Intraoperative cholangiography during cholecystectomy using a biliary-nose tube: Routinely used in patients with main bile duct stones

Background: Nowadays, the “gold standard” treatment for gallbladder stones is laparoscopic cholecystectomy but the risk of iatrogenic biliary duct injuries is increased compared to “open” surgery. Intraoperative cholangiography (IOC) can be useful to avoid biliary injuries but it can also be a no-safe procedure in center in which it is not routinely performed. Aim and objective: The aim of our study is to trust the efficacy of IOC in a patient with common bile duct (CBD) and gallbladder stones using a biliary-nose tube. Materials and methods: 135 patients with gallbladder and CBD stones were treated with sequential therapy and randomly divided into two groups. Laparoscopic cholecystectomy w…

GASTRIC METASTASES ORIGINATING FROM OCCULT BREAST LOBULAR CARCINOMA: DIAGNOSTIC AND THERAPEUTIC PROBLEMS

Abstract Background Breast cancer is the most frequent malignant tumour to metastasize into the gastrointestinal tract in female and is second only to malignant melanoma. Nevertheless gastrointestinal metastases arising from breast cancer are quite rare. The upper gastrointestinal tract is more frequently involved and lobular infiltrating carcinoma has a greater predilection compared to the ductal type. Case presentation The authors describe the case of a 70 years old woman with a preoperative diagnosis of gastric undifferentiated medullary – type carcinoma, which was the first manifestation of an occult breast carcinoma. The primary site of carcinoma was identified with the use of a panel …

Transanal hemorrhoidal dearterialization versus Milligan-Morgan hemorrhoidectomy in grade III/IV hemorrhoids.

La terapia delle emorroidi di III e IV si basa sul trattamento chirurgico. All’emorroidectomia secondo Milligan Morgan (MM), da molti chirurghi considerata il gold standard, si affiancano attualmente metodi chirurgici considerati meno invasivi come la Procedura per Prolasso ed Emorroidi (PPH) e la dearterializzazione emorroidaria transanale (THD). Gli Autori hanno voluto confrontare in un trial prospettico e randomizzato la emorroidectomia secondo MM e la THD nel trattamento di emorroidi di III e IV grado valutandone i risultati a breve e medio termine. Materiali e metodi: Tra gennaio 2010 e marzo 2013 sono stati reclutati 87 pazienti con emorroidi di III e IV grado secondo la classificazio…

AN EFFECTIVE TREATMENT FOR HEMORRHAGIC RADIATION PROCTITIS

Seven-day subcutaneous continuous glucose monitoring demonstrates that treatment with acarbose attenuates late dumping syndrome in a woman with gastrectomy for gastric cancer.

Malignant colorectal obstruction. Palliative endoscopic treatment with self-expanding metallic stents

The Authors report their experience in the palliative management of malignant colorectal obstruction. Between June 2000 and April 2003 sixteen patients (11 men and 5 women, age range 63-82) were found suffering from malignant colorectal obstruction. In these patients it was not possible to perform definitive surgical treatment because of the old age, advanced neoplastic disease and poor health condition, colostomy was the only therapeutic option. Endoscopic self-expanding stents placement was performed as a definitive palliative method to treat colorectal obstructions caused by advanced and unresectable tumours. This procedure was performed under endoscopic and fluoroscopic control and neit…

What is the Meaning of an Early Anastomotic Recurrence after Curative Right Hemicolectomy? A Synchronous, Metachronous, or What Else?

In this paper we present a case of unexpected early local recurrence after surgery for colon cancer. Notably, an anastomotic recurrence was diagnosed two months after curative right hemicolectomy. Accurate preoperative endoscopic and radiological explorations were carried out, the resection was performed according to the oncological surgical principles, and the pathologic report confirmed the oncological radicality of the treatment performed. Therefore, the precocity of local recurrence appeared surprising, and led us to carry out a review of the literature in order to look into its possible explanations. The results of this research are presented.

trattamento sequenziale endoscopia-chirurgia in casi di calcolosi colecisto-coledocica.Utilità del drenaggio nasobiliare

Unexplained neoplastic anastomotic recurrence after right hemicolectomy: a case report

Abstract Background Anastomotic recurrences of the colon are postulated to arise due to inadequate margins, tumor implantation by exfoliated cells, altered biological properties of bowel anastomosis, and missed synchronous lesions. In this paper, a case of unexpected early local recurrence after surgery for colon cancer is presented. Case presentation A 68-year-old Caucasian man underwent right hemicolectomy for invasive G2 adenocarcinoma. Two months later, endoscopy revealed a wide and well-functioning anastomosis with a hyperemic, hard, and thickened mucosal area of about 2 cm in diameter. Biopsies showed the presence of an adenocarcinoma with the same grading of the previous lesion. Ten …

Gastric and Rectal Metastases from Malignant Melanoma Presenting with Hypochromic Anemia and Treated with Immunotherapy

The authors present a case of an 80-year-old Caucasian male with multiple gastric and rectal metastases from malignant melanoma presenting with hypochromic anemia as the sole symptom of disease without evidence of cutaneous and ocular tumor localization. The patient had a medical history positive for malignant lentigo melanoma of the occipital region of the scalp and early stage laryngeal squamous cell carcinoma and prostatic carcinoma treated with radiation therapy. The authors make some considerations on intestinal involvement by metastatic melanoma and discuss the choice of not treating with endoscopic procedures the gastric metastatic lesions most likely responsible for the clinical sig…

Erratum to “Gastric and Rectal Metastases from Malignant Melanoma Presenting with Hypochromic Anemia and Treated with Immunotherapy”

ITTERO OSTRUTTIVO INOPERABILE. QUALE PALLIAZIONE? PRESENTAZIONE DI UNO STUDIO PROSPETTICO PROTESI VS DERIVAZIONE CHIRURGICA

Use of BICAP in a case of colon angiodysplasia

This paper reports on a case of colonic bleeding from an angiodysplastic lesion of the ascending colon in a 71-year-old diabetic woman, resulting in severe anemia in the patient, who was treated using the BICAP electrocoagulation system. The present report includes a description of this technique, which involves the use of a 7-F hemostatic probe connected to a 25-W BICAP source.

[Spontaneous pneumoperitoneum: a case secondary to thoracic trauma].

Spontaneous pneumoperitoneum is the radiographic manifestation of free air in the peritoneal cavity without visceral perforations and peritoneal signs, and it occurs in about 10% of the cases of pneumoperitoneum. The etiology can be postoperative, thoracic, abdominal, gynecologic, idiopathic; it generally introduces a benign evolution and does not require surgical treatment but just a conservative approach. The authors describe here a case of spontaneous pneumoperitoneum secondary to thoracic trauma. This case is interesting for the occurrence of pneumoperitoneum without clinical peritoneal signs such as fever and leucocytosis, after closed thoracic trauma in absence of pneumothoracic and p…

IL TRATTAMENTO DELLE EMORRAGIE POST-ATTINICHE NELLA NOSTRA ESPERIENZA

Single-Stage Laparoscopic Treatment of the common bile duct lithiasis

Gastric and Rectal Metastases from Malignant Melanoma Presenting with Hypochromic Anemia and Treated with Immunotherapy

The authors present a case of an 80-year-old Caucasian male with multiple gastric and rectal metastases from malignant melanoma presenting with hypochromic anemia as the sole symptom of disease without evidence of cutaneous and ocular tumor localization. The patient had a medical history positive for malignant lentigo melanoma of the occipital region of the scalp and early stage laryngeal squamous cell carcinoma and prostatic carcinoma treated with radiation therapy. The authors make some considerations on intestinal involvement by metastatic melanoma and discuss the choice of not treating with endoscopic procedures the gastric metastatic lesions most likely responsible for the clinical sig…

La colangiografia intraoperatoria in corso di colecistectomia videolaparoscopica: quale ruolo?

The routine use of intraoperative cholangiography during laparoscopic cholecystectomy remains controversial. Mirizzi was the first to recommend the use of intraoperative cholangiography in 1931 based on the high incidence of unsuspected common bile duct stones. The use of intraoperative cholangiography before common bile duct exploration reduced the incidence of unnecessary common bile duct explorations from 66% to less than 5%. With the introduction of laparoscopic cholecystectomy, an increase of incidence of bile duct injury two to four times that seen in open cholecystectomy was witnessed. The vast majority of the injuries were a direct result of the surgeon misidentifying the anatomy. T…

ADDOME ACUTO DA PERFORAZIONE DI DIVERTICOLO DEL SIGMA CAUSATO DALLA MIGRAZIONE DI UNO STENT BILIARE

LOCAL EXCISION ANORECTAL MELANOMA SIMULATING HEMORROIDAL MASS BY LIGASURE

AA. report an extremely rare case of anorectal melanoma s imul a t ing an hemor rhoida l ma s s in a s ixty- four ye a r old woman. The first symptom was anal pain attributed to an anal fissure, easily bleeding, unsuccessfully treated with ointments. It was confused with hemorrhoids andthe patient a underwent to operation. Dur ing thi s proc edur e , us ing Liga sur e™ (Va l l e y l a b , California, S.U.A.) the surgeon suspected the presence of malignancy togheter too rmorroidal mass. Extemporaneous istological exam shos the presenceof the melanoma. Instrumental examination to staging disease demonstred bilateral inguinal linfoadenectomy. The linfonodes excised veren’t metastatic.