Giornale di Chirurgia最新文献

Fournier's gangrene is a rare and potentially lethal condition. Previously described as an idiopathic process, this necrotising fasciitis is secondary to infection and in 95% of cases the cause arises from ano-rectum (30-50%), uro-genitalia (20-40%) or genital skin (20%). Cancer could lead to a Fournier's gangrene thanks a Romacompromised host immunity condition. In the past the rate of death was high ranging from 20% to 80%, while currently mortality is decreasing to 10%. We report a case of a 76-years-old man with Fournier's Gangrene due to locally advanced prostate cancer. The multimodal therapeutic management included broad-spectrum antibiotic therapy, intravenous fluid resuscitation and surgical debridement that was delayed by the will of the patient. To our knowledge, this is the first case of Fournier's gangrene caused by prostate cancer without common predisposing factors. In order to improve the knowledge about this rare disease, we performed a narrative review of the literature.

Background: Undifferentiated pleomorphic sarcoma (UPS) of the breast is an extremely rare, but aggressive subtype of sarcoma that can develop in radiotherapy (RT)-treated breast cancer patients. Due to the low incidence, there are many uncertainties regarding the adequate management of these tumors. We present a rare case of radiation-induced UPS in a 63-year-old woman who had undergone breast conserving therapy for invasive ductal carcinoma of the left breast, six years prior to presentation.

Case presentation: A 63-year-old woman presented with a rapidly growing left breast mass. She had been diagnosed with invasive ductal carcinoma of the left breast for which she underwent a left upper outer quadrantectomy and ipsilateral axillary dissection followed by RT, six years previously. During her routine oncologic follow-up, the mammography revealed a dense, nodular opacity with microcalcifications. The breast ultrasound (US) confirmed the presence of the nodule. US-guided fine needle aspiration biopsy was performed and the diagnosis of UPS was made, the reason for which the patient underwent wide local excision of the left breast.

Conclusion: The diagnosis of RT-induced UPS is challenging and often missed due to the low incidence, long latency period, unspecific imaging findings, and difficulties in clinical and histological detection of these lesions. These tumors should be considered in differential diagnoses of rapidly-growing breast masses in previously RT-treated breast cancer patients, as they can mimic the local recurrence of the primary tumor. Since the prevalence of breast-conserving surgery followed by RT has been increasing, the careful monitoring of at risk patients is of utmost importance, as UPSs are highly aggressive tumors associated with very poor outcomes.

Splenic artery aneurysm (SAA) is the most common aneurysm of visceral vessels. Usually the rupture occurs into the free peritoneal cavity and causes massive bleeding, much less frequently the rupture happens into the lumen of the gastrointestinal tract. We describe the case of a 39-year-old male patient with a spontaneous rupture of a splenic artery aneurysm and an acute massive peritoneal bleeding. The case described confirms the rupture of SAA is always a dramatic event and an emergency laparotomy is a life-saving procedure.

Introduction: Nipple reconstruction is the final stage of breast reconstruction and performed after acceptable breast mound shape and symmetry has been achieved. Here is a description of an original technique of L shaped nipple reconstruction to address issues such as transverse mas-tectomy scar which lies at the Neo nipple position.

Aim: The objective of this study is to describe an original tech-nique of nipple reconstruction, using a combination of random flap and dermal graft; and also measures patient satisfaction of outco-mes. This original technique is set to overcome challenges of nipple reconstruction such as correct positioning, maintaining adequate projection and creating an almost inconspicuous scar.

Methods: 31 patients underwent the L-shaped nipple reconstruction between 2011 and 2016 at our Breast Unit. Complications and outcomes were analysed and compared with 59 patients who underwent traditional CV flap during the same study period (total N=90, i.e., L flap n=31 and CV flap=59).

Results: There was no statistically significant difference in complication rates between traditional CV flap (9.7%) and L-shaped (13.6%) nipple reconstructions (Fishers exact test p=0.74). In our study cohort undergoing L flap nipple reconstruction, 94% were either pleased or very pleased with their decision to have undergone nipple reconstruction and 93% would either strongly or very strongly recommend it to a friend.

Conclusions: The innovative L-shaped nipple reconstruction has positive patient satisfaction out-comes and is a very suitable alternative to traditional nipple reconstruction such as CV flap.

Since gastroduodenal FTRD system is commercially available, several data have been reported in Literature concerning duodenal full-thickness resections, whereas few cases of gastric full-thickness resections has been described. In this case series We report three patients treated with this innovative tool for resecting lesions of the gastric wall. The indications ranged notably: a neuroendocrine tumor in a difficult to treat environment in the first case, a recurrent adenocarcinoma in a poorly surgical candidate patient in the second case and a pre-pyloric lesion for the third patient. In the third patient, a complete pyloric stenosis due to the clip deployment occurred. Clinical success rate was 100%. Even if current Literature is still poor of articles dealing with gastric full-thickness resection device based on over-the-scope-clip system. Our case series show how this novel tool might be take into consideration for whenever both surgery and standard endoscopic resection techniques are poorly feasible.

We retrospectively collected data of 100 consecutives elective Longo's procedures for third- and fourth-degree simptomatic haemorroids, classified ASA grade I and II. All patients stayed overnight, because discharge was scheduled the day after the operation. 98 were discharged the day after the operation. Two patients were not discharged the day after because mild and severe bleeding respectively occurred during the first night after the operation which settled conservatively. All the patients were discharged on oral NSAID and stool softeners. None required rehospitalisation. Our retrospective study, pointing out that, in general patients did not require active intervention on the first postoperative night, represents an encouragement to introduce day-case stapled procedure for haemorroids.

Hemoperitoneum due to ruptured retroperitoneal varices is an extremely rare condition and a poor prognostic sign with a catastrophic and life-threatening situation. Early recognition affords appropriate management and urgent surgical intervention in order to favor the survival rate. In this case report we accurately describe the complex clinical course of a 56-year old woman with retroperitoneal varices, who few months earlier had a chest trauma with multiple left lower rib fractures and 10 years earlier she underwent to ovarian hyperstimulation for an ovulation induction. She was taken to the emergency room for a fainting episode with signs of a clear hemodinamic shock without a present history of trauma. The intricacy of this case was mostly due to the choice of the correct management, where the damage control resuscitation turned out to have an important role.

The discovery of two archaeological objects describing La Peyronie's disease. They come from the archaeological excavation of Pantanacci (Lanuvio, south of Rome), that has returned numerous objects of medical representation dating back to the IV-III sec. B.C.

Aim: The purpose of this study is to analyze a rare and under-reported complication of abdominal liposuction and the role of laparoscopy.

Clinical case: We report a case of bowel perforation after 7 days of abdominal liposuction and bilateral mastopexy. The patient presented clinical and radiological findings of bowel obstructive syndrome and bilateral peripheral pulmonary embolism. An emergency diagnostic laparoscopy was performed and confirmed the diagnosis of bowel perforation.

Discussion: Bowel perforation is a known but under-reported comSOD Romaplication of abdominal liposuction, and it is characterized by a difficult diagnosis. The clinical presentation is characterized by a difficult diagnosis and severe complications. Bowel obstructive syndrome was constant, as our case and also peritonitis was never frank. This is an important point because it is one of the reasons for diagnostic delay. The development of laparoscopic surgery has changed the way to manage such conditions, where the diagnosis was doubt. In particular, when an acute abdomen occurs, laparoscopy may have three different roles: to confirm or not the diagnosis, to facilitate and guide a subsequent laparotomy or, finally, to entirely treat the disease.

Conclusion: The bowel perforation is a dramatic and underestimated complication of abdominal liposuction. Diagnosis is complex. A clinical and radiological investigation should be quickly performed. In doubtful cases, an emergency laparoscopy can confirm the diagnosis and guide a possible subsequent laparotomy.