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A young man was hospitalised with acute abdomen and signs of pancreatitis. He became seriously ill and required surgery to address the underlying cause.

Background: Pancreatic injuries in children are rare and most often caused by mechanisms of blunt injury. Injury to the pancreas in children may be difficult to diagnose and treat., Material and Method: The article is based on literature searches in PubMed from the last 10 years (performed on 20 October 2015 and terminating on 20 October 2016) and on the authors’ own clinical experience and knowledge of the literature., Results: The search yielded a total of 20 articles, of which 6 concerned diagnostics and 14 dealt with treatment. Pancreatic injuries are rare and constitute around 0.3 % of all injuries in children, and 0.6 % of all abdominal traumas. Pancreatic injury is the fourth most frequent abdominal organ injury in children, and most occur in the age group 5 – 18 years. A little less than one fifth are isolated injuries. Computed tomography is the first choice in diagnostics, supported by magnetic resonance cholangiopancreatography to achieve optimum sensitivity. Where findings are unclear or pancreatic duct injury is suspected, early endoscopic resonance cholangiopancreatography and stent treatment are relevant to determine pancreatic duct injury. Less severe (grade I–II) injuries are treated conservatively. The choice of surgery or conservative treatment of severe injuries (grade III–V) where the pancreatic duct is involved must be considered for each individual patient. Mortality is generally associated with other severe traumas such as head injuries and multiple organ injuries., Interpretation: Pancreatic injuries or blunt traumas are rare in children and in most cases can be managed by observation. The evidence base is scant, particularly for severe injuries.

Background: Pilonidal disease is relatively common and is most often seen in young men. It presents either as acute abscesses or as chronic secretion of pus from inflamed sinus tracts in the gluteal region. Many different methods are used for surgical treatment and recurrences are common. We present an update for surgical treatment of pilonidal disease., Material and Methods: The article is based on literature identified through a non-systematic search in PubMed and the authors' clinical experience., Results: An acute abscess has to be drained before curative surgery can be considered. Definitive surgery should be planned for continuous, recurrent or secreting pilonidal disease. A recent meta-analysis indicates that removal of an asymmetric skin flap and primary closure of the wound by mobilising skin from the opposite side (Bascom cleft-lift procedure) is associated with fewest recurrences, shortest time to healing and fewest infections., Interpretation: The Bascom procedure should be the preferred surgical treatment for patients with pilonidal disease in a chronic phase.

Background: Colorectal cancer is one of the most frequent cancers in the Western world. Systematic surveillance after curative resection is common practice in Norway. The article presents the scientific grounds for surveillance in general, and for the Norwegian guidelines in particular., Material and Method: The basis for the study is literature on updated meta-analyses, randomized studies and reviews from 2002 to April 2007 (retrieved from Medline), and an evaluation of own experience with the national guidelines for follow-up., Results and Interpretation: Meta-analyses indicate better overall survival with systematic surveillance after curative resection for colorectal cancer, but the scientific evidence remains uncertain. Clinical practice varies from the setup in randomized trials and direct comparison is difficult. The exact factors associated with better survival remain unclear. The Norwegian surveillance routines contribute to diagnosing about 10 % of all patients with recurrent disease while they are still asymptomatic and amenable to secondary curative surgery. Systematic surveillance after curative resection for colorectal cancer is time-consuming and costly, and secondary curative surgery is only possible in a small proportion of the patients. Realistic and adequate information on what the surveillance can offer is an important part of optimal care. Several large ongoing international studies will shed new light on the usefulness of systematic surveillance.

Background: Colorectal cancer is a genetic disease for which the adenoma-carcinoma-sequence has served as a teaching model. This article presents an update on carcinogenesis and classification, according to the increased understanding of precursors and the improved insight into molecular biological mechanisms., Material and Methods: Literature from 1.1 2002 to 15.7 2007 was reviewed from PubMed by using the search words "colorectal cancer" matched with MeSH-terms "genetic instability", "epigenetic", "molecular classification", "crypt", "apoptosis", "proliferation" and "carcinogenesis". Focus is based on recent reviews (including systematic reviews), and selected original papers., Results and Interpretation: Colorectal cancer develops in the stem cells of the crypts through deregulated molecular mechanisms such as the Wnt-pathway, which lead to increased proliferation, lack of differentiation and loss of apoptosis. Precursors, such as the aberrant crypt foci, have potential as early biomarkers, but consensus lacks for their clinical utility. Assumed "innocent" polyps, such as serrated adenomas, appear to play a larger role than previously expected, mainly through epigenetics (CpG Island Methylator Phenotype; CIMP) and microsatellite instability (MSI). Three main pathways occur in the colorectal carcinogenesis (chromosomal instability [CIN] , MSI and CIMP), of which CIN represents the major part. These pathways have distinct clinical, pathological, and genetic characteristics, which can be used for molecular classification for improved diagnostics, prognosis and treatment.

Background: Pancreatic adenocarcinoma is a relatively frequent cancer with an extremely poor prognosis. Until recently, the natural history of pancreatic adenocarcinoma has not been possible to study, but the identification of precursor lesions (pancreatic intraepithelial neoplasia, PanIN) has lead to a better understanding of the stepwise morphological and genetic alterations involved in the development of invasive adenocarcinoma., Material and Methods: Relevant literature from the period of 1996-2005 was found by searching the Medline database, combining the terms "pancreas", "cancer", "PanIN" and "neoplasia". Principal original and review papers were extracted and used as background for a presentation of the PanIN cancer progression model., Results and Interpretation: PanINs are established as designation of histological precursor lesions to pancreatic adenocarcinoma. PanIN grade I to III represent stepwise morphological alterations in the pancreatic ductal epithelium, from early neoplasia (PanIN I and II), via carcinoma in situ (PanIN III) to the development of invasive ductal adenocarcinoma. This model allows for the investigation of sequential molecular changes such as activation of oncogenes and inactivation of tumour suppressor genes. Increased knowledge about pancreatic carcinogenesis may pave the way for prevention strategies, early detection, and new treatment options, thus ultimately improving the prognosis of the patients.

Background: Appendiceal neoplasms are rare. Patients may present with clinical symptoms suggestive of "acute appendicitis" or other unspecific abdominal complaints. An appendiceal mucinous neoplasia is sometimes diagnosed during a laparotomy performed on another indication. Frequently, the condition remains undiagnosed until the pathologists' examination., Materials and Methods: We present the case of a 49-year-old woman who presented with symptoms suggestive of acute appendicitis. An appendectomy was performed. The appendectomy specimen revealed a mucinous cystadenoma with a diverticulum in the appendix. The case is discussed in the light of the current literature., Results and Interpretation: Appendiceal tumours account for less than 0.4% of neoplasias in the gastrointestinal tract and are found in less than 1% of appendectomies. Mucinous lesions ("mucocele") are classified as mucosal hyperplasia, mucinous cystadenoma, or mucinous cystadenocarcinoma. However, there are reports of great variability in the biological behavior, especially concerning the development of pseudomyxoma peritonei. No current consensus exists as to diagnostic criteria or treatment. A radically removed appendix is curative in most cases of mucinous cystadenoma, whereas right hemicolectomy should be considered for patients with malignant mucinous lesions of the appendix.

An acute scrotum is a potential urologic emergency and requires urgent evaluation in order to rule out conditions that need immediate surgical management. The most important condition to rule out is torsion of the testis. In cases of less emergency, a wide variety of differentials may be considered. Scrotal pain or swelling may occur in 10 to 15% of boys with Henoch-Schönlein purpura. We present the case of a 19-year-old boy who had intermittent scrotal pain of two weeks' duration with acute exacerbation prior to admission. The clinical examination gave no specific results. A regular and Doppler sonographic scan showed no evidence of testicular affection. The patient was observed in hospital. Two years earlier he had present with abdominal cramps, rectal bleeding, duodenitis, proteinuria and a purpuric rash, suggestive of Henoch-Schönlein purpura; IgA-nephritis was proven after a renal biopsy. As all other differentials had been ruled out, we concluded that Henoch-Schönlein syndrome was the cause of the recurrent scrotal pain in our patient.

Background: Hurler's syndrome is a rare congenital metabolic disorder and is inevitably lethal when untreated. The presenting symptoms are usually vague, resembling those found in otherwise healthy children., Material and Methods: We present a patient with Hurler's syndrome and discuss the unspecific clinical signs and symptoms seen in these patients based on a review of relevant literature., Results: A two-months-old infant boy was operated for a rightsided inguinal hernia. The anaesthesiologist had difficulty intubating the patient. During the following months the patient had a severe allergic reaction to vaccination, chronic rhinitis with recurrent upper airway infections, and diarrhoea and vomiting. Eventually, failure to gain weight, and psychomotoric delay led to a thorough clinical investigation. Extensive X-ray diagnostics and analysis of urine and serum concluded with Hurler's syndrome., Interpretation: Clinical vigilance is needed in the diagnosis of Hurler's syndrome. Early symptoms, such as rhinitis and hernia, are vague and unspecific. Radiological features, such as broad costae or gibbus, are helpful in obtaining the diagnosis. Decreased level of alpha-L-iduronidase in serum confirms the diagnosis of Hurler's syndrome. Patients tend to be treated symptomatically before the eventual diagnosis of this syndrome.