this condition, one bowel loop makes a knot with anadjacent bowel loop, resulting in mechanical obstructionand even gangrene of the bowel. We present a case of ayoung girl with ileo-ileal knotting resulting in a closed-loopobstruction and gangrene of the small bowel loop. This is adifficult condition to diagnose; a high index of suspicion andearly surgical intervention are essential to reduce morbidityand mortality.

Periampullary carcinoma metastases are usually located at regional nodes, adjacent organs, liver or lung. On the other hand, metastatic penile cancer is uncommon. Penile metastasis usually originates from pelvic region with prostate and bladder being the most frequent primary location. We present a very rare case of periampullary carcinoma with penile metastasis in a 49-year-old man. He initially presented with early ampullary type periampullary carcinoma and had pyloric preserving pancreatoduodenectomy and adjuvant chemotherapy. However, after six years of uneventful follow up, he presented with a penile lesion which was confirmed to be pancreatic metastasis. He was started on chemotherapy but passed away two months later. Ampullary carcinoma type of periampullary carcinoma usually presents early with favourable prognosis. However, tumour recurrence can present much later after definitive treatment and at a rare site such as penis with generally poor outcome.