Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified, the most important being bowel ischemia and mesenteric vascular accident. The primary factors that favor the development of this pathologic entity are intestinal wall alterations, bowel distention, and sepsis. Portomesenteric vein gas in idiopathic in approximately 15% of cases. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. However, when CT show portomesenteric vein gas and clinical findings suggests the presence of mesenteric ischemia, surgery is mandatory.

Endoscopic stents have evolved dramatically in recent decades since their introduction in clinical practice in the 1990s. They are currently regarded as the first-line option for palliative care, but their use as a bridge to surgery in patients with intestinal obstruction is still under debate. We discuss the indications and complications of colonic stents.

Pneumoperitoneum is usually secondary to perforation of gastrointestinal tract. In very rare cases this perforation can be caused by a barotrauma.  A barotrauma is the trauma caused by rapid or extreme changes in air pressure, especially affecting enclosed cavities within the body such as the middle ear, the sinuses, the lungs and the bowel.

Intestinal barotrauma is produced by gas that is retained in the digestive tract after some manipulation of the respiratory tract. Gas retention may go unnoticed or cause only   abdominal pain, but in some isolated cases it could cause intestinal perforation due to the tension of the intestinal wall, especially if there is any cause that makes it likelier, such as the presence of a Diverticular disease.

Retrorectal tumours are uncommon and have a wide range of etiologies, congenital etiologies being the most common. The clinical presentation is heterogeneous and retrorectal tumours often pose diagnostic difficulties as non-specific chronic pain and suppuration are the most common symptoms.

Pica syndrome occurs in patients with severe personality disorders who repeatedly ingest foreign bodies resulting in life threatening situations. Despite of multiple medical therapy and surveillance some patients requires several interventional or surgical procedures during their lives. Minimal invasive surgery has a favorable role even in patients with multiples previous surgical interventions.

Surgery for morbid obesity is effective but has complications. Less invasive methods in treatment of obesity are being pursued. Transoral endoscopic methods are used to manage complications and as revisional procedures following obesity surgery. Transoral methods are attractive in that they are scarless and less invasive. In recent years, different endoscopic techniques have been described as alternatives to minimally-invasive surgery for the treatment of obesity. The Primary Obesity Surgery Endoluminal (POSE) procedure is an optional technique that is less invasive and safer for the treatment of obesity.

Mesenteric involvement is the main finding in 30-50% of patients with non-Hodgkin’s lymphomas (NHL). Diffuse large B cell lymphoma is the most common type of lymphoma in adults (40-50% of NHL). Mesenteric lymphomas can reach a large size without causing clinical symptoms. The most common symptoms are abdominal pain and a palpable abdominal mass.

A large long-term observational study found that 9.2% of patients with diverticulitis presented with obstruction. This infrequent condition requires individualized assessment for optimal treatment. Surgeons must choose between open vs laparoscopic approach, resection or colostomy, primary anastomosis or not.

Accidental ingestion of fishbones is a common issue, especially among cultures in which unfilleted fish ingestion occurs regularly. Fortunately, most fishbones pass the gastrointestinal tract in less than a week. However, some patients may present with bowel perforation. The diagnosis of fishbone bowel perforation may be clinically and radiologically challenging as the patient is usually not aware of having ingested a fishbone and presents with nonspecific abdominal pain.

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a common procedure in obesity surgery. The aim of an antecolic approach is to reduce the rate of internal herniation. An omental infarction after bariatric surgery is rare, but it can occur. Omental infarction is a rare condition which is being increasingly reported in the literature due to the advances in imaging techniques and its typical appearance in computed tomography. Omental infarction can be accurately diagnosed through computed tomography, thereby avoiding exploratory surgery.