Portal vein aneurysms (PVAs) are rare vascular anomalies that are most often discovered incidentally during imaging for unrelated conditions. Their management remains controversial due to the limited data available. Here, we report the case of a 72-year-old male who presented with gastrointestinal bleeding and was found to have an incidental 4.9 cm PVA on abdominal computed tomography angiography (CTA), managed conservatively with regular follow-up imaging and monitoring. PVAs, while rare, present a significant clinical challenge due to the lack of consensus on their management. Treatment strategies range from conservative monitoring to surgical intervention, depending on the presence of symptoms, aneurysm size, and underlying etiology. This case highlights the importance of a multidisciplinary approach in managing PVAs, particularly when they are discovered incidentally. Further research is needed to develop standardized guidelines that address the nuances of treating both congenital and acquired PVAs.

Jejunal diverticulosis is a rare form of diverticulosis characterized by acquired pseudodiverticula in the small bowel. Although most cases are asymptomatic, the condition can present diagnostic challenges due to its atypical presentation. Complications such as perforation can lead to acute abdomen, significantly increasing morbidity and mortality. We report a rare case of perforated jejunal diverticulitis in an 84-year-old female with a known history of diverticular disease. The patient presented to the emergency department with worsening left lower quadrant abdominal pain. A computed tomography (CT) scan revealed a focus of air adjacent to the mesentery, indicative of bowel perforation. An urgent exploratory laparotomy was performed, which identified a 4-cm perforated jejunal diverticulum. The affected segment of the small bowel was resected, followed by primary side-to-side jejunal anastomosis. The patient was discharged home in stable condition following uneventful postoperative recovery. This case highlights the importance of including jejunal diverticulosis in the differential diagnosis of acute abdomen, particularly in elderly patients with a history of diverticular disease. Due to the nonspecific presentation, prompt imaging is crucial for diagnosis. Surgical intervention is often necessary in cases of perforation. Increased clinical awareness of this rare condition may help reduce diagnostic delays and improve patient outcomes.

INTRODUCTION & IMPORTANCE:Adult Hirschsprung's disease (AHD) is a difficult diagnosis to make due to its rarity, frequently after emergency interventions have been conducted. We present a case of possible AHD and sketch a classic presentation of Adult Hirschsprung's Disease. This would help recognize and include AHD in the differential diagnoses of chronic constipation where appropriate.CASE PRESENTATION:The case involved a 41-year-old male with a history of multiple abdominal surgeries for volvuli and a ventral hernia repair complicated by post-operative SBO. Presenting symptoms were chronic constipation, abdominal colic, and dilation. SBO secondary to volvulus was discovered, decompressed, and emptied of 3000cc fecal material in the OR. His case was again complicated twice by SBO which led to the suspicion of AHD and instigated this systematic review. Papers were extracted from the EBSCO and PubMed databases. Papers were excluded if patients were younger than 10 years old.CLINICAL DISCUSSION:The classic patient will be a male over the age of 10 years old with an average age of 30 years old and a long history of chronic constipation, often complicated by an acute symptomatic obstruction. Patients may have had a history of multiple surgical or non-surgical interventions to relieve their constipation.CONCLUSION:AHD is being seen more frequently with the increasing availability of healthcare in underserved areas of the world. Duhamel's procedure is the most effective procedure after diagnosis has been made. Barium enema and a biopsy show hypo- or a-ganglionic segments that are to be resected for curative purposes.