Objective: We present a case of small intestinal perforation within an inguinal hernia following low-energy indirect trauma.Patient: A 55-year-old man with a known right inguinal hernia which had no prior indication for surgery developed acute right groin pain after sudden braking caused his scooter handlebar to strike his right thigh.Results: Physical examination and computed tomography (CT) scan of the abdomen and pelvis revealed multiple pockets of extraluminal air within the hernia sac, as well as gas bubbles in the surrounding intestinal contents. Based on these findings, we made a diagnosis of small intestinal perforation within the inguinal hernia.Conclusion: Small intestinal perforation within an inguinal hernia is an uncommon but potentially life-threatening complication requiring emergent surgical intervention. Delays in diagnosis and management can lead to peritonitis, abscess formation, sepsis, and prolonged hospitalization. Therefore, clinicians should maintain a high index of suspicion for intestinal perforation in patients with inguinal hernias, even in the absence of direct trauma or subsequent low-energy injuries.

A 36-year-old female with a high-grade fever and epigastric abdominal pain was prescribed antibiotics, but developed hypoxia and dyspnea. An echocardiography revealed diffuse hypokinesis and massive pericardial effusion, after which diagnostic cardiac catheterization and an endomyocardial biopsy (EMB) were peformed to reveal fibrosis and infiltration of inflammation cells composed primarily of neutrophils. Clinical manifestation of a spiking fever, leukocytosis, elevated ferritin levels, skin rash and EMB findings led to a diagnosis of adult-onset Still's disease (AOSD) with acute myocarditis. Pulse therapy of intravenous methylprednisolone was performed for three days, followed by a daily dose of prednisone (60 mg). After a course of steroid therapy for fever and pericardial effusion, and conducting a left ventricular ejection fraction, the patient showed improvement and was discharged asymptomatic within 32 days of admission. This study is the first to report on a case of myocarditis in AOSD diagnosed by neutrophil infiltration in the myocardium.
Abdominal Pain ; Adult ; Anoxia ; Anti-Bacterial Agents ; Biopsy* ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Dyspnea ; Echocardiography ; Exanthema ; Female ; Ferritins ; Fever ; Fibrosis ; Heart Failure ; Humans ; Inflammation ; Leukocytosis ; Magnetic Resonance Imaging* ; Methylprednisolone ; Myocarditis* ; Myocardium ; Neutrophil Infiltration ; Neutrophils ; Pericardial Effusion ; Prednisone ; Still's Disease, Adult-Onset* ; Stroke Volume