Alimentary tract duplications are uncommon congenital abnormalities usually diagnosed and treated in childhood. Rectal involvement is extremely rare. We report the case of a 22-year-old female who presented with chronic abdominal and perianal pain; feeling of rectal fullness. Workup revealed a rectal duplication cyst. The patient underwent a complete transabdominal excision of the cyst: an hybrid laparoscopic and laparotomic technique was adopted. The hybrid isolated anterior abdominal approach is safe and feasible even for the treatment of wide rectal duplication cysts. Real recurrence in rectal duplication cysts is uncommon when the first operation was performed with radical intent.

Our results suggest good efficacy and safety of TSH even when performed in a community hospital setting. Shifting patient selection from neoadjuvant to bridge chemotherapy had no impact on outcome once the clearing of the liver had been achieved. In patients presenting with synchronous CRLMs, simultaneous colorectal resection and clearing of the less involved hemiliver as the first surgical step is feasible without any negative impact on outcome.

Acute abdominal pain secondary to intussusception is rare in adults and mainly caused by malignancy (70-90%), whereas in childhood intussusception’s etiology is mostly idiopathic (90% of cases). Gastrointestinal lipomas, especially in small bowel, represent an unusual cause of intussusception with complete intestinal obstruction or bleeding (acute or chronic) from mucosal ulceration. In acute settings, computed tomography (CT) should be confidently considered the gold standard for diagnosis. In adulthood, surgical management of acute symptomatic intussusception caused by lipoma is mandatory. We report a case of complete jejunal obstruction with intussusception due to 5 cm submucosal lipoma.

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Background: Biliary tree cysts represent a genetic and pathological dilatation, focal or extended, of hepatobiliary system. Incidence in western populations is around 1/ 100.000-1/150.000 and is more frequent in asiatic areas (1/ 1.000). Todani classification is based on site and morphology of cysts. Acute cholangitis is the main clinical presentation, cancer incidence is around 2,5-16%. Material and Methods: From 2008 to 2018 we observed and surgically treated 8 cases.1: 63 y.o. male presented with abdominal pain and dilatation of left biliary tree at CT scan. He was treated with left hepatectomy.2: 72 y.o. woman presented with epigastric pain and fever. At CT scan colliquative lesion of left liver: she underwent left hepatectomy. Histological findings revealed Caroli disease.3: 53 y.o. man hospedalized for colelitiasis and dilatation of S3 biliary tree. He underwent S3 resection and colecistectomy.4: 68 y.o. woman admitted for abdominal pain and dilatation of S2-S3 biliary tree. She underwent S2 and S3 resection and cholecistectomy.5: 66 y.o. woman presented with abdominal pain and weight loss. At CT scan left liver was disomogenous and with dilatation of biliary tree. She was treated with left hepatectomy. Histological findings confirmed Caroli disease associated to cholangiocarcinoma.6: 30 y.o. woman resented with abdominal pain. CT scan showed Todani disease type II-III: She underwent laparoscopic resection of extrahepatic biliary tree with biliodigestive anastomosis. Results: 30-days complications was 12,5%. 90-days mortality was 0%. Two years follow-up: 7 patients are alive and in good conditions, patient 5 died for disease progression after 12 months from surgery. Conclusions: In case of unilobar and symptomatic disease surgical resection is treatment of choice. Liver transplant is indicated in bilobar disease. Extrahepatic disease is treated with resection of biliary tree and reconstruction. It's important to treat these rare diseases in order to avoid risk of malignant developement.