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HighlightsPostoperative pain in the Milligan-Morgan hemorrhoidectomy remains a reality in a large number of centers, where it is practiced routinely, without analgesic specific strategies. It involves a not inconsiderable number of days of hospitalization and a high utilization rate of opiates, comparable to other abdominal major surgeries as reported by the literature.In this sense we are proposing a new strategy for better control of post-hemorrhoidectomy pain.

Highlights We present a case of a small bowel adenocarcinoma at an advanced stage, following surgery and adjuvant therapy for colorectal adenocarcinoma, with an atypical presentation at the emergency room, as a rare cause of obstructive small bowel intussusception. After a successful removal of a carcinoma in the large bowel, there is a higher risk for developing a further primary (metachronous) large bowel tumor. However metachronous carcinomas affecting small bowel are rarer. Small Bowel adenocarcinoma (SBA) is a rare malignant neoplasm without specific signs and symptoms, and associated with late stage disease presentations. Patients who develop a small or large bowel adenocarcinoma are at high risk for a second cancer at both sites. However data available to guide therapeutic decisions for those presenting one at small bowel are scarce, and the role of adjuvant therapy in patients who undergo curative resection is unclear. Studies about strategies for detection at an earlier stage, optimal treatment and prognosis are mandatory for this disease.

Intranodal schawnomas are extremely rare. Just a few cases have been described before. Clinical presentation comprises not only symptomatic mass in several anatomical body parts, but also, they can be found during analysis of surgical specimens resected for other reasons. The report is based on the case of an 80-year-old patient who underwent to right hemicolectomy for an adenocarcinoma. The histopathologic analysis revealed one mesenteric intranodal schwannoma in the surgical specimen. The diagnosis was confirmed by immunohistochemistry with positive result for vimentin and S100 protein. Less than 12 cases have been reported in the literature before. The findings pointed out our patient as, one of these few reported with such diagnosis.

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