A woman in her 40s presented on post-operative day 2 following vaginal hysterectomy and uterosacral ligament suspension (USLS) with severe abdominal pain, distention and emesis. A distended colon was seen on CT, and rectal contrast confirmed complete obstruction at the rectosigmoid junction. She was taken urgently to the OR by the general surgery, urogynecology and reconstructive pelvic surgery teams for flexible sigmoidoscopy and diagnostic laparoscopy, where the right-sided uterosacral stitches were found to obstruct the colon. The obstruction resolved after releasing the right uterosacral stitches. We postulate that the obstruction resulted from kinking of the colon, which was noted to be redundant and right-deviating. This case highlights important considerations regarding uterosacral stitch placement during USLS to optimise both apical support and protection of nearby structures.

Trichobezoars are rare intraluminal masses formed from ingested hair. They are most commonly located in the stomach. When trichobezoars extend from the stomach into the small intestine, it is referred to as "Rapunzel syndrome." One of the rarer complications of trichobezoars is small bowel obstruction due to distal migration. We present a case of a pediatric patient with a large gastrointestinal trichobezoar that migrated into the distal ileum, resulting in a small bowel obstruction. This case emphasizes the importance of radiographic imaging in the diagnosis of trichobezoars and their potential complications.

Waugh syndrome is the rare coexistence of intussusception and intestinal malrotation. We describe the case of a nine-year-old boy who initially presented with nonspecific gastrointestinal symptoms mimicking viral gastroenteritis. His condition worsened over several days, progressing to bowel obstruction. Imaging with contrast-enhanced CT confirmed an extensive ileocolic intussusception, although an associated malrotation was not recognized on the initial report. Given clinical deterioration, an exploratory laparotomy was performed. Intraoperative findings revealed a large ileocecal intussusception (involving the terminal ileum, appendix, cecum, and ascending colon) extending into the transverse colon, along with a midgut volvulus and underlying malrotation of the intestine. The intussusception was successfully reduced manually, an inflamed appendix within the intussuscepted segment was removed, and a Ladd's procedure was carried out to correct the malrotation. The child recovered uneventfully and remained asymptomatic on follow-up. This case highlights an atypical age presentation of intussusception due to malrotation (Waugh syndrome) and underscores the importance of maintaining a high index of suspicion in older children. Early surgical intervention was critical in confirming the dual pathology and achieving a favorable outcome.

Goblet cell adenocarcinoma (GCA) is a rare tumor described exclusively in the appendix, comprising < 1% of gastrointestinal tumors. The 2019 WHO classification of tumors of the digestive system has renamed and defined it. This study aims to analyze the clinical presentation and evaluate the histomorphological profile of GCA. A retrospective search of our database was done spanning a period of 10.5 years (July 2014-January 2025). Clinicopathological features were analyzed. Fourteen patients included had a median age of 50 years at the time of diagnosis with a male to female ratio of 1:0.75. Six patients presented with symptoms of acute to subacute intestinal obstruction. On imaging, these patients revealed circumferential thickening in the ileocecal region. Three of the female patients presented with symptoms predominantly pertaining to the gynecological tract. Histopathological evaluation revealed tubules and clusters of goblet-like mucinous cells with a variable number of endocrine cells and Paneth-like cells. Overall mean survival was 26 months and the median survival was 24 months. Recognition of GCA warrants a high degree of suspicion as they may present to different clinical departments owing to highly variable presentation and can be mistaken for signet ring cell adenocarcinoma on biopsy samples.

Gallstone ileus is a rare cause of mechanical bowel obstruction, typically involving the small intestine. Large bowel obstruction (LBO) due to gallstone impaction is exceedingly uncommon, particularly at a sigmoid stricture. We present the case of a 76-year-old male with significant cardiac comorbidities who was managed non-operatively for acute cholecystitis complicated by cholecystoduodenal fistula. He subsequently re-presented with LBO from an impacted gallstone at a sigmoid diverticular stricture. Multidisciplinary endoscopic intervention using mechanical lithotripsy avoided surgical resection. This case highlights the potential for nonoperative management of gallstone LBO in select patients and emphasizes the utility of advanced endoscopic techniques in the setting of challenging anatomy. It also contributes to the limited but growing body of literature describing colonic gallstone ileus, particularly in the context of diverticular disease.