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• Intestinal malrotation is uncommon in adulthood and is often missed. • Computed tomography scan of the abdomen is the diagnostic tool of choice. • Prompt intervention by surgical exploration is crucial for patient survival. • Laparoscopy is challenging in diagnosed volvulus or acute bowel obstruction. • Correcting asymptomatic malrotation after 20-years-old is not recommended. Malrotation is considered a newborn disease. This case report sheds light on the rare, but possible late presentation of malrotation in adulthood, which if missed, can leave the patient in a detrimental state. 28-year-old female presented in critical state with acute abdomen. Computed tomography abdomen/pelvis showed midgut volvulus, requiring urgent laparotomy. The patient's bowels were discolored, yet they normalized upon detorsion, except for a small portion, which was equivocal and left for observation. Ladd's bands were excised, and the abdomen was closed with Bogota bag for re-exploration. The patient underwent two more laparotomies to observe the intestinal segment until it was back to normal. Ladd procedure was then completed, and an absorbable mesh was applied. Follow-up of 20 months has been uneventful, except for a small, asymptomatic, incisional hernia. Malrotation in adults is often missed due to its subacute, nonspecific presentation. It is often diagnosed by CT abdomen, which shows inversion or vertical positioning of the superior mesenteric vessels. Symptomatic, but stable patients, can undergo laparoscopic Ladd procedure, which carries the benefit of less length of stay. While an incidental malrotation can be prophylactically operated on, correcting asymptomatic malrotation beyond age of 20 is ineffective and possibly harmful. Intestinal malrotation presenting in an adult should be on the differential diagnosis when dealing with abdominal pain, especially in the context of small bowel obstruction in a virgin abdomen. It is vital to consider a patient's age prior to prophylactically operate on malrotation discovered incidentally. [ABSTRACT FROM AUTHOR]

Background The pneumatosis intestinalis is an entity with multiple aetiologies and may be associated with a fatal outcome when present on plain radiographs. When associated with the presence of portomesenteric venous gas (PMVG) it is typically the result of bowel ischaemia. Methods and results We are presenting a case of a 43 year old male who presented with a two days history of haematemesis, generalised abdominal pain and distension. Computed tomography (CT) scan revealed a gross amount of air within the portal venous system and small bowel dilatation to the level of distal ileum was also seen with associated pneumatosis intestinalis. Emergency laparotomy was conducted which demonstrated a simple band adhesion resulting in bowel ischaemia. The patient was making a good post-operative recovery complicated only by sub-therapeutic treatment of schizophrenia. Conclusion The presence of gas within the portal venous system and PI in adults can indicate severe life-threatening disease. This requires early surgical intervention in those patients with a clinical suspicion of bowel ischaemia, and with radiological signs. This may avoid significant mortality. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: Colorectal cancer is the third commonest cancer in the UK. The commonest site of colorectal cancer metastases is the liver, followed by lungs. Metastases to small bones are recognized but are a rare occurrence of colorectal malignancy. PRESENTATION OF CASE: A 92 year old lady presented with a swollen, fractured right clavicle following a fall. On follow up, a swelling of approximately 10cm was still noted in the area. A CT scan revealed a ten by ten centimetres mass arising from the clavicle and a 9cm mass arising from the left aspect of the sacrum. She was also found to have complete collapse of the left lung with an underlying mass and a mass within the right lung. Biopsy of the clavicular mass was suggestive of metastatic colorectal adenocarcinoma. She had undergone an anterior resection for Dukes C adenocarcinoma six years previously. DISCUSSION: This case demonstrates the rare metastases of a colorectal primary to the clavicle, a clavicle metastases of this size has not been previously reported in literature. CONCLUSION: A high index of suspicion for potential of small bone metastases has to be entertained in a patient presenting with a non-healing fracture and a history of colorectal carcinoma. [Copyright &y& Elsevier]