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An injury to the pericardium or the great vessels is considered a true medical emergency, with a poor survival rate. The early identification and immediate response from all the medical services play a significant role in the management of this type of injury. In this case report, we report a young male patient brought to the emergency room (ER) after sustaining two stab wounds to the chest. We present the successful management of the patient from admission to the ER until discharge a few days later, after a successful surgical intervention for a penetrating cardiac injury.

Highlights • Superior mesenteric vein and inferior vena cava injuries are associated with high mortality. • Damage control surgery is an effective strategy to stabilize the patient initially. • Second-look operations allow to identify injuries which might not have been discernable at first. • A mature hospital system with rapid response to trauma is integral when handling gunshot injuries., Introduction Injury to the superior mesenteric vein (SMV) is considerably rare amongst abdominal visceral vascular injuries. Multiple factors play a role in identifying such injuries, leading to the high morbidity and mortality associated. Case presentation We report a twenty-six-year-old male sustaining a SMV injury following a self-inflected gun shot. Initial assessment of the patient reveals hemodynamic instability and intraabdominal hemorrhage. Surgically approaching the patient was performed in two stages. Midline laparotomy was performed to control the active bleeding and stabilize the patient. Kocherizing the duodenum reveals that the source of retroperitoneal bleeding was from the SMV and one of the supra-renal tributaries of the Inferior Vena Cava (IVC). Several stitches were taken in a figure-of-eight manner to control the bleeding. Second-look operation was performed to rule out other injuries and permeant closure of the abdominal wall. Proper psychiatric care was ensured before transferal of the patient in good conditions to another healthcare facility specialized in mental health. Discussion High mortality rates reaching up to 65% are reported in similar cases. Multiple factors have contributed to the patient’s favorable outcome, including rapid trauma response, absences of other associated injuries, and the patient’s baseline healthy status. Conclusion The principle of damage control surgery in trauma is an effective strategy to stabilize the patient and rule out other injuries which might not have been discernible initially.

Appendiceal diverticular disease is a rare entity. We report a case of appendiceal diverticulitis mimicking acute appendicitis and diagnosed postoperatively on histopathology. A 28-year-old female presented with a 2-day history of shifting periumbilical pain associated with nausea and anorexia. A computed tomography scan of the abdomen demonstrated acute appendicitis. She was taken to laparoscopic appendectomy. Histopathology showed appendiceal diverticulitis, and perforation of an inflamed diverticulum with periappendicitis. Diverticulosis of the appendix is classified as congenital and acquired. Diagnosis can be made preoperatively by imaging. In this case, diverticulosis was not radiologically evident, and was interpreted as acute appendicitis. Gross appearance of the resected appendix was not suggestive of diverticulitis. Other cases reported that the gross specimen had evidence of diverticular disease. Surgeons should be aware that inflamed appendixes may harbor different pathologies warranting further management.

Inflammatory fibroid polyps (IFPs), or Vanek’s tumor, are rare benign mesenchymal lesions of the gastrointestinal tract (GIT). IFPs can be found throughout the GIT but most frequently in gastric antrum or ileum, with the appendix accounting for only