the abdomen and pelvis suggested an ureteroinguinal hernia. Further diagnostics and treatment via cystoscopy, retrograde pyelogram, and right ureteral stent placement were performed, confirming the diagnosis and providing relief of the obstructive uropathy. The patient underwent an attempted elective transabdominal preperitoneal repair that was converted to an open Lichtenstein repair. Intraoperatively, an extraperitoneal ureteroinguinal hernia was identified. The patient did well postoperatively, and the stent was removed 1 month later. Conclusions: Only 20% of the ureteroinguinal hernias described in the literature are extraperitoneal. In our case presentation, we demonstrated successful identification and treatment of an extraperitoneal ureteroinguinal hernia. The diagnosis was made using a combination of the clinical presentation, CT of the abdomen and pelvis, and cystoscopy with retrograde pyelogram. The extraperitoneal classification was an intraoperative diagnosis. The treatment consisted of a temporizing ureter stent and definitive management with an open Lichtenstein repair. We recommend obtaining a CT scan when a patient presents with a combination of urinary symptoms and an inguinal hernia because this process was invaluable in our preoperative diagnosis. Stent placement at the time of diagnosis permitted an elective repair and aided in the identification of the ureter during the hernia repair.

Internal hernias are an uncommon cause of small bowel obstruction and present a challenging clinical diagnostic scenario. They result from the abnormal protrusion of an abdominal organ through a peritoneal defect and can cause intermittent obstructive symptoms, diffuse abdominal discomfort, and postprandial pain. Paraduodenal hernias comprise 53% of all internal hernias 1 and occur due to failure of the fixation of either the left or transverse mesocolon to the posterior abdominal wall. Its relative rarity results in mortality between 20 and 50% 2 because of delayed diagnosis and consequent obstruction, strangulation, and bowel ischemia. Our case series describes three patients before and after operative fixation of paraduodenal hernia. Only one of the three was identified by preoperative radiologist interpretation. Subsequent diagnosis and definitive treatment were completed by surgical staff to resolve undiagnosed undulating abdominal pain and obstructive-type symptoms. We further analyze left-sided paraduodenal hernias after laparoscopic and robotic repair to define common symptomatology, typical CT findings, and preferred laparoscopic repair techniques.

Foramen of Winslow hernias are one of the most uncommon types of internal hernias that a surgeon will encounter. They are often initially indolent with vague symptoms that present over an extended period of time. Unfortunately, these hernias are not often diagnosed prior to requiring emergent operative intervention. This case report describes a patient who had a long history of vague abdominal pain and radiographic evidence of a foramen of Winslow hernia 4 years prior to presenting with acute obstructive symptoms. This raises the question: Should foramen of Winslow hernias, if diagnosed early, be repaired on an elective basis?

Pneumatosis intestinalis can be identified radiographically incidentally in an asymptomatic patient, or it may be present in its fulminant form with peritonitis. Although multiple mechanisms have been postulated, most believe it arises from mechanical or infectious factors. Respiratory factors have also been described as possible causes for this condition. Clinically, it is important to differentiate among patients whom require surgical intervention from those who would benefit from conservative management, such as hyperbaric oxygen, changes in diet, and/or antibiotic administration. Although supplemental oxygen has become the standard of care for the treatment of benign pneumatosis intestinalis, we question whether all patients require oxygen therapy as a treatment. Although oxygen may be beneficial, the literature suggests there may be detrimental effects from oxygen toxicity and the free radicals formed during hyper-oxygenation. Furthermore, given the rising epidemic of antibiotic resistance and the various toxicities associated with usage of antibiotics, do all patients really require antibiotics? We present a case of a patient with complaints of hematuria, but no other gross abdominal complaints and was incidentally found to have pneumatosis intestinalis and pneumoperitoneum without any evidence of vascular compromise or ischemia. This patient was managed successfully with conservative treatment without oxygen therapy or antibiotics.

Subcapsular bilomas are a rare complication of laparoscopic cholecystectomy and an even more rare occurrence to occur spontaneously. We present a case of left sided subcapsular biloma following a laparoscopic cholecystectomy. The location of the biloma was unrelated to our area of dissection. The operation was without difficult dissection or pressurization of the biliary tree. In addition, we present percutaneous drainage alone, without ERCP as adequate management in subcapsular bilomas.