HighlightsDiagnosis is often difficult and delayed because clinical symptoms are not specific.The etiopathogenesis of jejuno–ileal diverticulosis is unclear.Flatulent dyspepsia = epigastric pain abdominal discomfort, flatulence one or two hours after meals.The extraluminal air develops an arrowhead-like shape surrounded by inflammatory tissue when the diverticulum is perforated.In the presence of complications, surgical resection with reestablishment of the bowel continuity is the preferred treatment option.

The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis.

BackgroundPancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms. About 40–80% of patients with PNET are metastatic at presentation, usually involving the liver (40–93%). Liver metastasis represents the most significant prognostic factor. The aim of this study is to present an up-to-date review of treatment options for patients with liver metastases from PNETs.MethodsA systematic literature search was performed using the PubMed database to identify all pertinent studies published up to May 2018.ResultsThe literature search evaluated all the therapeutic options for patients with liver metastases of PNETs, including surgical treatment, loco-regional therapies, and pharmacological treatment. All the different treatment options showed particular indications in different presentations of liver metastases of PNET. Surgery remains the only potentially curative therapeutic option in patients with PNETs and resectable liver metastases, even if relapse rates are high. Efficacy of medical treatment has increased with advances in targeted therapies, such as everolimus and sunitinib, and the introduction of radiolabeled somatostatin analogs. Several techniques for loco-regional control of metastases are available, including chemo- or radioembolization.ConclusionsTreatment of patients with PNET metastases should be multidisciplinary and must be personalized according to the features of individual patients and tumors.

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