Surgery 1973, 73:936.PubMed 23. Lorea P, Baeten Y, Chahidi N, Franck D, Moermans JP: A severe complication of muscle transfer: clostridial myonecrosis. Ann Chir Plast Esthet 2004, 49:32–5.PubMedCrossRef 24. McNae J: An unusual case of Clostridium welchii infection. J Bone Joint Surg Br 1966, 48:512–3.PubMed Competing interests The authors declare that they have no competing interests. Authors’ contributions IA and

AT had the original idea and drafted the manuscript. PK and KL drafted, reviewed, finalized and revised the manuscript. GK and JK CA4P order searched the literature and prepared the figures. All authors read and approved the final manuscript.”
“Background Multiple endocrine neoplasia 2A (MEN2A) is a rare autosomal dominant syndrome caused by missense mutations in the RET proto-oncogene associated with medullary thyroid cancer, pheochromocytoma and hyperparathyroidism. Pheochromocytoma is a rare catecholamine-secreting tumor of the adrenal glands most often presenting with the characteristic symptoms of paroxysmal hypertension, palpitations, diaphoresis, and headache. Acute onset

abdominal pain and nausea may be the only presenting symptoms of spontaneous intra-abdominal hemorrhage, a rare and highly selleck kinase inhibitor lethal complication. We present a case of spontaneous intra-abdominal hemorrhage secondary to a ruptured pheochromocytoma, subsequent management, and a review of the literature. Case Presentation M.J., a 38-year-old man developed sudden severe abdominal pain, nausea, and vomiting after shoveling snow. Prior to this event, he denies having had any episodes of hypertension, tachycardia or

diaphoresis, selleck chemicals although several months prior he was diagnosed with essential hypertension and was started on lisinopril. In addition, he denied any recent abdominal or flank trauma. Of note, his past medical history is significant for a diagnosis of MEN2A which was made at the age of 18 months, and a prophylactic total thyroidectomy at age 10 secondary to elevated serum calcitonin levels. Since that time he has had no STI571 purchase further follow-up, although of his two children, his daughter has been diagnosed with MEN2A and undergone a prophylactic total thyroidectomy 2 years prior to this event. On arrival, paramedics found him near syncopal and diaphoretic with a heart rate of 180 bpm and systolic blood pressure of 64 mmHg. Fluid resuscitation was initiated and the patient was taken to an outside hospital. Initial evaluation at the local level II trauma center was notable for a heart rate of 150 bpm, systolic blood pressure of 70 mmHg, diffuse peritoneal signs, a hematocrit of 34%, INR of 1.0 and PTT of 30.4. Following resuscitation with additional crystalloid and 2 units of packed red blood cells (pRBC), his hematocrit was 34%, INR 2.4 and PTT 66.2. A non-contrast abdominal computed tomogram revealed bilateral adrenal masses and a large amount of intra and retroperitoneal hemorrhage (Figure 1).