Accurate assessment and timely interventions are critical in the treatment of patients affected with necrotizing fasciitis, a rare, fulminating, potentially life-threatening, infectious process of the soft tissues. Understanding the natural history and unique characteristics of this disease is crucial to achieve early recognition, effective management and a favorable patient outcome. Classic symptoms include severe pain, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, bullous formations and edema in the affected area and fever. This article aims at reviewing the information known about this disease, collected from various sources. Radical surgical debridement, broad-spectrum antibiotics, negative pressure wound therapy and hyperbaric oxygen therapy are considered to be the cornerstones of treatment.

are linked to a baleful prognosis, with a survival average of 6-10 mo after surgery [3,4] . Many studies have demonstrated that only surgery can lead to a control of chronic anemia related to intestinal melanoma bleeding and resolution of the episodes of intestinal sub-occlusion. Surgery on melanoma metastases moreover, can guarantee an increase of sur vival, in addition to an excellent improvement in quality of life [5][6][7] .Intestinal metastases represent the occurrence of an occult skin melanoma in only 3%-5% of cases, in which a spontaneous regression of the cutaneous lesion happens [8] .Intestinal metastasis bleeding is extremely rare [9,10] . In order to add more information about surgical presentation of intestinal occult melanoma herein we describe a case of a young woman affected by bloody jejunal metastasis of occult cutaneous melanoma, complicated by intestinal invagination-an extremely rare case in the adult population. CASE REPORTA 45-year old woman complained of continual nausea and biliary vomiting, associated with a weight loss of 5 kg. Due to localized abdominal pain, mainly in the right hypochondrium and episodes of hematemesis, the patient was admitted to our hospital. Blood tests revealed sideropenic anemia with 81 g/L haemoglobin, serum iron 100 pg/L, ferritin 23 µg/L, and fecal occult blood test (FOBT) positive in three fecal samples. A gastroscopy was performed, which showed the presence of gradeⅠesophagitis, moderate hiatal hernia and chronic erosive gastritis. The colonoscopy was incomplete due to the presence of colic stools. Abdominal ultrasonography highlighted a distension of the intestinal loops without signs of parenchymatous organ pathology. The patient therefore received an abdominal CT, which suggested the presence of a gastric distension with duodenum-jejunal distension and the presence of a jejunal loop with thickened walls. A second hyperdense image inside the intestinal lumen, forming a targetshaped image was also present: typical feature of intestinal invagination (Figure 1). We therefore decided to proceed to urgent surgical operation after blood transfusion. During surgery, intra-peritoneal fluid was found and samples were removed for cytological testing. Invagination at the third jejunal loop (Figure 2) AbstractCutaneous melanoma is one of the most studied neoplastic lesions in biology and clinical oncology. It has been well documented that this type of neoplasm presents a high metastatic rate, and is able to involve nearly every tissue. Non-cutaneous melanoma represents an unusual pattern of melanoma, and the small intestine is an uncommon anatomic localization. Herein we report an extremely rare clinical case of a young woman affected by a bleeding jejunal melanoma, whose early clinical presentation was an intestinal invagination.

Bowel duplications are rare congenital anomalies commonly found in pediatric patients; few cases may remain undetected until adulthood. Malignant carcinomatous changes are rare complications in intestinal duplications. An 88-year-old female patient was referred to our surgical unit with the diagnosis of a large abdominal mass. An explorative laparotomy was performed, revealing a large (22 × 11 cm) neoplasm strictly connected to the lowest ileal segment and completely filling the pelvis. Definitive histology revealed a moderately differentiated adenocarcinoma developing in a duplication of the terminal ileum. The hypothesis of a gastrointestinal duplication should be evaluated in the differential diagnosis of large, complex, indeterminate masses located in or near the bowel; the possibility of neoplasm within the duplication should be considered.

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