Nodular lymphoid hyperplasia (NLH) is a rare, benign condition of lymphoid proliferation within the gastrointestinal tract. NLH is a recognized feature of specific immunodeficiency syndromes, including common variable immunodeficiency and selective IgA deficiency. NLH may develop throughout the gastrointestinal tract; however, it usually develops in the small intestine. We report an extremely unusual case of previously undiagnosed selective IgA deficiency presenting with subacute rectosigmoid obstruction.

Rapunzel syndrome is a rare manifestation of trichobezoar in which a gastric hair mass extends beyond the pylorus into the small intestine. It typically presents with abdominal pain, nausea, vomiting, early satiety, weight loss, or bowel obstruction. Presentation of acute pancreatitis is uncommon and may delay diagnosis. We report a previously healthy nine-year-old girl who presented with progressive epigastric pain, nausea, vomiting, decreased oral intake, and constipation. Laboratory evaluation demonstrated markedly elevated lipase levels consistent with acute pancreatitis. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary ductal dilatation without gallstones or choledocholithiasis. Symptoms initially improved with supportive care; however, persistent pain and a palpable epigastric mass prompted further imaging. Computed tomography demonstrated a large gastric trichobezoar extending into the jejunum, consistent with Rapunzel syndrome, with associated intussusception and compression of the pancreatic duct. The patient underwent exploratory laparotomy with complete bezoar removal, followed by resolution of symptoms and normalization of lipase levels. This case highlights Rapunzel syndrome as a rare mechanical cause of pediatric pancreatitis and emphasizes the importance of considering extrinsic compression when pancreatitis occurs with biliary dilatation and normal liver biochemical findings.

Intussusception is a condition in which one segment of the intestine (intussusceptum) telescopes into the lumen of an adjacent segment (intussuscipiens), potentially leading to obstruction. Giant colonic lipomas are rare and often asymptomatic, but when large enough, can serve as a lead point for intussusception. We present the case of a 62-year-old male patient who presented with nausea and vomiting. A computed tomography (CT) abdomen/pelvis without contrast showed intussusception of the ascending colon into the transverse colon without bowel obstruction, along with a lobulated fatty mass at the tip of the intussusceptum. This mass was suspected to be a colonic lipoma serving as the lead point. Due to the patient's benign abdominal exam, emergent surgical intervention was deferred. A colonoscopy then revealed a large, 5 cm pedunculated lipoma in the transverse colon near the hepatic flexure. An Endoloop was applied and tightly cinched around the base of the lesion. He was discharged in stable condition with recommendations for close gastroenterology follow-up. The purpose of presenting this case is to highlight the utilization of endoscopy in management of colonic intussusception caused by a structural lesion, as well as the importance of considering intussusception as the cause of a patient's nausea and vomiting (although it is a rare cause in adults). A CT scan is helpful in establishing this diagnosis and guiding management. Furthermore, if intussusception is suspected in an adult, it is important to consider a structural lesion that may be acting as a lead point, such as an intraluminal tumor or mass.

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.