Umbilical hernias are commonly diagnosed ventral abdominal wall defects and are frequently managed electively. Diagnosis is primarily clinical but may be supported by imaging modalities such as computed tomography (CT), ultrasound (US), or magnetic resonance imaging (MRI). Although most patients remain asymptomatic, surgical intervention is required for definitive repair. However, delayed repair can transform a low-risk outpatient procedure into a surgical emergency associated with increased morbidity and limited operative options, including the inability to place mesh. The absence of mesh reinforcement is associated with substantially higher recurrence rates, even in small hernias. Therefore, patient education and elective surgical repair of umbilical hernias should occur before complications arise that restrict mesh use. We present the case of a 64-year-old man with a previously diagnosed umbilical hernia who deferred elective repair and subsequently presented with acute abdominal pain due to incarceration. Emergent robotic-assisted repair was performed, requiring extensive lysis of adhesions and primary fascial closure with suture. Intraoperative findings of bowel edema and serosanguineous fluid rendered the surgical field contaminated, ultimately precluding mesh placement. This case highlights the tangible cost of delayed elective umbilical hernia repair. Deferral of intervention can lead to emergent presentation, limit surgical options, and increase the risk of recurrence. The true cost of delay is not the emergent operation itself, but the permanent loss of the ability to perform the most durable repair possible.

Free-floating gallbladder is a rare anatomic variant characterized by excessive mobility due to an elongated mesentery, predisposing it to torsion and vascular compromise. When torsion occurs, obstruction of the cystic duct and artery may rapidly progress to ischemia, necrosis, and gangrene, constituting a surgical emergency. Preoperative diagnosis is challenging because clinical, laboratory, and imaging findings often mimic uncomplicated acute cholecystitis. We report the case of an 87-year-old male with liver cirrhosis presenting with diffuse abdominal pain and elevated inflammatory markers. Ultrasonography and computed tomographic angiography were consistent with acute cholecystitis. However, laparoscopic exploration revealed a torsioned, necrotic, gangrenous free-floating gallbladder. Laparoscopic cholecystectomy was successfully performed, and recovery was uneventful. This case highlights the diagnostic limitations of imaging in rare anatomic variations and underscores the importance of early surgical intervention and intraoperative vigilance.

Internal herniation through the broad ligament is an exceptionally rare cause of small bowel obstruction (SBO), particularly in pregnant patients, and is often misdiagnosed due to non-specific clinical manifestations. This is a 35-year-old woman at 9 weeks' gestation, medically free, presented to the emergency department with abdominal pain associated with persistent vomiting. Despite conservative management, the patient was deteriorating. Therefore, a patient-shared decision for diagnostic laparoscopy was performed. Intraoperatively, a reduced viable loop of distal ileum was herniated through a defect in the right broad ligament. The postoperative course was uneventful. The persistence of clinical deterioration despite conservative therapy should prompt urgent surgical evaluation, and when indicated, laparoscopy is considered safe in pregnancy and provides diagnostic and definitive management. This case emphasizes that signs of SBO should have a low threshold for early multidisciplinary evaluation, and timely diagnostic laparoscopy is crucial to prevent delayed diagnosis and adverse maternal-fetal outcomes.

Description of the clinical presentation and tumor behavior, its general and pathological characteristics, diagnostic and therapeutic approaches, as well as treatment outcomes in children with neuroblastoma (NB) at a single-center. Special focus was placed on the duration of the diagnostic process and the correlation between disease stage, presence of metastases, and treatment outcomes. Given the small cohort, this report is presented as a descriptive case series complemented by a focused review of the literature NB. A retrospective study was conducted for the time period from January 1st, 2010, to December 31st, 2024. The study included 13 patients (7 males, 6 females; median age: 44 months; range, 0-114) diagnosed with NB who underwent surgery and were hospitalized at the Department of Pediatric Surgery, Clinical Center of the University of Sarajevo. Demographic, clinical, biochemical, radiological, and treatment data were extracted from medical records. A narrative review of major published NB cohorts was conducted to compare our observations with existing evidence. The median age at diagnosis was 44 months. The largest number of patients were in the age group of 2-4 years, and most presented with stage four disease (according to International Neuroblastoma Staging System classification). The tumor was located in the adrenal gland in 92.3% of cases. The median survival time was 36 months. Patients had elevated serum neuron-specific enolase, urinary vanillylmandelic acid, as well as blood ferritin and lactate dehydrogenase levels. The most common symptoms were loss of appetite, presence of a palpable mass, and abdominal pain. Metastases were present in 76.9% of patients, and stage four was associated with aggressive metastatic dissemination. A multimodal approach was used in treatment. The median time from symptom onset to primary care physician consultation was 12 days, and the median time from physician consultation to diagnosis was 14 days. Relapse occurred in 46.2% of cases, most frequently in patients with stage four disease. A total of 7 patients (46.2%) survived. Advanced-stage disease at diagnosis, metastatic burden, and unfavorable outcomes, are dominating factors in our single-center experience. When compared with larger published cohorts, our findings align with global patterns. Due to inherent sample size limitations, these observations are hypothesis-generating and the need for larger, multicenter studies remains.

Accidental foreign body ingestion is a recognized clinical emergency, particularly among elderly individuals, and may lead to serious gastrointestinal complications. Denture ingestion is often silent and may occur due to poor prosthesis fit or fracture. We report a case of a 78-year-old hypertensive woman who presented with a 1-week history of colicky abdominal pain, abdominal distension, constipation, and hematochezia. On examination, she showed signs of generalized peritonitis. Further history revealed that she had unknowingly swallowed a fragment of her broken removable denture several days earlier. Contrast-enhanced computed tomography demonstrated sigmoid colon perforation with a retained foreign body. Emergency exploratory laparotomy confirmed a metallic denture fragment perforating the sigmoid colon. The affected bowel segment was resected, the foreign body removed, and a Hartmann procedure performed. Denture ingestion accounts for a small proportion of gastrointestinal foreign bodies but carries a higher risk of perforation due to sharp components. Early recognition, prompt imaging, and timely surgical intervention are essential for favorable outcomes.

We report the first documented case of Gardnerella vaginalis peritonitis in a 55-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD) for renal failure of unknown etiology. He was started on CAPD three months after catheter insertion and simultaneous umbilical hernia repair with mesh placement. His follow-up was notable for poor compliance and geographical isolation. He presented to the emergency department for abdominal pain associated with an abscess at the catheter exit site. Microbiological culture identified G. vaginalis, an organism typically found in the female vaginal flora. The outcome was favorable with metronidazole treatment, to which this organism is generally susceptible. This case highlights the potential role of atypical pathogens in peritoneal dialysis-related infections, and in particular the pathogenicity of G. vaginalis through biofilm formation in patients carrying implanted medical devices, including in men.

Background and Objectives: Visceral artery aneurysms (VAAs) are rare but potentially catastrophic vascular abnormalities, particularly in pregnant patients or women of childbearing age. Rupture is often fatal for both mother and fetus, with mortality rates exceeding 70% in some series. While most VAAs are found incidentally, a subset may present acutely with nonspecific abdominal or flank pain, making early recognition and appropriate referral essential. This review article aims to provide General Practitioners (GPs) and emergency department (ED) clinicians with a practical approach to the recognition, investigation, initial management, and escalation pathways for VAAs. Results: Physiological and hormonal adaptations in pregnancy heighten aneurysm rupture risk. Despite this, imaging is frequently delayed. Computed tomography angiography (CTA) remains the gold standard for diagnosis and is safe in pregnancy when clinically justified, with fetal radiation exposure well below teratogenic thresholds. Guidelines from major vascular societies uniformly recommend repairing VAAs in pregnancy or women planning pregnancy irrespective of aneurysm size, and treating pseudoaneurysms urgently in all patients. Endovascular intervention is first-line where anatomy permits, while open or hybrid approaches remain essential in unstable presentations. The manuscript outlines practical steps for ED and GP settings, including haemodynamic stabilization, early obstetric involvement, transfer considerations for rural environments, reproductive counselling, and post-repair surveillance. Conclusions: With an increasing number of abdominal scans being performed in primary and tertiary settings, there is an associated increased volume of incidental findings that require work-up. This article outlines a practical investigation and management strategy for clinicians presented with VAAs, including in high-risk cohorts, emphasizing early imaging, inter-specialty coordination, and guideline-supported thresholds for intervention.

Background and objectives: Acute colicky abdominal pain, involving visceral spasms and inflammatory mechanisms, is a common complaint in everyday medical practice. Despite its widespread use, clinical evidence on the fixed-dose combination of pargeverine 10 mg plus lysine clonixinate 125 mg remains limited. The objective of this study was to describe real-world clinical outcomes, safety, and patient-reported experience associated with this combination in routine practice. Materials and methods: This multicenter, observational, non-comparative, real-world study included adult patients with acute colicky abdominal pain of gastrointestinal, urological, or gynecological origin. Pain intensity was assessed using a visual analog scale (VAS) at baseline and at 5 ± 3 days. Secondary outcomes included time to pain relief, satisfaction with treatment, and safety. Associations between pain reduction and patient-reported outcomes were explored. Results: A total of 202 patients were analyzed. Significant pain reduction was observed across all etiologies (p < 0.001), with median VAS reductions ranging from 6 to 9 points (approximately 70% to 90% from baseline). More than 95% of patients reported early improvement, and sustained relief was maintained in more than 96% throughout the study period, regardless of the pain's origin. Adverse events were infrequent (3%), mild in intensity (primarily transient gastrointestinal symptoms), and did not lead to treatment discontinuation. Conclusions: In real-world clinical practice, the fixed-dose combination of pargeverine and lysine clonixinate was associated with early and sustained, clinically meaningful pain reduction across multiple forms of acute visceral colicky pain, with a favorable safety and tolerability profile, supporting its relevance as a short-term therapeutic option in mild to severe acute pain.