0000000000541074
AUTHOR
Giuseppe Frazzetta
Achalasia Secondary to Submucosal Invasion by Poorly Differentiated Adenocarcinoma of the Cardia, Siewert II: Consideration on Preoperative Workup.
Secondary achalasia due to submucosal invasion of cardia by gastric cancer is a rare condition. We report a case of pseudoachalasia, secondary to the involvement of gastroesophageal junction by poorly differentiated gastric cancer, initially mistaken as idiopathic form. We focus on the difficulty to establish differential diagnosis only on the basis of routine exams and we stress the necessity of “second level” instrumental exams; EUS in routine workup in selected patients should be considered. We support that routine workup based on history, clinical presentation, radiological and endoscopic findings, and certainly manometry could be insufficient for a correct differential diagnosis betwee…
Right diaphragmatic injury and lacerated liver during a penetrating abdominal trauma: case report and brief literature review
Introduction: Diaphragmatic injuries are rare consequences of thoracoabdominal trauma and they often occur in association with multiorgan injuries. The diaphragm is a difficult anatomical structure to study with common imaging instruments due to its physiological movement. Thus, diaphragmatic injuries can often be misunderstood and diagnosed only during surgical procedures. Diagnostic delay results in a high rate of mortality. Methods: We report the management of a clinical case of a 45-old man who came to our observation with a stab wound in the right upper abdomen. The type or length of the knife used as it was extracted from the victim after the fight. CT imaging demonstrated a right hem…
LAPAROSCOPIC ADRENALECTOMY: SINGLE CENTRE EXPERIENCE.
Objective: Laparoscopic adrenalectomy is today considered the gold standard treatment for all benign adrenal tumors. The aim of this study is to evaluate the results of laparoscopic adrenalectomy in a single centre. Methods: We reviewed clinical data on 32 adrenalectomies performed at our istitution from 2009 to 2012. The average age of patients was 47 years (range 38-68); 18 were men and 14 women. For the clinical analysis, patients were divided into the nonfunctioning tumor group (n = 20) and the functioning tumor group (n = 12). All operations were performed via transperitoneal lateral access. Results: All laparoscopic adrenalectomy were finished successfully and no open surgery was nece…
“Relaparoscopic” management of surgical complications: The experience of an Emergency Center
Background/aim: Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications. Materials and methods: We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated. Results…
DUODENAL ADENOCARCINOMA: A CASE REPORT
Objective: Cancers of the small intestine are rare pathologies. They occur with vague and unspecific symptoms and cause many problems in differential diagnosis. Methods: A 64-years-old man, smoker, suffered inappetence, nausea and vomit over about 20 days until the presence of melena led to his admission to our hospital. His history included diabetes mellitus and moderate alcohol intake. The objective examination showed a hard-inelastic swelling in epi-mesogastric region. Laboratory data showed an increase of leukocytes and elevated level of CA 19-9. Esophagogastroduodenoscopy showed a duodenal vegetans neoformation, subjected to examination biopsy and bacterial culture. Computed tomography…
Corrigendum to “Hiatal Hernia Repair with Gore Bio-A Tissue Reinforcement: Our Experience”
Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50-90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH stu…
Laparoscopic adrenalectomy for large adrenal masses: Single team experience
Abstract Introduction Laparoscopic adrenalectomy is today considered the standard treatment for benign small adrenal tumors. An open question is the use of laparoscopy for large adrenal masses because of technical limitations and increased risk of malignancy. In this study we report our experience in laparoscopic adrenalectomy for adrenal masses larger than 6 cm. Methods Between January 2010 and December 2013 we performed 41 laparoscopic adrenalectomy. Fourteen of 41 patients (34,1%) were submitted to laparoscopic adrenalectomy for lesion >6 cm in size. All patients were submitted routinely to radiological and hormonal tests to indentify tumors characteristics. Results The patients treated …
Laparoscopic drainage of liver abscess: case report and literature review.
Aim To evaluate the safety and efficacy of the minimally invasive surgical approach (laparoscopic drainage) of liver abscesses in selected cases. Case report Male, 58 years old, from a rural area, presented with epigastric abdominal pain, fever, weight loss, loss of appetite, a palpable mass in the epigastrium and neutrophilic leukocytosis. CT revealed a complex multiloculated liver abscess in segments 2-3. Systemic antibiotic therapy alone was ineffective; percutaneous drainage was excluded due to the characteristics of the lesion. Result Given the complexity of the lesion, a laparoscopic approach was chosen involving complete drainage of the abscess, debridement and irrigation; the cavity…
Adrenal gunshot wound: Laparoscopic approach. Report of a case
introduction: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating abdominal injury, it is also clear that certain stable patients may be managed without operation. Controversy persists regarding use of laparoscopy. PRESENTATION OF CASE: We report a case of gunshot wounds with bullet in left adrenal gland and perirenal subcapsular hematoma. The patients had no signs of peritonitis but in the observation period we noted a significative blood loss, so we performed an exploratory laparoscopy. DISCUSSION: We found the bullet in adrenal parenchyma. The postoperative period was regular and the patient was discharg…
Acute appendicitis and endometriosis: Retrospective analysis in emergency setting
Introduction. The aim of this study is to evaluate the incidence of appendiceal and pelvic endometriosis in a population with diagnosis of acute appendicitis in an emergency setting. Materials and methods. We carried out a retrospective study in the period between January 2010 and October 2013. We performed 429 appendectomy including 233 in female subjects (54.3%). In all patients of childbearing age, we did β-hCG urine test to rule out the presence of an extra-uterine pregnancy. Results. 127 of 233 patients received a laparoscopic approach (54.5%). The median age was 29 years-old (range 17-68). The diagnosis of appendiceal and/or pelvic endometriosis was performed in 10 patients (4.3%): 9 …
Role and outcomes of laparoscopic cholecystectomy in the elderly.
Abstract Introduction : Laparoscopic cholecystectomy is the standard of treatment for gallstones disease and acute colecystitis. The prevalence of this disease increases with age and the population is aging in industrialized countries. So, in this study we report our experience in the treatment of gallstone disease in elderly patients, particularly analyzing the outcomes of laparoscopic approach. Methods : Between January 2010 and May 2014 we performed a total of 1227 cholecystectomies. In this retrospective study age group was the primary independent variable: 351 patients were 65–79 years of age and 65 were 80 years of age or older. Results : Only 65 patients (5.3%) of all population had …