Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic neoplasm. The presentation varies from recurrent pancreatitis, steatorrhea and weight loss to incidental findings during imaging studies. The recognition of IPMN is crucial in deciding for prompt surgical intervention, which is the best treatment modality for this precancerous condition. Here, we report a case of 55-year-old man with massive upper gastro intestinal bleeding arising from a huge fungating duodenal mass. In view of massive bleeding, a decision for emergency Whipple's pancreaticoduodenectomy was made. Final histological diagnosis confirmed as IPMN. To the best of our knowledge, this is the first case of IPMN presented with a huge fungating duodenal mass causing massive UGIB requiring surgical intervention.

Colorectal cancer is ranked as the most common cancer for men and the second most common cancer for women according to the Malaysian National Cancer Registry Report (MNCR) 2007-2011. However, delay in the diagnosis of colorectal cancer is still common partly attributable due to late presentation and incorrect diagnosis by the general practitioners. The aim of this study is to determine the relationship between presenting symptoms of colorectal cancer to the location of the tumour in order to prevent delay in diagnosis of colorectal cancer. Between 1996 until 2009, a total of 212 patient data from Hospital Universiti Sains Malaysia were retrospectively analyzed. The demographic and surgical data were obtained. We studied the relationship of the presenting symptoms of colorectal cancer to the location of the tumour. The age of candidate included in this study range from 16 to 93 years old with mean age was 56 and male predominance. In this study, there is a strong relationship between presenting symptoms and the location of the colorectal cancer but no significant relationship between age and sex to the anatomical location of the tumour. The study showed the presenting symptoms of rectal bleeding, change in bowel habit and tenesmus were significantly associated with rectal tumor, intestinal obstruction with left sided tumors and anemia and abdominal mass with right sided tumors (p-value <0.05). However abdominal pain does not follow this role as it is mostly associated with other presenting symptoms and it has no significant relation to the anatomical location of the tumor.

Wandering spleen is renowned as a surgical enigma due to its diverse presentations. Due to lack of its attaching ligaments which would usually place it at the left hypochondrium region, the spleen ‘wanders’ and may be located anywhere within the abdominal cavity. This condition has been associated with many complications such as splenic torsion, pancreatitis and portal hypertension. We report a case of a wandering spleen presenting as acute appendicitis in an 18-year-old young active sportsman. The patient developed post-operative ileus and later intestinal obstruction which necessitated exploratory laparatomy onto which the final diagnosis of splenic and small bowel infarct due to splenic torsion with small bowel volvulus was made. Splenectomy, small bowel resection and primary anastomosis were performed and the patient made a full recovery.

Necrotizing fasciitis (NF) is a deadly soft tissue infection causing a significant morbidity and mortality. Abdominal and chest wall NF are unusual. We describe a 49-year-old male with anterior abdominal wall NF secondary to perforated gastric ulcer (PGU). He was admitted in septic shock presenting an abdominal wall NF with severe metabolic acidosis requiring dialysis and admission to the intensive care unit. There was a patch of gangrene with surrounding skin discoloration at lower quadrant of the abdominal wall. Local debridement was done without a preoperative computed tomography that was performed after surgery. Adequate source control was not achieved after the second surgery and the patient had worsened resulting to death. We describe this rare presentation of NF and discuss the issues learnt from this unfortunate event.