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Introduction: Acute pneumococcal peritonitis represents an unusual entity characterized by infection in the abdominal cavity despite the absence of an obvious causative source. Patients with portal hypertension such as cirrhotics and those with nefrotic syndrome are more frequently encountered in the every day practice., Presentation of Case: A 14 years old female was referred to our department by his general practitioner with a 24h history of right lower abdominal pain and fever. Clinical examination was suggestive for peritonitis and the girl was transferred to the operation room. A diagnosis of primary pneumococcal peritonitis was made on the basis of the findings during surgery and the microbiological tests. Institution of appropriate antibiotics resulted to complete recovery., Discussion: A mini literature review was performed., Conclusion: Primary bacterial peritonitis in adolescents is extremely rare. Surgeons are required to be aware of this entity., (Copyright © 2016. Published by Elsevier Ltd.)

Introduction: Vago-glossopharyngeal neuralgia is an unusual clinical syndrome characterized by paroxysms of sharp pain in the distribution of glossopharyngeal nerve. Rarely the condition is associated with arrhythmia and cardiac syncope, a phenomenon named vagoglossopharyngeal neuralgia., Presentation of Cases: Here we present two patients with glosopharyngeal neuralgia associated with repetitive episodes of syncope referred from their primary care physician to neurosurgery department of a general hospital in Crete, Greece. The patients were successfully treated with microvascular decompression., Discussion: A literature review on pathogenesis, diagnosis and management is also performed., Conclusions: Surgeons as well as primary care physicians have to be aware of this rare condition in order to prevent associated life-threatening complications and improve patient's clinical status with accurate therapy., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Intra-thoracic herniation of abdominal organs following diaphragmatic rupture represents an unusual clinical occurrence that poses great diagnostic difficulty., Presentation of Case: We report a rare case of delayed total hepatothorax caused by a right sided post-traumatic diaphragmatic rupture in a 67 year old male. Reduction of the liver in the abdominal cavity and repair of the diaphragm was feasible via a thoraco-abdominal approach. Postoperative chest radiography showed normal position of the right diaphragmatic border., Discussion: Characteristics of right diaphragmatic rupture and subsequent complications are reviewed with the aim to reinforce physicians' awareness of this uncommon clinical condition in order to establish a timely diagnosis and reduce the mortality related burden., Conclusion: Surgeons should consider this entity in the differential diagnosis of injured patients experiencing sudden respiratory distress during hospitalization as well as days or months after discharge., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: Isolated ectopic varices located in the small bowel are uncommon. Portal hypertension caused by liver cirrhosis is the most common predisposing risk factor., Presentation of Case: We present an unusual case of massive gastrointestinal bleeding from idiopathic jejunal varices in a 73-year-old Caucasian male without portal hypertension. Exploratory laparotomy disclosed ectopic varices located in the small intestine. Segmental resection of the jejunum with end to end anastomosis resulted in a complete resolution of the haemorrhage. During a 5 year follow up, the patient is stable with no bleeding recurrence., Discussion: Information on aetiology, diagnosis and management of jejunal varices is reviewed., Conclusion: Diagnosis and management of isolated jejunal varices is challenging. Surgeons as well as acute care physicians have to consider idiopatic form of jejunal varices as a potential cause of gastrointestinal bleeding when gastroduodenoscopy and colonoscopy are negative., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: Wandering spleen is a rare condition characterized by ectopic position of the spleen due to the absence or laxity of peritoneal ligaments that hold the organ within the left upper quadrant. Lower abdomen and pelvis are the most common locations of the wandering spleen. The disorder usually remains asymptomatic., Presentation of Case: We present a case of acute abdomen due to torsion of a wandering spleen in a primiparus, healthy female shortly after delivery. Diagnosis was based on ultrasonography and computed tomography and was confirmed later on surgery. Total splenectomy was performed successfully., Discussion: The rarity of the condition and the nonspecific clinical symptoms and signs make prompt diagnosis challenging., Conclusion: Prompt recognition and intervention are necessary in order to minimize the risk of complications. For this reason physicians have to include the condition in the differential diagnosis of acute abdominal pain especially when they encounter females in a pregnancy or post-natal period., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)