Background. Torsion of greater omentum is a quite uncommon cause of acute abdomen. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. Symptoms are unspecific and preoperative diagnosis is difficult. The widespread and increasing use of computer tomography (CT) in differential diagnosis of acute abdomen can be useful for making a specific diagnosis. Objectives. This work aims to describe primary omental torsion in order to help avoid misdiagnosis, especially with acute appendicitis, which is eventually based solely on a physical examination. Case Report. We present a case of primary omental torsion in a young man and discuss contemporary methods in diagnosis and management of the condition. Conclusions. When a right diagnosis has been posed, possible treatments for omental torsion and necrosis are two: conservative or surgical. Conservative treatment had been rarely carried out because of frequent and important sequelae just like abdominal abscesses. Nowadays, surgical treatment, laparoscopic or laparotomic, is preferred because it is a safe method in diagnosis and management of this condition.

BackgroundBezoars are an uncommon cause of mechanical intestinal occlusion. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Symptoms are classically indistinguishable from one another and from more common causes of intestinal occlusion, so it can be difficult to establish a correct diagnosis in order to apply the correct treatment. We present a rare case of two different phytobezoars causing intestinal occlusion (gastric and jejunal). We also describe the correct techniques for making a correct and fast diagnosis of occlusion caused by phytobezoars, and the possible conservative and operative treatments.Case presentationWe present the case of a double phytobezoar that was surgically treated with a double enterotomy. Our patient was a 68-year-old Caucasian man with a medical history of hypertension, a previous open appendectomy, and open repair of a perforated gastric ulcer. He was admitted with a 5-day history of abdominal pain located in his upper quadrants along with vomiting. After a preoperative examination, he was taken to the operating room. He was discharged in a good clinical condition 11 days after surgical intervention. A physical examination at 6 months demonstrated our patient was in good health.ConclusionsDiagnosing bezoars is difficult because of their rarity. However, they must be taken into consideration in a differential diagnosis because their treatment is not always surgical. In fact, it may be conservative in many cases and a correct diagnosis will guide towards the correct therapy.

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.

Patients with a nomogram total point ≥ 74 should be considered at high risk of severe acute cholecystitis (at 74 total point, sensitivity = 78.5%; specificity = 78.2%; accuracy = 78.3%) and this finding could be useful for surgical planning once confirmed in a prospective study comparing the risk score stratification and clinical outcomes.

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.