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Introduction. Neuroendocrine neoplasms (NENs) of the gastrointestinal tract (GIT) are slow-growing and rare tumors with different clinical, histological, and biological characteristics with an increased incidence in recent years. Most of them are indolent and colonic NENs are rare among all GIT-NENs. Compared to colorectal adenocarcinoma neuroendocrine tumors of the colon and sigmoid colon are uncommon. Case outline. We present a 25-year-old female patient, who was admitted to our department in hemorrhagic shock due to life-threatening bleeding from a tumor on the sigmoid colon, and after unsuccessful endoscopic hemostasis during colonoscopy. The complaints started the day before admission to the ward with hematochezia. The patient had no complaints before that. Emergency operation and colon resection with terminal colostomy were performed. Pathohistological and immunohistochemical analysis of the tumor showed unclear histogenetic origin from the group of neuroendocrine tumors. Conclusion. Regardless of the asymptomatic period of the disease, these tumors can cause severe bleeding as the first symptom, which can be life-threatening.

Introduction. In healthy adults, accidental ingestion of foreign bodies is uncommon. Intestinal perforation by ingested bone fragments is rare, but can be presented as a life-threatening condition, especially when the diagnosis is delayed. Case outline. We present an uncommon case of a 73-year-old female with acute abdominal symptoms due to ileal perforation caused by accidentally ingested animal bone. Pneumoperitoneum revealed by abdominal X-ray and abdominal free fluid revealed by abdominal ultrasound as well as the general condition of the patient required urgent laparotomy, when the diagnosis of ileal perforation was made. A foreign body was removed from the intestine, along with partial resection of the intestine and endto- end anastomosis. Conclusion. Surgical treatment of life-threatening complications arising after ingestion of foreign bodies is the only method of choice in the treatment of such patients.

Introduction. Gallstone ileus is a complete or partial mechanical bowel obstruction due to gallstone impaction in the bowel lumen and most commonly occurs after stones migrate through the cholecystoenteric fistula. Case outline. We present a patient with signs of gallstone ileus after stone migration through the cholecystoduodenal fistula into the duodenum with hematemesis as the first symptom. Conservative treatment had been started, to which the patient initially responded well. On the eighth day from the onset of the disease, the condition worsened. Signs of the Rigler triad were identified on computed tomography and magnetic resonance imaging of the abdomen. Enterolithotomy was successfully performed by the open surgical method. Postoperative recovery was orderly, without any biliary problems. Conclusion. Physical examination, upper endoscopy, and radiological diagnostic procedures are complementary and necessary in monitoring the dynamics of stone movement and deciding on when to perform surgery.

Introduction. Necrotizing fasciitis is a rare, severe, aggressive infection, life-threatening surgical emergency that spreads quickly, characterized by extensive necrosis of the deep and superficial fascia, associated with significant morbidity and mortality. Case outline. We are presenting two case reports with necrotizing fasciitis: a 54-year-old male patient, obese, with hypertension and untreated perianal fistula with severe infection of perianal region, perineum and scrotum, and a 64-year-old female patient with diabetes mellitus and heart disease, with severe infection of the lower extremity, anterior abdominal wall, inguinal and gluteal region, in which the entry point of infection were microlesions of the skin after shaving. Both patients were treated by emergency extensive surgical necrectomy with eradication of the deep infection source, with all conservative treatment measures. One patient was treated with hyperbaric oxygen therapy, the other was not because of cardiac and pulmonary contraindications. Conclusion. Better treatment outcome requires a multidisciplinary approach (cardiologist, endocrinologist, nephrologist, orthopedist, surgeon). Rapid and extensive surgical necrectomy is necessary to increase the success of the treatment of patients with this infection.