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Highlights • Ischemic gastric necrosis could be provoked by acute gastric dilatation. • Early diagnosis is crucial to increase survival from fundic gastric necrosis. • Conservative treatments should be considered as first-line management. • Surgical treatment is advised when massive gastric necrosis is encountered., Introduction Gastric fundus ischemia is a rare event, which does not account for many significant clinical studies. This disorder could have different etiologies, but authors agree that a prompt diagnosis and a proper treatment could avoid dangerous complications and ultimately the death of the patient. Presentation of case We herein report an interesting idiopathic case of acute gastric dilatation and fundus ischemia of an 83-year-old Caucasic woman who was admitted to the Emergency Department complaining of abdominal discomfort, vomiting and constipation. Discussion In literature, only a few case reports about this condition are reported. Possible risk factors, etiologies, and the different therapeutic options available for this condition are examined, in order to try to favor clinicians to formulate a timely diagnosis and provide patients with rapid healthcare services. Conclusion Further investigations are still needed to analyze the pathophysiological pathways responsible of gastric fundus ischemia and to provide a definitive treatment to this dangerous disorder.

Patient: Male, 42-year-old Final Diagnosis: Neuroendocrine tumor Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Jejunoileal neuroendocrine tumors (JI-NETs) are rare tumors that can be associated with mesenteric fibrosis. This case report is of an incidental finding of a JI-NET in a patient who was previously misdiagnosed with sclerosing mesenteritis. Case Report: A 42-year-old man was admitted to our institution with diffuse abdominal pain and clinical and radiographic signs of bowel obstruction. He had a previous diagnosis of sclerosing mesenteritis, which had been histologically diagnosed after an exploratory laparoscopy performed in 2009 for recurrent acute abdominal pain. He was also annually monitored through computed tomography scans for an incidentally discovered, gradually enlarging mesenteric mass for which a “wait and watch” management approach was adopted. After a period of fasting and observation, the patient underwent an urgent exploratory laparotomy because of his worsening condition. Intraoperatively, an ileocecal resection was performed, along with excision of the known mesenteric mass. The pathology report revealed an ileal NET with nodal metastases within the mesentery and mesenteric tumor deposits (pT3N1). Conclusions: JI-NETs are rare entities, which are usually encountered as incidental findings or in patients with unspecific abdominal pain. Our case represents a probable delayed diagnosis of JI-NET in the context of sclerosing mesenteritis; therefore, a possible association between these 2 conditions should be investigated.

Background:: Hemorrhoidal disease represents one of the most common anorectal disorders in the general population. Energy devices, such as LigaSureTM scalpel, have reshaped the concept of hemorrhoid surgery and in turn, have improved patient outcomes and simplified the work of surgeon. Objective:: The study aims to evaluate the outcomes of LigaSureTM hemorrhoidectomy (LH) analyzing main post-operative complications rate, length of stay, operating time, and time to return to work. Methods:: In this monocentric descriptive study, from June 2001 to February 2019, 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed. Complications were classified in early, late, and long-term if they occurred within 1 month, between 1 and 2 months or after 2 months, respectively. Results:: 90.2% of patients were treated in day surgery regimen and the mean operating time was 14.3 minutes. The post-operative pain decreased from 3.7 mean VAS on the 1st postoperative day to 0.1 mean VAS on 30th post-operative day. Early complications rate was 2.1%: urinary retention accounted for 1.8% of patients. 0.3%-of patients experienced postoperative bleeding and only one required reoperation. Late complications rate was 5.8%: anal stenosis, incomplete healing, and anal fissure were detected in 3.6%, 1.2%, and 1% of patients, respectively. The long term complications rate was 5.3%: anal fistula, soiling, perianal abscess, and recurrence were identified in 0.2%, 0.1%, 0.3%, and 4.8% of patients, respectively. Conclusion:: LH is a safe and fast procedure with a proven minimal complication rate.

Patient: Female, 26-year-old Final Diagnosis: Completely isolated enteric duplication cyst and appendiceal neuroendocrine tumor Symptoms: Dysmenorrhea Medication: — Clinical Procedure: — Specialty: Oncology • Surgery Objective: Rare disease Background: Completely isolated enteric duplication cysts (CIDCs) are rare malformations that can occur at any site in the gastrointestinal system. This report describes a woman with a CIDC and an incidental appendiceal neuroendocrine tumor (ANET). Case Report: A 26-year-old woman who presented with dysmenorrhea was assessed by ultrasound (US), which revealed a pelvic mass. Other imaging modalities, including magnetic resonance imaging (MRI), failed to clarify the origin of the mass. Intraoperative findings during diagnostic laparoscopy revealed an isolated, ovaloid mass with autonomous peristalsis and a short pedicle towards the root of the ileal mesentery. In addition, the appendix appeared enlarged with a hardened consistency. The mass was resected and an appendectomy performed laparoscopically. The pelvic mass was diagnosed as a CIDC and the appendix was incidentally found to contain a pT3Nx carcinoid tumor. Based on histological examination and guidelines of the European Neuroendocrine Tumor Network (ENET), the patient later underwent a laparoscopic right hemicolectomy. Conclusions: CIDC in adulthood is very rare, especially when combined with an incidentally discovered pT3Nx appendiceal carcinoid tumor. Neither US nor MRI was able to provide a precise preoperative diagnosis. Diagnostic laparos-copy clarified the nature of the mass and revealed a lesion missed during the preoperative workup. Because of the diagnosis of ANET, the patient subsequently underwent a laparoscopic right hemicolectomy.