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Gastric outlet obstruction is any mechanical or functional blockage preventing adequate gastric drainage and decompression. It is a complex condition that can have benign or malignant causes. Computed tomography (CT) helps to delineate the underlying etiology and to aid in the treatment planning, while endoscopy is the gold standard for diagnosis. Endoscopic stent placement is a minimally invasive treatment option that is ideal for patients with poor prognosis and short life expectancy. Surgical gastrojejunostomy remains the preferred treatment of choice as it provides a reliable and durable means for gastric drainage.

Rib fractures are reported in at least 10% of all trauma admissions. The associated morbidity and mortality worsen with advanced age and increasing number of rib fractures. In this population, the risk of nosocomial pneumonia has been documented to be as high as 29%. The utilization of clinical care pathways results in favorable outcomes. Despite this evidence, the medical management of rib fractures is yet to be truly standardized. At the core of recommended clinical care pathways is the identification of high-risk patients, appropriate patient disposition, multimodal pain control, aggressive pulmonary care, nutritional support, and early mobilization.

Acute cholecystitis (AC) is one of the most common causes of emergency admissions to a general surgery service. Although early laparoscopic cholecystectomy (LC) is considered the appropriate treatment for patients with AC, the procedure can be associated with significant morbidity and mortality in high-risk patients [1–3]. High-risk surgical patients, such as the elderly and those with cardiopulmonary comorbidities have pathological changes in their organ systems resulting in increased morbidity and mortality such as myocardial infarction, congestive cardiac failure, stroke, pneumonia or atelectasis [4]. Additionally, the exposure of such high-risk patients to the pneumoperitoneum of a LC can further lead to cardiopulmonary and renal dysfunction [4]. Due to these observations, less invasive or “damage control” techniques have emerged for AC. These techniques attempt to foster temporary and sometimes permanent disease management of AC. The following discussion addresses some of these techniques.

In the United States, gallstones may be present in up to 20 % of the adult population. The majority of those with cholelithiasis do not experience associated symptoms or complications (asymptomatic cholelithiasis). As such, the presence of cholelithiasis is usually discovered incidentally at the time of other abdominal radiographic studies. In general, these patients can be managed expectantly without the need for follow-up imaging or surgery due to the low rate of subsequent development of symptoms or complications. This presentation contrasts with those patients with symptomatic cholelithiasis or gallstone-related complications (e.g., acute cholecystitis, choledocholithiasis, and pancreatitis), for which standard treatment includes laparoscopic cholecystectomy. However, there are certain subsets of patients for which prophylactic cholecystectomy is indicated. These include patients at risk for gallbladder cancer (porcelain gallbladder, large gallbladder polyp, anomalous pancreatic duct drainage, or large gallstones), certain ethnic groups, and those with hemolytic disorders. Other more controversial indications include transplant candidates and/or immunosuppressed patients, pediatric patients, and those undergoing bariatric surgery with expected, rapid postoperative weight loss.