Permanent stenting in “unextractable” common bile duct stones in high risk patients. A prospective randomized study comparing two different stents

BACKGROUND: Endoscopic sphincterotomy (ES) and stone extraction is the treatment of choice for bile duct stones. Therefore, if ES and conventional stone extraction fail, further treatment is mandatory. Insertion of a biliary endoprosthesis is an effective option. MATERIALS AND METHODS: We treated 30 high-risk patients (17 women and 13 men, mean age 82 years) affected by difficult common bile duct stones. The patients were randomly assigned preoperatively using closed envelopes (blind randomization) into two groups to receive insertion of polyethylene or hydrophilic hydromer-coated polyurethane stent, respectively. Follow-up was achieved by contacting referring physicians and patient's relat…

LESIONI VASCOLARI MINORI IN CORSO DI COLECISTECTOMIA VIDEOLAPAROSCOPICA. NOSTRA ESPERIENZA

Herpes Simplex Esophagitis in Immunocompetent Host: A Case Report

Introduction. Herpes simplex esophagitis is well recognized in immunosuppressed subjects, but it is infrequent in immunocompetent patients. We present a case of HSE in a 53-year-old healthy man. Materials and Methods. The patient was admitted with dysphagia, odynophagia, and retrosternal chest pain. An esophagogastroduodenoscopy revealed minute erosive area in distal esophagus and biopsies confirmed esophagitis and findings characteristic of Herpes Simplex Virus infection. Results. The patients was treated with high dose of protonpump inhibitor, sucralfate, and acyclovir, orally, with rapid resolution of symptoms. Discussion. HSV type I is the second most common cause of infectious esophagi…

LA TOTAL MESORECTAL EXCISION (TME) STOMIA DERIVATIVA DI PRINCIPIO O DI NECESSITÀ?

L’ittero ostruttivo da emobilia: una rara complicanza della biopsia epatica.

Le complicanze della fibrobroncoscopia. Revisione della letteratura

Fiberoptic bronchoscopy is the gold standard to study and eventually treat tracheobronchial pathology. Performance of fiberoptic bronchoscopy enhances diagnostic precision and has not well documentated risks for the patients. This review examines the international literature of the last 30 yrs about the indication, complications and their prevention during bronchoscopy.

UNA RARA COMPLICANZA DELLE ANASTOMOSI DIGESTIVE MECCANICHE: L'EMORRAGIA ANASTOMOTICA. NOSTRA ESPERIENZA

Il trattamento chirurgico della idatidosi epatica: nostra esperienza

Endoscopic Resection of a Large Colonic Lipoma: Case Report and Review of Literature

Colonic lipomas are uncommon, benign, submucosal adipose tumors that are usually asymptomatic. Large lipomas can cause symptoms such as constipation, abdominal pain, rectal bleeding and intussusception. We report the case of a 60-year-old man with a history of lower abdominal pain and pseudoobstructive symptoms. Colonoscopy revealed a large polypoid sessile lesion in the sigma. We used a standardized technique of polypectomy, preceded by submucosal injection of dilute 5 ml polygelin with epinephrine 1:10,000 solution, to fully resect large colonic lipomas. The lipoma size was 3.5 cm. No bleeding or perforation developed. Histology showed the polyp to be a submucosul lipoma. On follow-up, th…

PERCORSO DIAGNOSTICO TERAPEUTICO DEGLI ITTERI OSTRUTTIVI. IL RUOLO DELLA ERCP

Common Bile Duct Stones in Cholecystectomized Patients

The incidence of retained or primary stones is approximately 2–5% after conventional and laparoscopic cholecystectomy (LC) and 5–15% after common bile duct exploration (CBDE) [1]: in principle these patients are in need of further intervention [2, 3].

PREVENTION OF POST-ERCP PANCREATITIS BY POSITIONING OF PANCREATIC STENT. PERSONAL EXPERIENCE

LA PALLIAZIONE DELL'ITTERO NEOPLASTICO

Trocar-related abdominal wall bleeding in 200 patients after laparoscopic cholecistectomy: Personal experience

AIM: To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy. METHODS: We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005. One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99 patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar. RESULTS: Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site …

Presence of white bile in malignant biliary obstruction is associated with poor prognosis: personal preliminary observations

OBJECTIVE: The chemical composition and clinical significance of white bile in patients with malignant obstructive jaundice were evaluated in a prospective study. MATERIALS AND METHODS: 115 consecutive patients with inoperable malignant biliary obstruction underwent endoscopic placement of 10 Fr straight, plastic biliary stents, Amsterdam-type. Bile was aspirated during the endoscopic procedure and a blood sample was taken. Patients were divided into two groups: those with white bile and those with yellow bile. The groups were compared for decremental fall in bilirubin, cholangitis after stent insertion, and survival. RESULTS: Thirty-five patients (15 men, 20 women; mean age 54 years) under…

Cholangitis prevention in endoscopic Klatskin tumor palliation: air cholangiography technique.

INTRODUCTION: Endoscopic biliary drainage is the treatment of choice for inoperable hilar cholangiocarcinoma (so-called Klatskin tumor). Cholangitis is the main complication post-endoscopic retrograde cholangiopancreatography (ERCP) in Klatskin patients, specially when medium contrast is injected into biliary tree that could not be subsequently drained. Bacterial cholangitis is the principal cause of mortality in these patients. The aim of this study is to analyze cholangitis rate resulting from the use of air versus iodine contrast to obtain cholangiography during ERCP. METHODS: In 9 years, 188 inoperable Klatskin patients were recruited and divided into two groups: iodine (A) or air (B) c…

ANATOMIC-CLINICAL CONSIDERATIONS NON RECURRENT LARYNGEAL NERVE COEXISTING TO RECURRENT NERVE:PERSONAL EXPERIENCE AND LITERATURE REVIEW

Una rara complicanza della ERCP: la sindrome di Mallory-Weiss

Secondary aortoduodenal fistula.

Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a ga…

TRATTAMENTO ENDOSCOPICO DEL SANGUINAMENTO DA ANASTOMOSI DIGESTIVA MECCANICA. NOSTRA ESPERIENZA

Duodenal Signet Ring Cell Carcinoma in a Celiac Patient

Celiac disease results from damage to the small intestinal mucosa due to an inappropriate immune response to a cereal protein. Long-standing or ‘refractory’ celiac disease is associated with an increased risk of autoimmunity and malignancy. We produced a brief literature review starting from a case of duodenal cancer in a celiac patient. The patient with an history of celiac disease since six months presented with acute manifestation of gastric outlet syndrome. A duodenal stricture was diagnosed at upper gastrointestinal endoscopy and confirmed by abdominal computed tomography. He was successfully treated by segmental duodenal resection. In the resected specimens, the diagnosis was duodenal…

L’utilità del drenaggio biliare transepatico percutaneo ecoguidato negli itteri ostruttivi

CARCINOMA DELLA COLECISTI: TRATTAMENTO PALLIATIVO PER VIA ENDOSCOPICA. NOSTRA ESPERIENZA

RUOLO DELLA ERCP + SE NEL TRATTAMENTO DELLE COMPLICANZE DELLA IDATIDOSI EPATICA. NOSTRA ESPERIENZA

A Strange Case of Left Bowel Ischemia after Right Hernioplasty

We report the first observed case of a young man who suffered of large and unsuspected left bowel ischemia following an elective right open hernioplasty. A 54-year-old man had a 2-year history of right inguinal reducible mass and was admitted to hospital for an elective day case open inguinal hernioplasty for a direct right inguinal hernia. Apart from mild hypertension controlled with ACE inhibitor, he was medically fit and well. The patient was submitted to open tension-free mesh repair with polypropylene preshaped mesh with local infiltration anesthesia and additive sedation with midazolam. The local anesthesia and surgery were uneventful and he was discharged home on the same day as per …

Plasma calprotectin levels in patients suffering from acute pancreatitis

Calprotectin (Cal) concentration is elevated in acute inflammatory reactions and its increase in the plasma suggests a diagnostic potential for Cal assay. This study aimed (a) to evaluate the Cal plasma levels in patients suffering from acute pancreatitis (AP) and (b) to assess whether early assay of Cal plasma levels can be helpful in assessment of the severity of AP. Forty-six consecutive patients, median age 45 years, suffering from a first attack of AP were recruited at two medical centers. Data collected on admission included age, sex, delay between pain onset and admission, and Glasgow score. A severe outcome was defined according to the Atlanta criteria. AP was defined as edematous o…