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Competing Interests: The authors declare that they have no conflict of interest.

Introduction and Importance: Large bowel obstruction caused by volvulus poses a life-threatening risk without immediate intervention. Sigmoid colon volvulus is predominant (43-75%), followed by cecal volvulus 10-52%). Synchronous double colonic volvulus is extremely rare, with limited documented cases in academic literature., Case Presentation: We report a case of synchronous volvulus involving the sigmoid colon and cecum in a 45-year-old male of the Toro tribe from Fort Portal city in western Uganda who presented with acute abdominal pain, distension, and complete constipation for 2 days, accompanied by five episodes of non-bloody feculent vomiting and anorexia., Clinical Discussion: Upon admission, the patient presented with stable vital signs and a mildly tender, tympanic, distended abdomen with absent bowel sounds. Plain radiographs revealed the characteristic "coffee bean" sign, indicative of sigmoid volvulus. Following optimization, laparotomy confirmed synchronous volvulus involving both the sigmoid and cecum. Subsequently, a total colectomy with end ileostomy was performed, after which the patient experienced an uneventful recovery., Conclusion: Synchronous double colonic volvulus, a rare condition, is frequently overlooked clinically. Timely recognition and intervention are crucial to address diagnostic challenges and prevent potentially fatal outcomes., (© 2024. The Author(s).)

Background: Intussusception with intestinal malrotation is termed as Waugh's syndrome. The incidence of Waugh's syndrome is less than 1%. There are very few reported cases. Once presented, it is a pediatric surgical emergency., Case Presentation: We present here two cases of Waugh's syndrome: an 11-month-old male patient of Punjabi descent and a 4-month-old female patient of Afghan descent who presented to us with abdominal pain and bleeding per rectum. Abdominal sonography revealed an intussusception with a target sign. They were explored and perioperatively had intestinal malrotation alongside intussusception, thus a diagnosis of Waugh's syndrome was made. A right hemicolectomy and Ladd's procedure was performed., Conclusion: Waugh syndrome is a rare congenital anomaly but can present with vague abdominal symptoms. Once presented, it is a pediatric surgical emergency. The patient should be optimized followed by surgical exploration., (© 2024. The Author(s).)

In Southeast Asia, the higher prevalence of Intestinal tuberculosis (TB) challenges the diagnosis of Crohn's disease (CD) due to their overlapping symptoms. This case involves a 25-year-old male misdiagnosed with Intestinal tuberculosis presenting with abdominal pain, weight loss, and bowel ulceration. Recurrence after anti-tubercular therapy led to further investigation paving to right hemicolectomy and histopathological analysis confirming Crohn's disease. This case highlights the complexity of the diagnosis of Crohn's disease in tuberculosis-prevalent areas, stressing the clinical importance, advanced diagnostics tools, and multidisciplinary approach for effective intervention.

In this article, we present case reports of two patients admitted to the University Hospital in Pilsen for acute abdomen due to a disorder of the passage through the gastrointestinal tract (GIT). Both were indicated for surgery. The patients were diagnosed intraoperatively with rarely occurring cecal volvulus (CV). The findings required an ileocecal resection; nevertheless, both patients fully recovered despite the need the resection.

An internal hernia through the foramen of Winslow represents a rare surgical pathology. This report describes a case with incipient caecal ischaemia and discusses current diagnostic and therapeutic approaches. A patient in his early 60s presented at the emergency department with abdominal pain and last bowel movement three days prior. A CT scan of the abdomen suggested an internal hernia into the lesser sac. Intraoperatively, the suspected diagnosis could be confirmed laparoscopically with a twisted mobile caecum herniating through the foramen of Winslow. Due to a suspected ischaemia and laparoscopic frustrated reduction, a right open hemicolectomy was performed. The hernia gap was closed. The postoperative course was uneventful. Despite the rarity of internal hernias in patients without prior abdominal surgery, surgeons should be aware of this entity. The diagnosis can be difficult and sometimes only established intraoperatively. Open surgery is usually required. If the gap is clearly identified, the recommendations tend towards its closure., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

We report a case of ileocecal intussusception due to Burkitt's lymphoma(BL). A 14-year-old boy was admitted to our hospital for abdominal pain and diarrhea. He was diagnosed an intussusception by the ultrasonography and the CT scan. Laparoscopic ileocecal resection was performed. A diagnosis of BL was made on basis of pathological examination. He was transferred for the chemotherapy on postoperative day 8. We conclude that, if the intussusception associated with malignant lymphoma is assumed from the preoperative findings, we have to keep minimal surgical invasion and start postoperative chemotherapy immediately.

Competing Interests: Competing interests: None declared.

OBJECTIVE. With heightened interest in nonoperative antibiotic management of uncomplicated appendicitis, appendicoliths become a more relevant issue, and because of higher failure rates their presence may be considered a contraindication. The purpose of this study was to investigate the prevalence of appendicoliths at CT in adults with suspected appendicitis. MATERIALS AND METHODS. Among adults undergoing MDCT for suspected appendicitis, 248 patients (134 women, 114 men; mean age, 35.2 years) consecutively registered over a 3-year period constituted a cohort with surgically proven appendicitis. A cohort of 248 patients (175 women, 73 men; mean age, 37.7 years) without appendicitis consecutively registered over a 1-year period served as control subjects. CT examinations were reviewed for the presence, size, and attenuation of appendicoliths and whether the appendicoliths were obstructing. In the cohort with appendicitis, degree of inflammation (3-point scale) and likelihood for perforation (5-point scale) were scored. RESULTS. The prevalence of appendicoliths at CT was 38.7% (96/248) among patients with appendicitis and 4.4% (11/248) among control subjects ( p < .001). Among the 96 patients with appendicitis who had visible appendicoliths, mean width, length, and maximum attenuation of the dominant appendicolith were 6.0 mm, 8.2 mm, and 313 HU, respectively. In 70.8% (68/96) of patients appendicoliths were obstructing, and 32.3% (31/96) of patients had more than one appendicolith. Inflammation (1.75 vs 1.43) and likelihood of perforation (2.07 vs 1.51) ( p < .05) scores were higher among patients with appendicitis who had appendicoliths. Extraluminal appendicoliths were seen in five cases of perforated appendicitis. CONCLUSION. Appendicoliths were identified at CT in nearly 40% of adults with proven appendicitis, compared with slightly more than 4% of those without appendicitis, and were associated with increased inflammation and risk of perforation.

Small bowel obstruction is a common surgical presentation, but intestinal faecoliths are rarely reported as a cause. A 75-year-old woman presented with small bowel obstruction from a large faecolith lodged in the caecum. This required removal at laparoscopy-assisted surgery. This case highlights the need to deal promptly with symptomatic intestinal faecoliths as they are unlikely to pass spontaneously and are prone to cause acute obstruction.

Introduction: Intussusception is a common condition in children, it is rare in adults. Adult intussusception differs from pediatric intussusception in various respects, including etiology clinical characteristics and therapy., Methods: We present and discuss a new case of intussusception in children and adults., Results: In child the Barium Enema x-ray examination is identified an endoluminal filling defect to refer to the apex of the invaginated loop at the rectal level, with slow ascent during the progressive injection of the radiopaque contrast medium. At the end of the procedure, incomplete reduction of the picture is documented. The patient undergoes emergency surgery where the presence of an ileo-ceco-colic invagination is documented. Intussusception is reduced by taxis. In the adult laparoscopic right hemicolectomy was performed. High-grade B-cell Burkitt's lymphoma was confirmed by immunohistochemistry., Discussion: In contrast to intussusceptions in children, in the adult population, a demonstrable etiology is found in most of the cases. In adults surgery is always indicated. The non-invasive resolutive intervention most commonly used in the child and best known consists in the rectal introduction of a radiopaque contrast medium (air or barium) at controlled pressure until., Conclusions: Although intussusceptions occur at all ages, there are major differences in the clinical presentation, diagnostic approach, and management between pediatric and adult populations. Intussusception is remarkably different in these two age groups and it must be approached from a different clinical perspective., Key Words: Intussusception in children, Intussusception in adults, Intussusception symptoms, Radiology and treatment.

A 62-year-old Asian man presented with a 3-month history of right iliac fossa pain which had progressively worsened over the last 3 weeks. All blood parameters were found to be unremarkable except for mildly elevated erythrocyte sedimentation rate. CT imaging demonstrated thickening of the ascending colon and caecum. Colonoscopic biopsies showed submucosal granulomas with features suggestive of schistosomiasis and parasite serology was positive for Schistosoma antibodies. He was treated with praziquantel and showed subsequent symptomatic and radiological improvement. However, he represented nearly 2 years later and underwent a right hemicolectomy for small bowel obstruction. The resected bowel showed an inflammatory caecal mass and a terminal ileal adenocarcinoma., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Sepsis is a severe organic dysfunction caused by an infection that affects the normal regulation of several organ systems, including the central nervous system. Inflammation and oxidative stress play crucial roles in the development of brain dysfunction in sepsis. The aim of this study was to determine the effect of a fish oil (FO)-55-enriched lipid emulsion as an important anti-inflammatory compound on brain dysfunction in septic rats., Methods: Wistar rats were subjected to sepsis by cecal ligation and perforation (CLP) or sham (control) and treated orally with FO (600 µL/kg after CLP) or vehicle (saline; sal). Animals were divided into sham+sal, sham+FO, CLP+sal and CLP+FO groups. At 24 h and 10 d after surgery, the hippocampus, prefrontal cortex, and total cortex were obtained and assayed for levels of interleukin (IL)-1β and IL-10, blood-brain barrier permeability, nitrite/nitrate concentration, myeloperoxidase activity, thiobarbituric acid reactive species formation, protein carbonyls, superoxide dismutase and catalase activity, and brain-derived neurotrophic factor levels. Behavioral tasks were performed 10 d after surgery., Results: FO reduced BBB permeability in the prefrontal cortex and total cortex of septic rats, decreased IL-1β levels and protein carbonylation in all brain structures, and diminished myeloperoxidase activity in the hippocampus and prefrontal cortex. FO enhanced brain-derived neurotrophic factor levels in the hippocampus and prefrontal cortex and prevented cognitive impairment., Conclusions: FO diminishes the negative effect of polymicrobial sepsis in the rat brain by reducing inflammatory and oxidative stress markers., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Sepsis in older children is often associated with the presence of developmental abnormalities and cerebral palsy. While relatively uncommon, surgical abdomen in these patients is associated with a high rate of mortality. Few reports have been described of sepsis caused by isolated cecal necrosis., Case Report: We report a 13-year-old child with cerebral palsy and global developmental delay who presented to the emergency department with acute worsening abdominal distention that the mother attributed to chronic constipation. Clinical evaluation revealed that she was in severe septic shock and needed immediate stabilization after which she underwent an exploratory laparotomy. Operative findings revealed cecal necrosis that necessitated an ileocecectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Children with intellectual disabilities presenting with sepsis to the emergency department can be particularly challenging given the communication barriers and the time-sensitive nature of the condition. When evaluating these patients, a thorough history and examination are often the only tools that assist in the early identification of the infectious source, leading to improved clinical outcomes.© 2019 Elsevier Inc., (Published by Elsevier Inc.)

Background: Appendiceal inversion with neoplasia in adults is an extremely rare event with a reported incidence of < 0.01%. Preoperative diagnosis is very important for surgical treatment; however, it is very difficult to be exact., Case Presentation: The patient was a 60-year-old woman with complaints of intermittent abdominal pain. Computed tomography and colonoscopy revealed a cecal mass, which was diagnosed as a tubulovillous adenoma in the preoperative colonoscopic biopsy. At surgery, the appendix was found to be completely inverted into the cecum. The cecum was partially resected, and surgical pathology examination confirmed a tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia., Conclusions: Although preoperative diagnosis of appendiceal inversion with neoplasia may be often difficult due to its non-specific symptoms, clinicians should consider this disease entity when they encounter an intraluminal protruding cecal mass without visualization of the normal appendix on CT and colonoscopy.

A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management., Competing Interests: Competing interests: Not required., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The preoperative diagnosis of cecal volvulus (CV) is rare and difficult and emergent laparotomy is frequently performed. Here, we report a case of CV that was diagnosed by preoperative computed tomography in a patient with an intellectual disability. In addition, we demonstrate that elective laparoscopic cecopexy can be performed following conservative treatment, such as the use of an ileus tube per anus.

Atraumatic splenic rupture, an infrequent surgical emergency, constitutes a life-threatening situation. The lack of a traumatic background makes it difficult to suspect. We present a case of a 45-year-old woman, with history of bariatric surgery, referred to our emergency due to 3 weeks long abdominal and lumbar pain, in shock. Imaging diagnosis of splenic rupture, emergent surgery was performed with atypical findings and good evolution. The bibliographic review, background and surgical findings allowed to postulate causality in this unusual presentation. Despite its low frequency, this pathology involves significant mortality and must be present in the patient in shock in the emergency room., (Copyright: © 2019 Permanyer.)

The present paper describes a case of ileocecal intussusception detected by ultrasound and confirmed by CT, including the imaging characteristics allowing its diagnosis. The patient was referred for colonoscopy, which could not be completed, to assess the cause of intussusception. Then it was decided to resort to Virtual colonoscopy, which allowed to identify and characterize a cecal neoplasm serving as a lead point for the intussusception.

Bowel involvement in endometriosis is uncommon and is most frequently located in the sigmoid colon and the rectum. We present a case in a 37-year-old woman of a cecal endometrioid mass complicated with an ileocolic intussusception which extended beyond the splenic colon flexure. Careful manual extraction allowed a reduction of the intussusceptum, followed by an oncological right hemicolectomy. The patient suffered postoperative ileus, which was spontaneously solved. Intussusception is infrequent in the adult population and usually involves the small bowel. The great majority of ileocolic intussusceptions have a malignant origin (cecal adenocarcinoma). An endometriotic mass located at the cecum as the lead point for ileocolic intussusception is an extremely rare presentation. On reviewing the literature, we found only 13 reports with no other cases extending beyond the splenic flexure, as occurred in our patient.

Background: In the setting of a known ectopic pregnancy, severe abdominal pain with clinical concern for rupture is an indication for emergency surgery. In rare cases, appendiceal pathology may occur simultaneously., Case: A woman with a known ectopic pregnancy presented to the emergency department with a clinical picture consistent with its rupture. At the time of surgery, an appendectomy also was performed owing to concern for concurrent appendicitis; histopathologic examination revealed appendiceal endometriosis., Conclusion: During surgical management of ectopic pregnancy, it is important to undertake a thorough examination of the pelvis, because patients may present with multiple concurrent pathologies. In the setting of an emergency operation, when the diagnosis seems clear, this survey should not be forgotten.