Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment.

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Spigelian hernia consists one of the most uncommon anterolateral abdominal wall hernias (<1%). The defect occurs at the spigelian fascia which is located lateral to rectus abdominis muscle along the linea semilunaris and is comprised of the transversus abdominis and internal oblique aponeuroses. Most commonly the defect is located at or below the level of arcuate line. Its diagnosis may be challenging because the aponeurosis of external oblique remains intact, leading to an intraparietal hernia, with no obvious bulge on inspection or even palpation of the abdominal wall in many cases. Computed tomography (CT) is the most reliable imaging method to diagnose a spigelian hernia. Due to the high risk of strangulation, surgery should be advised to all patients with spigelian hernia. Surgery can be performed either by open or by minimally invasive techniques. In this video we present the case of a 54-year-old female patient suffering from a symptomatic right spigelian hernia. The diagnosis was suspected during clinical examination and was confirmed with CT. The patient underwent a laparoscopic transabdominal preperitoneal repair. During the procedure, a peritoneal flap was created; the content of the hernia sac, composed from preperitoneal fat, was completely reduced; the defect was closed with 2/0 PDS sutures; a PVDF mesh, measuring 14 cm by 12 cm, was placed in the preperitoneal area and fixed with N-butyl cyanoacrylate glue; the peritoneal flap was closed also with glue. The patient had an unremarkable postoperative period and was discharged on the first postoperative day in good clinical condition.

The clinical presentation of congenital abnormalities in adult life is a rare condition since they usually make their appearance in early childhood. A combination of two different congenital deformities is even more infrequent, a fact that might complicate the differential diagnosis of acute abdomen. This is a case report of an inflamed Meckel's diverticulum in a 16-year-old male with intestinal malrotation presented in an acute setting, and a review of the literature. The patient presented at the emergency department with an atypical abdominal pain located in the right abdomen and quite elevated inflammatory markers. Computed tomography revealed Meckel's diverticulitis in combination with intestinal malrotation, findings that were confirmed intraoperatively. A partial enterectomy with a side-to-side anastomosis was performed, and the patient was discharged uneventfully. Only a few cases of this combination have been reported in the literature till nowadays. This article indicates the importance of the computed tomography scan in the differential diagnosis of abdominal pain since it might reveal rare clinical entities and determine the further therapeutic plan. Furthermore, it is a reminder that congenital abnormalities might make their clinical appearance not only in early childhood but also in adult life, pointing out the ability of the general surgeon to deal with such cases.