We present the case of an adult woman with a medical history of repetitive episodes of intestinal subocclusion and occlusion that remitted with medical treatment. During hospital admission due to acute abdominal pain and secondary to CT scan results, an urgent surgical approach was decided with findings of a malrotation anomaly consisting in a short, dilated and volvulus cecum behind hepatoduodenal ligament and a collapsed transversal colon, requiring intestinal resection and ileocolic primary intestinal anastomosis. Conclusion:Repetitive intestinal occlusion and subocclusion symptoms also in an adult patient with history of repetitive episodes that were always treated conservatively should be considered as a possible malrotation anomaly. Cecal volvulus is a very rare clinical entity, difficult to early diagnose and can be associated to a malrotation anomaly. Early surgery in this types of patients, that are used to conservative treatment, require a high index of diagnostic suspicion but can be associated with lower mortality and morbidity.

Intestinal angiodysplasia is one of the main etiologies of bleeding within elderly patients. This entity can present in any portion of the intestinal tract, however, when it affects the small intestine it appears as obscure gastrointestinal bleeding up to 30 to 40% of the cases and it represents a diagnosis and management challenge. Early diagnosis is important to establish the most adequate treatment. We present the case of a 69 years old male patient with obscure gastrointestinal bleeding due to a jejunal angiodysplasia, requiring endoscopic location of varicose vessels and dye instillation followed by surgical management with a video-assisted intestinal resection. Conclusions:Intestinal angiodysplasia is an important etiology of bleeding and should be considered when treating an obscure gastrointestinal bleeding case. The combination of endoscopic procedures to precise diagnosis and surgical management is possible and has low rates of complications, morbidity or mortality.

Objective: We present a case report of an 89 years old male with a diagnosis of incarcerated left inguinal hernia, with surgical findings of a complicated sigmoid diverticulum and a tubular structure of 0.5 mm attached to the sigmoid colon, fixed to the inguinal ligament with a true lumen that could correspond to a duplicated appendix B4 type. Introduction: Colon diverticular disease is more frequent in western countries, present in 30% of 60 years old patients and in more than 50% in 80 years old patients, with 95% of the times located at sigmoid colon. The most frequent complication is the acute diverticulitis (25%) and in 30% of these patients, surgery is required. Discussion: Acute, complicated, diverticular disease is an infrequent pathology, even more, a colonic diverticulum included within the hernia sac. Of the appendix congenital malformations, a duplicated appendix is the rarest; usually found in asymptomatic adults as an incidental find during abdominal surgery or during contrasted abdominal scans. Conclusion:Awareness must be raised within first-contact health care professionals about diagnosing surgical entities with high mortality rates, in asymptomatic patients with unclear clinical findings, especially with the occurring of a demographic transition in most countries. In this specific patient, Hartman surgical procedure and a second time inguinal plasty were the best surgical options for this patient; even considering the mortality rates (25%) of a perforated diverticulum, considering added surgical site infection.

Endometriosis is defined as the presence of functional endometrial tissue, glands and stroma outside the uterine cavity, mainly at ovaries and at pelvic peritoneum, causing a chronic inflammatory reaction. The abdominal wall endometrioma is an infrequent pathology; occurs after abdominal surgery, by minimal invasion, open surgery or gin-obs surgery. It happens in about 0.03 to 1.5% women after having a cesarean section, presenting transvaginal bleeding, endometrial ultrasound with 9 mm thickness and uterine myomatosis, having a painful node at the infra-umbilical abdominal scar, with skin colour change and due to increasing pain is diagnosed with an incarcerated hernia. Urgent surgery was performed, finding a 6 × 6 × 4 cm vesicle, with brownish secretion, attached to the muscular aponeurosis. Conclusion:Not every node or bulge within the abdominal wall should be considered hernia. in the scenario of a painful node and skin colour change at a surgical scar, with a medical history of cesarean section, hysterectomy and laparoscopic procedures, diagnosis of endometriosis should be considered and therefore always perform histopathological exams.