Right paraduodenal hernia is a rare congenital internal hernia resulting from abnormal midgut rotation. Although paraduodenal hernias represent the most common type of congenital internal hernia, the right-sided variant is an uncommon cause of small bowel obstruction and is often challenging to diagnose preoperatively. We report the case of a 46-year-old woman who presented with a 48-hour history of acute abdominal pain, nausea, and vomiting, without any prior history of abdominal surgery. Physical examination revealed tenderness in the epigastric and mesogastric regions without signs of peritonitis, while laboratory findings showed leukocytosis. Plain abdominal radiography demonstrated small bowel air-fluid levels, and contrast-enhanced computed tomography suggested small bowel obstruction secondary to an internal hernia. Urgent exploratory laparotomy revealed a right paraduodenal hernia through Waldeyer´s fossa with viable entrapped small bowel loops. The herniated bowel was successfully reduced, and the mesenteric defect was closed without the need for bowel resection. Right paraduodenal hernia should be considered in patients presenting with small bowel obstruction in the absence of prior abdominal surgery. Early diagnosis using computed tomography and prompt surgical intervention are crucial to prevent strangulation and ischemic complications.

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.

Meckel's diverticulum (MD) represents a remnant of the embryonic vitelline duct and is recognized as a congenital anomaly of the small intestine. While it is more frequently identified in children, the majority of cases remain clinically silent, with symptomatic presentation in adults being relatively rare. When present, symptoms typically reflect complications, including gastrointestinal hemorrhage, diverticulitis, or intestinal obstruction. The probability of developing complications decreases with advancing age, making clinically significant presentations in elderly individuals uncommon and diagnostically challenging. We present the case of a 72-year-old male with features of small bowel obstruction, in whom intraoperative findings demonstrated a small-bowel volvulus occurring around an MD that functioned as the axis of rotation.

Abdominal pain is a common presentation in emergency departments. Among these cases, small bowel obstruction (SBO) is a common diagnosis. Diagnostic procedure is currently based on CT, an imaging modality associated with radiation exposure. Studies suggest good accuracy of point of care ultrasound (POCUS) for SBO. Through the OCCLUS-POCUS study, we aim to evaluate the POCUS ability to rule out SBO in patients with low to moderate clinical suspicion, thereby avoiding unnecessary CT scans.

Background and Objectives: Small bowel obstruction (SBO) is a common surgical emergency, accounting for 15-20% of acute general surgical admissions. Despite the Bologna Guideline's introduction to the surgical community almost a decade ago, adherence to it remains variable. The therapeutic role of contrast media and the optimal timing of its administration remain a matter of debate. This study aimed to compare SBO resolution rates according to the timing of water-soluble contrast media (WSCM) administration. Materials and Methods: A prospective, randomised pilot trial was conducted at two regional hospitals in Estonia. Patients hospitalised with adhesive or virgin abdomen SBO were randomised to receive WSCM at either 4 h or 24 h after admission. Results: A total of 128 patients were enrolled, with 63 assigned to the 4 h group and 65 to the 24 h group. SBO resolved with conservative management in 74.6% of patients in the 4 h group and 73.8% in the 24 h group. Rates of surgical intervention and bowel resection due to necrosis were comparable between groups. Univariable and multivariable analyses showed no significant association between early administration and improved resolution. A prior history of SBO was associated with a higher likelihood of successful non-operative management. Conclusions: conservative management of SBO is safe and effective, and early WSCM administration did not provide a clear additional benefit in this cohort with respect to resolution or surgical outcomes. A prior history of SBO was associated with a higher likelihood of successful conservative management in this cohort. Larger multicentre studies are warranted to further define the optimal timing of contrast administration and to compare isotonic and hyperosmolar agents with respect to clinical outcomes.

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.

Jejunal diverticulosis (JD) is a rare condition of the small intestine characterized by acquired pseudodiverticula arising along the mesenteric border. Although most cases remain asymptomatic, complications may occur in a minority of patients and include diverticulitis, perforation, intestinal obstruction, malabsorption, and, more rarely, GI hemorrhage. Bleeding originating from jejunal diverticula is an uncommon but potentially life-threatening cause of obscure GI bleeding (OGIB). We report the case of a 59-year-old woman who presented to the ED with melena associated with symptomatic anemia. Initial gastroduodenal endoscopy failed to identify a source of bleeding. Subsequently, contrast-enhanced CT angiography of the abdomen was performed and demonstrated multiple jejunal diverticula. One diverticulum contained spontaneous hyperdense material on non-contrast images, compatible with intraluminal blood, and was associated with a dilated submucosal vascular structure, suggesting the site of recent hemorrhage. JD is a rare but important cause of OGIB. When endoscopic investigations are inconclusive, CT angiography plays a crucial role in identifying the bleeding source and guiding management. Awareness of this entity and its imaging features is essential for radiologists and clinicians involved in the evaluation of GI hemorrhage.

An 87-year-old woman with no prior history of laparotomy visited her local doctor complaining of anorexia. She was diagnosed with intestinal obstruction and initially managed conservatively with fasting; however, her condition did not improve, and she was referred to our hospital on the seventh day after symptom onset. Abdominal CT revealed a 2-cm cystic lesion on the anterior surface of the sacral pelvic cavity and a whirlpool sign near the end of the ileum. Based on these findings, a diagnosis of small intestinal volvulus and an ovarian cyst-previously noted-was made, and emergency surgery was performed on the same day. Intraoperative findings showed no ovarian abnormalities; instead, a lobulated tumor with an extramural cystic growth was identified in the ileum, 210 cm proximal to the anal verge from the ligament of Treitz and 120 cm distal to the ileocecal valve. The small intestine was twisted 360 degrees in a counterclockwise direction around the tumor. There was no evidence of ischemia in the small intestine, and a partial ileal resection including the tumor was performed. Histopathological examination confirmed a diagnosis of gastrointestinal stromal tumor (GIST) of the small intestine. Small intestinal GISTs with cystic features are relatively rare, and there have been scattered reports highlighting the difficulty in differentiating them from ovarian tumors on imaging. Additionally, secondary small bowel volvulus caused by small intestinal GISTs is also uncommon. We report these 2 characteristics of small intestinal GISTs with a review of the relevant literature.

A 74-year-old man presented with abdominal pain. Preoperative evaluation for small bowel perforation revealed a 74-mm tumour shadow obstructing the right lower lobe bronchus. Endobronchial biopsy from the truncus intermedius was diagnostic of squamous cell carcinoma (SCC). Pathological findings in the small intestine were consistent with SCC. Based on other radiological findings, the patient was diagnosed with stage IVB (cT4N3M1c) lung SCC (LUSC). Serum amylase levels were elevated at 1693 U/L (pancreatic amylase 184 U/L) prior to treatment. AMY1 (2D4) immunohistochemistry was positive, confirming amylase-producing LUSC, a rarely reported entity. Amylase levels decreased to 203 U/L following combination therapy with carboplatin, nab-paclitaxel and pembrolizumab. The patient had no symptoms or signs of pancreatic or salivary gland disease. To our knowledge, this is the first reported case of LUSC with both histological evidence of amylase production and hyperamylasemia. This case provides new evidence that LUSC can produce amylase and cause hyperamylasemia.

Adhesive small bowel obstruction (aSBO) remains one of the most common causes of surgical admission and morbidity. With advancements in imaging and the advent of water-soluble contrast, management has become increasingly non-operative. Although this is successful in a majority of patients, patients who fail this trial without operation may face worse outcomes. Delays to surgical intervention are associated with increased rates of bowel ischemia, resection, infectious complications, and mortality. Optimal management therefore depends on early risk stratification, disciplined non-operative trials, and timely escalation to operation when indicated. This review summarizes contemporary evidence regarding pathogenesis, pathophysiology, epidemiology, diagnostic evaluation, management, and outcomes of aSBO, with a focus on practical decision-making. The evaluation of each patient's obstruction consists of subjective clinical findings in combination with objective data including labs and imaging. CT with intravenous contrast remains a cornerstone of diagnosis, allowing identification of obstruction severity and features concerning for ischemic physiology that mandates immediate operative exploration. In the absence of these findings, a structured trial of non-operative management may be pursued, including nasogastric decompression, intravenous resuscitation, electrolyte correction, and inpatient admission with close oversight from a surgical team. Water-soluble contrast studies serve as both a prognostic and therapeutic adjunct, as failure of contrast to reach the colon within 24 hours is strongly predictive of unsuccessful non-operative management. Operative management should be undertaken promptly in patients with clinical deterioration, imaging evidence of ischemia, or failure of non-operative therapy. Although open laparotomy remains the standard approach, laparoscopy may be considered in carefully selected patients in experienced hands. Across management strategies, early surgical ownership and avoidance of prolonged non-operative trials in high-risk patients are critical to optimizing outcomes. aSBO is best managed through structured algorithms that prioritize early diagnosis, time-sensitive reassessment, and decisive operative intervention when indicated.

Calcifying fibrous tumor (CFT) is a rare benign tumor of mesenchymal origin that may develop in several sites in the body, including the gastrointestinal tract. CFTs could present with clinical symptoms or remain asymptomatic. We report a rare case of CFT located at the jejunal mesentery and attached to a mesenteric band causing small bowel obstruction. This case is distinctive due to the presence of a mesenteric CFT combined with a mesenteric band, causing constriction of the small bowel. To our knowledge, this is the first case in the literature to report a congenital band associated with CFT. The mass was surgically removed, and the band was released and ligated.