Small bowel metastasis from colorectal cancer (CRC) is rare and difficult to diagnose, especially in patients with inflammatory bowel disease (IBD). We report two cases with two different presentations. The first, a male in his 80s known to have ulcerative colitis in remission, presented with an elevated CA 19-9 tumour marker one year after laparoscopic anterior resection for CRC. Positron emission tomography and subsequent enteroscopy revealed a duo-jejunal lesion, histologically confirmed as consistent with metastatic CRC. The second patient, a man in his 60s with stricturing Crohn's disease, presented acutely with small bowel obstruction eight months after hemicolectomy for stage IIIc CRC. Imaging and enteroscopy identified a jejunal mass, also confirmed as consistent with metastatic CRC. Both patients underwent resection but later developed peritoneal spread, with both undergoing palliative chemotherapy and immunotherapy. These cases highlight the need to consider small bowel metastasis in IBD patients with previous CRC.

Chronic enteropathies characterized by multiple superficial ulcers of the small intestine have long been under-recognized, particularly in their early stage. However, the occurrence of refractory occult bleeding and episodes of partial bowel obstruction in this disease severely impacts quality of life, while targeted therapeutic options remain limited. Although dysfunction of the prostaglandin metabolic pathway has been associated with mucosal damage, the underlying molecular mechanisms and potential therapeutic targets remain unclear. In recent years, in-depth investigations of nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy, along with the discovery of rare monogenic disorders affecting the prostaglandin metabolic pathway, have helped bridge this knowledge gap. A broader concept, termed "prostaglandin-associated enteropathy (PGAE)", has since emerged, representing a monumental breakthrough in the differential diagnosis of nonspecific small intestinal ulcers. This narrative review focuses on prostaglandin metabolism and chronic intestinal ulcers, including NSAID-induced enteropathy and chronic enteropathies associated with solute carrier organic anion transporter family member 2A1 (SLCO2A1) and phospholipase A2 group IVA (PLA2G4A). By unraveling molecular connections and highlighting innovative therapeutic avenues, we aim to advance clinical management and improve the well-being and quality of life for patients with PGAE.

Meckel's diverticulum is a congenital anomaly of the gastrointestinal tract that occurs in approximately 2% of the population. It is the result of incomplete obliteration of the vitelline duct (ductus omphaloentericus). During the fetal period, this duct connects the yolk sac with the primitive intestine and normally closes around the 5th-7th week of gestation. It is a true diverticulum because it contains all layers of the intestinal wall. Most diverticula are asymptomatic; however, they may lead to serious complications such as inflammation, perforation, obstruction, and bleeding. Our case report presents a case study of an 18-year-old patient who presented to the surgical outpatient clinic with several hours of abdominal pain in the right lower quadrant, mimicking acute appendicitis. However, the perioperative findings confirmed a different pathology: a perforation of Meckel's diverticulum.

Congenital intestinal webs of the bowel are an exceedingly rare cause of mechanical bowel obstruction in adults. Their presentation beyond the neonatal period is rare and may represent a diagnostic challenge. We report a case of multiple intestinal webs in an adolescent patient who initially presented with chronic abdominal pain, constipation and iron deficiency anaemia refractory to oral supplementation. The patient underwent evaluation for multiple gastrointestinal pathologies, including coeliac disease, eosinophilic gastrointestinal disorders and inflammatory bowel disease. As part of the evaluation, the patient underwent wireless capsule endoscopy. However, the capsule failed to progress beyond the small bowel. Laparoscopic-assisted retrieval revealed 18 intestinal webs which were surgically resected with subsequent resolution of symptoms. Although rare, failure of progression of a wireless capsule endoscope should raise concerns of possible intestinal webs in children as an underlying aetiology. Intestinal strictures should be further investigated and multiple webs must always be ruled out.

Plexiform fibromyxoma is a very rare gastrointestinal tumor, usually located in the stomach, predominantly in the antrum region. There are some cases reporting the tumor location in the small intestine, whereas originating from the esophagus has been described only twice up to now. This is the first report of a fast growing and symptomatic giant esophageal plexiform fibromyxoma requiring transthoracic esophagectomy and reconstruction by gastric pull-up.A 73-year-old patient was admitted with the clinical symptoms of dysphagia, chest pain, fever and weight loss for at least 2 months. A computed tomography (CT) scan revealed a giant mediastinal tumor measuring 11 × 7 × 7 cm with subsequent compression of the esophagus, the trachea and the heart. Endoscopy showed an ulcerated esophagus with signs of necrosis and obstruction of the esophageal lumen. A 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan detected a massive tracer uptake of this esophageal tumor suggesting malignancy.After discussion in the interdisciplinary tumor board transthoracic esophagectomy and reconstruction by gastric pull-up were performed. The patient fully recovered and was discharged on the 12th postoperative day. Contrary to the intraoperative frozen section indicating an esophageal sarcoma the final histopathological examination confirmed a giant esophageal plexiform fibromyxoma.

Mesenteric fibrosis (MF) is an extensive fibrotic reaction common in small intestine neuroendocrine tumours (SI-NETs), which develops around mesenteric metastasis. While primary SI-NETs can remain asymptomatic for years, mesenteric metastasis (MM) and the resulting MF frequently leads to serious complications. Despite its clear impact on quality of life, MF pathophysiology remains poorly understood and treatment options are currently limited to surgical interventions. This review summarizes the literature on MF in SI-NET patients, emphasizing gaps in knowledge and potential research directions. Clinical research confirms that MF is a frequent complication, often causing severe morbidity, including mesenteric ischaemia and obstruction. Addressing these issues requires further research into MF pathogenesis and contributory factors, such as Elastic Vascular Sclerosis (EVS), which are currently underexplored. Advancing this field will necessitate collaboration, supported by clear definitions and standardized diagnostic and grading systems for MF linked to clinical data, which are presently lacking. While MF-directed translational research remains scarce, recent studies focusing on tumour microenvironment have begun to uncover possible pathways involved in MF. Serotonin, pro-fibrotic growth factors and cytokines may play a role in activating cancer-associated fibroblasts and immune cells within the tumour microenvironment, aggravating extracellular matrix protein deposition and possibly creating positive feedback loops which promote fibrosis. Recently classified as an organ, the mesentery may harbour unique properties for stimulating the establishment of MF. Emerging research is paving the way for new MF treatment options which are urgently needed.

Metastatic spread of malignant melanoma to the small intestine occurs more frequently than primary intestinal melanoma, which remains an exceptional finding. Clinical manifestations often include gastrointestinal hemorrhage, intestinal obstruction, or acute peritonitis. Prompt surgical intervention is essential in emergency presentations, both to control life-threatening bleeding and to improve survival prospects. This report describes a rare case of jejunal melanoma presenting with massive gastrointestinal bleeding and an additional tumor with identical histological characteristics in the right parotid gland.

While postoperative adhesions, hernias, and tumors are common causes of small bowel obstruction (SBO), food-induced obstruction is rare. Konjac (Amorphophallus konjac)-related SBO is exceptionally uncommon, with only a few cases documented in the English literature. We present the case of a man in his 50s who developed abdominal pain during breakfast. After conservative management at a local clinic failed, he was referred to our hospital. Abdominal computed tomography indicated SBO of unknown etiology. Emergency laparotomy revealed four connected pieces of konjac obstructing the small intestine. The patient recovered uneventfully and was discharged on postoperative day 8. This case represents a rare instance of konjac-induced SBO. Given the rising global consumption of konjac products-especially in Western countries-clinicians should consider konjac ingestion as a potential cause of food-induced bowel obstruction.

Bariatric surgery, or metabolic and weight loss surgery, has become a widely accepted and effective therapeutic modality for individuals with severe obesity and its associated comorbidities. Obesity is a significant risk factor for cardiovascular disease, the leading cause of morbidity and mortality worldwide. The indications for bariatric surgery are typically based on body mass index (BMI). Typically, a BMI of >40 or a BMI of >35 with the presence of one or more obesity-related comorbidities such as type 2 diabetes, hypertension, and obstructive sleep apnea meet the criteria for surgical intervention. Bariatric surgery procedures induce significant weight loss and improve metabolic parameters, ameliorating these and other comorbid conditions.  The primary objective of bariatric surgery is to restrict food intake by reducing stomach capacity, thereby promoting weight loss. Several types of bariatric surgery are performed in current clinical practice. The Roux-en-Y gastric bypass (RYGB) is a restrictive and malabsorptive procedure. A small gastric pouch is created by transecting the proximal stomach and rerouting the proximal small intestine to the new pouch. The distal small intestine is connected to the Roux limb, forming the Y-shaped configuration. The procedure decreases stomach capacity and reduces calorie and nutrient absorption. A sleeve gastrectomy is a restrictive procedure removing a significant portion of the stomach, leaving a narrow, sleeve-shaped stomach. The adjustable silicone gastric banding (ASGB) procedure places an inflatable band near the upper stomach to form a small gastric pouch. The band is connected to a subcutaneous access port. Inflating or deflating the band via the access port modifies the pouch size. Biliopancreatic diversion with duodenal switch (BPD-DS) is a comprehensive surgical procedure combining elements of restriction and malabsorption. A significant portion of the stomach is resected, and the proximal small intestine is rerouted to a new connection, creating a common channel. Intragastric balloon (IGB) placement is a nonsurgical, restrictive procedure. A deflated silicone balloon is inserted into the stomach via the oral cavity. Once the inserted balloon is inflated with saline or air, it can help reduce feelings of hunger and promote weight loss. All surgical procedures inherently involve perioperative, short-term, and long-term risks and complications, especially concerning cardiovascular outcomes. This activity examines the existing knowledge regarding the influence of bariatric surgery on the cardiovascular system.

Scleroderma, meaning "hard skin," refers to a heterogeneous group of disorders, where patients often experience skin thickening and fibrosis. In the systemic form of the disease, systemic sclerosis (SSc), internal organ involvement and vasculopathy are prominent features with gastrointestinal (GI) involvement especially common - affecting the esophagus in approximately 90% of patients. Symptoms and clinical disorders that reflect GI involvement in the cardinal pathogenic features of scleroderma (vasculopathy, immune-mediated inflammation and neuropathy) emanate from every segment of the GI tract: dysphagia and GERD from the esophagus, gastroparesis and gastric antral vascular ectasia (GAVE) from the stomach, telangiectasia, pseudo-obstruction and small intestinal bacterial overgrowth from the small intestine, constipation and colonic dilatation, and fecal incontinence due to thinning of the anal sphincters. Impaired motility is a cardinal feature reflective of atrophy of smooth muscle and scattered areas of fibrosis throughout the GI tract and results in impaired transit, stasis and luminal dilation leading to complications such as small intestinal bacterial overgrowth, megacolon and pneumatosis cystoides intestinalis. Symptoms often correlate poorly with the underlying GI pathology and functional impairment in SSc, and associations between GI manifestations, SSc disease features, and autoantibody titers are variable. High-quality SSc-specific evidence regarding the impact of various therapies on GI manifestations remains limited, and management recommendations for most GI manifestations are largely derived from experience in non-SSc patients. In caring for the SSc patient with GI problems a gastroenterologist should be aware of the particularities of clinical presentation and natural history of GI disease in this patient population, maintain diagnostic vigilance and tailor their therapeutic approach mindful of the SSc disease process.

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.

Abdominal cocoon syndrome (ACS), also known as sclerosing encapsulating peritonitis (SEP), is an uncommon cause of intestinal obstruction characterized by partial or total encapsulation of the small intestine by a fibrous membrane. It typically presents with recurrent or subacute episodes of bowel obstruction and is often diagnosed intraoperatively due to the non-specific nature of clinical and radiologic findings. A 17-year-old girl presented with symptoms of acute intestinal obstruction, including abdominal pain, vomiting, and obstipation. She had experienced similar episodes over the past year. Initial investigations were inconclusive, and though emergency laparotomy was considered, her symptoms transiently improved. Thus, an elective diagnostic laparoscopy was later performed, revealing the presence of an encapsulating fibrous membrane consistent with ACS. The membrane was dissected and removed. Histopathology showed fibrocollagenous tissue with inflammation but no granuloma or malignancy. The patient recovered well postoperatively, with a one-month follow-up uneventful. ACS remains a diagnostic challenge due to its rarity and non-specific presentation. Laparoscopic intervention serves as both a diagnostic and therapeutic tool, particularly in young patients with recurrent, unexplained episodes of obstruction.