Chirurgia italiana最新文献

Although rare, gastrointestinal stromal tumours (GIST) are the most common mesenchymal neoplasms of the gastrointestinal tract. We present our experience with the treatment of 8 patients affected by gastrointestinal stromal tumours of the ileum and colon. These cases were characterised by acute bleeding, intestinal obstruction or diffuse abdominal pain, and all of them underwent an emergency surgical treatment. We performed six partial resections of the ileum, one right hemicolectomy and one left hemicolectomy. Three patients died after surgical procedures for disease relapse, one died 10 years later due to other complications, and the others are still alive.

Retroperitoneal schwannoma is a very rare benign tumour that accounts for only a small percentage of retroperitoneal tumours. The preoperative diagnosis is difficult and the only treatment is complete surgical excision. The authors report their experience with a case of a voluminous retroperitoneal mass in a 42-year- old male patient, incidentally discovered during a diagnostic search for a blunt abdominal trauma. Because of the unclear origin of this mass, the patient underwent periodic radiological and ultrasonographic examinations. Three years later, owing to a slight increase in this mass and vague abdominal discomfort reported by the patient, surgical excision was performed. Histological examination of the surgical specimen revealed an "ancient schwannoma". The patient is alive and well and has had no recurrence in the twenty months since surgery. The authors, after a short discussion of the subject, go on to examine the diagnostic and therapeutic treatments of this rare benign neoplasm, which always arouses lively clinical and scientific interest.

A borderline Schwann cell tumour with common bile duct compression and jaundice is extremely rare. This paper presents the first report in the Italian literature of a hepatojejunostomy for a symptomatic lesion midway between benign and malignant.

An inflammatory fibroid polyp is a rare benign submucosal lesion frequently located in the gastric antrum but it may be found anywhere in the gastrointestinal tract with maximal incidence in the fifth and sixth decades of life. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils, high vascularisation and a myofibroblastic component. Its localisation in the small bowel can cause intestinal invagination in adults, a condition, that occurs most frequently in childhood where, however, it is generally not related to a pathological lesion. The diagnosis may often be delayed because of its non-specific symptoms and most cases are diagnosed at emergency laparotomy, although CT scans can furnish useful preoperative information. In the majority of cases, the treatment of choice is surgical resection. Reduction performed prior to resection proves controversial in patients with colic intussusception because of the high incidence of malignancy. We report a case of a 37-year-old man who had undergone emergency surgery for acute ileum intussusception associated with a voluminous inflammatory fibroid polyp. The case described emphasises that patients with bowel obstruction pose a complex and difficult challenge to surgeons as regards the choice of the correct diagnostic work-up and optimal therapeutic management.

Surgical resection is the main and most effective treatment for gastrointestinal stromal tumours (GISTs) and for all benign gastric tumours. All such tumours should be approached with the intention of performing complete en bloc removal of the tumour, achieving microscopically tumour-free pathological resection margins. More extensive surgery fails to guarantee better results over time. Consequently, wedge resection of the stomach ensures adequate therapy. Our personal experience with laparoscopic wedge resection for a gastrointestinal stromal tumour is described, demonstrating equivalent efficacy, greater safety, and applicability, and better postoperative results with this surgical approach.

Endovascular prosthesis infection after exclusion of an abdominal aortic aneurysm is a rare, dramatic event and its diagnosis and treatment are extremely complex. This particular complication has been less well explored in the literature than others such as endoleaks, migration or stent rupture. The incidence of aorto-iliac stent-graft infection is almost 0.7%, while the infection rate in open surgery varies from 0.6% to 3%. Moreover, the infection can be early when it arises within 4 months of the implant or late when it arises after 4 months. Since 1991 only 94 cases of endograft infections have been reported in the world literature, to which our two cases need to be added, making a total of 96 cases. The first of our patients was diagnosed with an early infection that was successfully treated by explanting the infected graft followed by aortic reconstruction with a homograft. Six months after the operation the patient died of cardiac failure. The second case was a late infection which developed 8 years after the first intervention in a patient with chronic renal failure treated with dialytic therapy. After aneurysmectomy and stent-graft removal, a bifurcated dacron silver graft was implanted. The patient died of cardiogenic shock 40 days after surgery. The surgical treatment of this serious complication is associated with high perioperative morbidity and mortality rates and requires very careful planning of the operation.

Although a possible link between gastro-oesophageal reflux disease (GORD) and obstructive sleeping apnoea has already been reported in the literature, there has never been any suggestion of an association with epilepsy, and epileptic attacks have not so far been included among gastro-oesophageal reflux disease symptoms. We report the case of a patient with gastro-oesophageal reflux disease associated with a sliding hiatus hernia, a short oesophagus and oesophagitis, who for the last ten years had not only presented the typical symptoms of gastrooesophageal reflux, but also symptoms of obstructive sleep apnoea and epileptic-like attacks occurring occasionally and only during sleep. Partial posterior fundoplication was performed and considerably reduced the reflux symptoms, and in addition brought about a drastic decrease in the number of epileptic-like attacks. Our case suggests that epileptic-like episodes in patients with obstructive sleeping apnoea may well be linked to the simultaneous presence of GORD associated with hiatus hernia, and surgical treatment of GORD may bring about an improvement of the neurological problems.

Rectal mucosal prolapse is characterised by the protrusion of the mucosa alone in the rectal lumen. The authors, after an experience conducted in ambulatory patients, have produced a score to classify the extent of rectal mucosal prolapse based on evaluation of qualitative and quantitative factors that should help in the correct management of proctological patients. A total of 30 patients with proctological symptoms during outpatient visits were submitted to a minimally invasive test in comparison to the traditional ones, using a simple gauze plug connected to the end of a suture thread, inserted in the rectal lumen and removed via the anus. The score designed by the authors made it possible to classify 96.6% of patients accurately. In 4 patients the score was equal to zero. In 12 patients there was a mucosal prolapse of less than 25% with a reduction score equal to 2.4 and therefore these were treated with a single rubber ligature (7 patients with classes a and b) and 5 patients were treated with the transfixed stitch technique (TST) (class c). In 10 patients a 50% mucosal prolapse of the anal circumference and a mean reduction score of 5.6 were found. In 5 of these patients (classes a and b) it was possible to perform a multiple ligature while the other 5 (class c) were treated with TST. In 3 patients a prolapse ranging from 50 to 75% with a mean reduction index of 8.1 was found. The therapeutic procedure preferred for these patients was TST. In one patient a circumferential prolapse was diagnosed with a reduction score of 11 treated with Longo's surgical technique. The mucosal prolapse score seems to be useful to stratify patients more precisely in the choice of surgical intervention and during follow-up. The plug test is a minimally invasive test, useful for the application of the rectal mucosal prolapse score.

In this retrospective study, the modality and advantages of the multidisciplinary diagnostic work-up and therapy regarding colorectal neoplasm were analysed. Over the period 2004-2008, 63 patients underwent multidisciplinary treatment for colorectal cancer. All patients underwent surgery (laparoscopic/open). Exeresis was supplemented by adjuvant chemotherapy in those cases beyond IIA stage; all cases of extraperitoneal rectal and anal canal neoplasms plus one case of carcinoma of the transverse colon, initially inoperable, underwent neoadjuvant radiotherapy plus chemotherapy. The treatment was initiated approximately 3 weeks after the diagnosis. Fifty-four percent of patients with colonic and upper rectal neoplasms were given adjuvant chemotherapy, starting around 4 weeks after surgery. Exeresis was performed in those patients with extraperitoneal rectal and anal canal neoplasms (12.7%) about 6-8 weeks after they had completed neoadjuvant therapy. At the end of the treatment, 76% of the overall total numbers of patients were in good condition (follow-up 4-50 months). The remaining 24% suffered recurrences about 13 months after the treatment for colonic and upper rectal neoplasm, and 8 1/2 months after treatment for extraperitoneal rectal/anal canal neoplasms. Seventy-five percent of the recurring cases underwent treatment again, with 50% success; the others are still undergoing treatment. The best therapeutic results were obtained by programmed integration of the various diagnostic-therapeutic steps according to an algorithm which we elaborated to evaluate all types of neoplasm at any stage of illness.

This article describes and discusses a successfully treated case of a primary posterior perineal hernia which is a rare cause of outlet dysfunction. A 46-year-old female patient had a 6 cm left para-anal protrusion and a 7-year history of outlet dysfunction. The perineal hernia orifice was closed via an abdominal approach using both a polypropylene mesh and a Parietex Composite Net. A rectopexy to the promontory of the sacrum was then performed. Moreover, after 6 months' follow-up, the patient presented a sense of incomplete evacuation and underwent a prolassectomy to treat a hidden rectal prolapse. This clinical case shows that the surgical treatment of a pelvic pathology can be successful for the correction of a serious functional defect such as outlet dysfunction.