The MDMA (3,4-methylenedioxy-methamphetamine) is a synthetic psychotropic molecule of the amphetamine class. It is a stimulant of the central nervous system which possesses particular psychotropic characteristics, of a powerful serotoninergic which provides it in high doses or in case of regular use a neurotoxic power [1]. The MDMA is a consumable drug in the form of crystals or pills, more commonly known under the name of ecstasy.

Bariatric surgery complications are associated with the nature of the procedure, reaching an incidence of 40%. One of them is the marginal ulcer, which is defined as a peptic ulcer produced over the jejunal mucosa, distal from the gastro-jejunal anastomosis. Its reported frequency ranges from 0.6 to 25% in gastric bypass patients. Associated risk factors are bad tissue perfusion by increased tension of the anastomosis, foreign bodies as stiches or staples, acidic exposure from gastric fistula, non-steroid anti-inflammatory drugs, tobacco and infection by Helicobacter Pylori. Female patient operated with Roux en “Y” Gastric bypass for obesity, 7 months after the first surgery she required emergency surgery with laparotomy due to postsurgical complications. 3 months after this event she was diagnosed with malnutrition and almost 1 year after the initial GB she presented to the ER with abdominal pain, distension and involuntary muscle resistance. She was admitted to the ER with tachycardia, bilateral hypoventilation and abdominal pain. A CT-scan revealed hollow viscera perforation. Pouch gastrectomy and anastomosis of the gastric remnant with the Henley-Longmire jejunal loop technique for reverse bypass procedure was performed successfully. The gastric bypass reversion is essential for long-term complications that do not respond to initial treatment, such as recurrent marginal ulcers, dumping syndrome, hiatal hernias, refractory hypoglycemia’s, nesidioblastosis, and hypocalcemia.

Solid Pseudopapillary Neoplasm (SPN) of the pancreas represents 1-3 % of all exocrine pancreatic tumors and is uncommon in children. We report four pediatric patients with SPN where each patient posed a unique diagnostic and therapeutic challenge. We describe these four cases with detailed clinical-radiological-pathological correlations. All patients are female, with a median age 13.5 years. Two patients presented with abdominal pain, one with jaundice and one with an incidental pancreatic mass on abdominal CT scan. Radiological studies included abdominal ultrasound, CT scan and MRI of abdomen. Pancreaticoduodenectomy was performed in three patients and laparoscopic distal pancreatectomy in one patient. Mean tumor size was 4.5 cm (ranged from 1.9 to 11.5 cm). All SPNs were benign on histological exam. One patient developed pancreatic insufficiency post-surgery. No tumor recurrence was observed over a mean follow up period of 1 year. We conclude that diagnosis of SPN in pediatric population can be challenging due to non-specific clinical findings, and surgical removal of the tumor is usually required for definitive histologic diagnosis and treatment. Most tumors are benign and recurrence is very rare.