Conversion of Roux-en-Y gastric bypass (RYGB) to biliopancreatic diversion with duodenal switch (BPD-DS) is one of the options for RYGB patients who fail to lose sufficient weight or weight gain. The conversion can be done in a single or staged approach which is dependent on surgeon preference and patient factors. While the conversion can be performed relatively safely through experienced hands, it still carries complication risks. The risks associated with the conversion are similar to those of primary BPD-DS and include anastomotic leak, bleeding, bowel obstruction, stricture of the gastro-jejunal anastomosis, wound infection, and deep vein thrombosis. We present a case of a single stage conversion of RYBG to BPD-DS which was complicated by necrotizing fasciitis of the abdominal wall and barotrauma-induced pneumatocele.

There are few reported cases of epididymo-orchitis secondary to Salmonella in the literature and even fewer in newborn males without immunocompromised systems. The existing reports generally describe adult males in underdeveloped countries with immunocompromised systems or rheumatologic diseases undergoing steroid therapy. The last documented case of newborn epididymo-orchitis was in 1983 and required surgical debridement to salvage the testicle. [1] We present a case of a newborn male with Salmonella epididymo-orchitis and testicular abscess refractory to antibiotic treatment requiring eventual orchiectomy.

Case Description: 19-year-old man with history of marijuana and Synthetic Cannabinoids use presented with status epilepticus. Labs showed tetrahydrocannabinol in urine. Imaging showed diffuse cerebral edema with non-traumatic subarachnoid hemorrhage. Intracranial pressure (ICP) was elevated to 30 mmHg. This was complicated by severe refractory metabolic acidosis with persistently elevated ICP unresponsive to medical care and cerebrospinal fluid drainage. Five days later patient suffered cardiac arrest from severe acidosis and metabolic derangements. Patient could not be resuscitated, and family withdrew care. Discussion: This case highlights the many challenges in managing a critically ill patient with cerebral edema and renal failure with medically refractory metabolic acidosis. Synthetic Cannabinoids are undetectable on routine drug screens and exposure is difficult to establish. Synthetic Cannabinoids can lead to multi-organ failure and death that may result from cardiovascular events, respiratory depression, pulmonary complications and acute kidney injury. A high clinical suspicion is warranted in at-risk patients. Conclusion:Clinicians should always consider Synthetic Cannabinoids use in high-risk patient and anticipate multi-organ damage for early intervention. Further research is needed to establish causality, improve detection and devise appropriate therapeutic strategies in managing such patients

Endometriosis is a common gynecologic diagnosis with prevalence in the general population of around 10%. Spontaneous rupture of an endometriotic cyst is not rare. Here we presented a case with ruptured endometrioma and borderline mucoserous cystadenoma in 24 years old patient.

Pruritus and erythroderma could be a presenting sign of numerous internal malignancies. These symptomes can occur in the early stages of internal malignancies or precede them by months. On the other hand, these symptoms can also be caused by various other common conditions; therefore they are not specific for paraneoplastic diseases. We report the case of systemic anaplastic large cell lymphoma accompanied by erythroderma.