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We present an interesting case of a 73-year-old female who presented to the emergency department (ED) with complaints of abdominal pain for the past few days. Patient admitted history of “stomach problems” for the past few years with similar attacks every 3 - 4 months and attributed this to her “gallbladder”. After her dinner the night before, she started experiencing intense abdominal pain, which prompted her to come to the ED for evaluation. A portable chest X-ray was acquired which showed herniation of the gas-distended stomach overlying the left lung base. CT scan with IV contrast was then performed which confirmed a left-sided diaphragmatic hernia containing the antrum of the dilated stomach but the antrum was twisted to the left of the esophagogastric (EG) junction. There was pneumatosis in the wall of the caudal aspect of the gastric body, suggestive of ischemia. The patient underwent emergent exploratory laparotomy, derotation, partial gastrectomy and gastrostomy where she was found to have an adult Bockdalek hernia on the left side. We discuss this rare case and review relevant literature. J Curr Surg. 2017;7(1-2):15-19 doi: https://doi.org/10.14740/jcs315w

Peliosis hepatis (PH) is a rare vascular condition of the liver characterized by the presence of cystic blood filled cavities distributed randomly throughout the liver parenchyma. We describe a case of a 42-year-old previously healthy male patient, airlifted to us in a state of hemorrhagic shock after undergoing percutaneous diagnostic liver biopsy for lesions seen on CT scan. Repeat CT scan with IV contrast on presentation in our hospital showed intraperitoneal bleeding. Hepatic angiography failed to identify any specific bleeding source. A diagnostic laparoscopy was performed and approximate 9 L of hemoperitoneum was evacuated. The postoperative course was complicated with rapid hemodynamic deterioration, associated with acute hepatic failure progressively leading to multiorgan failure and death in spite of aggressive intensive care support. We suggest that PH should be considered as differential diagnosis of hypervascular hepatic lesions. It potentially can cause fatal acute non-traumatic liver hemorrhage.