Intersigmoid hernia. A forgotten diagnosis, a systematic review of the literature over anatomical, diagnostic, surgical, and medicolegal aspects

Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods. In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. &e purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results. &e diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1–10 cm, SD 1.15 cm) and the length of the incarcerated small intestine was between 3 cm (min) and 150 cm (max): mean 25.25 cm, SD 35.04 cm. &e diameter of the sigmoid recess was greater in patients who underwent resection due to strangulation (mean 3.31 cm, SD 1.53 cm) compared to those who underwent only reduction of the hernia (mean 2.35 cm, SD 0.74 cm). &e time from onset to operation was less in patients undergoing resection surgery due to throttling (mean 3.03 days, SD 3.01 days) compared to those who underwent only a reduction of hernia incarceration (mean 8.49 days, SD 6.83 days). Conclusion. Intersigmoid hernia is often a forgotten diagnosis and a clinical challange due to its anatomical characteristics

Diagnostic and behavioural parameters differentiating proliferative muscolo-fascial low grade lesions. Case reports

Pseudosarcomatous nodular fasciitis and desmoid tumors can be very similar at physical examination. Although their behaviours and cytologic aspects are very different, they both undergo the same surgical approach. Nevertheless, only desmoid tumors - because of their high rate of local recurrence - require a strict follow-up and further therapies when radicality of primary surgery could not be likely performed

Attuale ruolo della chirurgia nel trattamento multimediale della malattia neoplastica

G Chir. 2008 Jan/Feb;29(1/2):5-7

Il linfoma della mammella: orientamento diagnostico e chirurgico

L'esperienza relativa all'osservazione e al trattamento chirurgico di una paziente operata per linfoma primitivo della mammella ha indotto gli Autori a riconsiderare le problematiche inerenti l'inquadramento nosologico, le difficoltà di una diagnosi clinica, il ruolo del chirurgo e il tipo di intervento chirurgico in tale patologia. English version: By clinical observation and surgical treatment of a patient with a primitive lymphoma of the breast, the Authors describe the nosological approach, the correct diagnosis and the relative surgical treatment in that disease

In tema di lesioni pseudosarcomatose

Di etiologia sconosciuta, a localizzazione prevalente negli arti superiori, la fascite nodulare viene oggi considerata una lesione, più che di natura neoplastica, di tipo reattivo-infiammatorio aspecifico. Scarsamente sintomatica, si avvale dell'esame istologico per la diagnosi di certezza. L?estensione dell'exeresi va modulata in relazione ai dati dell?esame istologico definitivo. English version: Of unknown ethiology, mainly located on the upper limbs, the nodular fasciitis nowadays is considered as a reactive inflammatory lesion more than a neoplastic one. With very few symptoms, it can be diagnosed through histhology and the extention of the excision is related to the report of the pathological examination

Vantaggi e limiti dell’anestesia per tumescenza in chirurgia ambulatoriale

Gli Autori hanno studiato le possibilità di applicazione della anestesia per tumescenza in 187 pazienti sottoposti a vari interventi chirurgici ambulatoriali. Ne hanno valutato le indicazioni, le complicanze, i vantaggi e i limiti, comparandone i risultati con quelli riscontrati nei pazienti sottoposti a interventi in anestesia locale per infiltrazione diretta

Vascularized fibula flap reconstruction of the mandible in bisphosphonate-related osteonecrosis.

Aims: To point out the feasibility of microsurgical reconstruction of the mandible in patients with bisphopsphonate-related osteonecrosis (BRONJ). Methods: Seven patients with extensive mandibular osteonecrosis underwent subtotal mandibulectomy and immediate reconstruction with a free fibula flap. They were six women and one man aged 49-72 years. The mean size of the bone and oral mucosa defects were 18.5 and 22.5 cm(2) respectively. Results: The mean time of surgical intervention was 12 h. All flaps survived and the postoperative course was uneventful. Oral feeding was resumed 14 days after surgery in all cases. The donor legs healed without complications. The pathology report confirmed the diagnosis of BRONJ in all patients. Normal bone was detected at the resection margins in six out of seven patients. Patients were followed-up at intervals of 3 months. After a median follow-up time of 23 months, no clinical and radiographic evidence of recurrent BRONJ were detected in six patients. One patient with osteomyelitis at the resection margins had signs of recurrent BRONJ 6 months after surgery. The overall curative rate of the population was 86%. Conclusions: Despite the limited number of patients studied so far, our data show that mandible reconstruction with the fibula flap is feasible and does not influence the natural course of the primary disease in BRONJ-resected patients.

Detection of sentinel node in breast cancer: Pilot study with the imaging probe

The commonly used gamma probes are easy to use but also give rough information when employed in radioisotope-guided surgery. When images are required for exact localization, a gamma camera as well as a probe have to be used. Position-sensitive photomultipliers have contemporaneously allowed high-resolution scintigraphy and miniaturization of gamma cameras. We have assembled a miniature gamma camera with a 1-square-inch field of view and an intrinsic resolution of about 1 mm. When the minicamera is collimated with a large-holed, highly sensitive collimator, it acquires a spatial resolution of 3 mm. This prototype has been tested in the detection of difficult-to-image breast cancer sentinel nodes. Five nodes that had not been found with the usual technique of an Anger camera plus conventional probe were checked with the miniature camera that we named imaging probe: it actually is small enough to be used as a probe and large enough to give an image. One of the five nodes was found and imaged. It was small, disease-free, close to the tumor and probably hidden by the Compton halo around the peritumoral injection site. Our pilot study shows that the imaging probe, although still a prototype, has certain advantages over conventional methods when lymph node localization is required during surgery