A stinging wasp in the stomach: accidental endoscopic diagnosis of a systemic anaphylactic reaction.

There are only four reported cases of bees or wasps being found as foreign bodies in the esophagus or stomach. We report the first case, to our knowledge, of a wasp puncture in the stomach causing local (acute heartburn) and systemic symptoms (anaphylaxis)

Endoscopic palliative management of esophageal and tracheal rupture

The increasing number of patients requiring intensive care and airway support has led to a growing recognition that significant short- and long-term morbidity may be associated with the use of artificial airways; this is despite significant improvements in the materials used in laryngeal tubes, which aim to decrease the trauma associated with long-term intubation. We present the first case, to our knowledge,of huge, nontraumatic, esophageal perforation, widely communicating with the trachea, and which was treated successfully with double endoscopic stent placement

Stump appendicitis. A case report

AbstractIntroductionToday, the diagnosis of SA is usually not considered as the etiology for right lower quadrant pain in patient with history of appendectomy, resulting in delaying making the correct diagnosis and treatment. Obviously, other more common causes should be excluded first.DiscussionStump appendicitis (SA) was first described by Rose in 1945. The commonest presenting symptom are abdominal pain (right lower quadrant pain 59%, non specific abdominal pain 16%, and central abdominal pain radiating to the right lower quadrant 14%).Presentation of caseA 54-year-old appendectomized woman presented with recent history of abdominal pain with periumbilical pain radiating to the right side and in the right iliac fossa, in the absence of fever, vomiting or other symptoms.Elective colonoscopy revealed appendicular orifice clogged by big fecalith, with hyperemic surrounding mucosa and CT confirmed “stump appendicitis”. After 30 days of therapy with metronidazole 500mg/day and mesalazine 1000mg×2/day, the patient was submitted to surgery and appendectomy was performed, with a specimen of 24mm stump appendicitis.ConclusionSA may well be considered as one of the differential diagnoses of acute right lower abdominal pain even in patients with history of appendicectomy

Surgical treatment of solitary sternal metastasis from breast cancer Case report

Bone metastasis is a frequent and early complication of breast cancer. This case report describes a technique for a partial exeresis of the sternum and the reconstruction of the pleura with autologous dermis from the lower abdomen and the loss of substance with a myocutaneous flap

Retrospective analysis of management of ingested foreign bodies and food impactions in emergency endoscopic setting in adults

Background: Ingestion of foreign bodies and food impaction represent the second most common endoscopic emergency after bleeding. The aim of this paper is to report the management and the outcomes in 67 patients admitted for suspected ingestion of foreign body between December 2012 and December 2014. Methods: This retrospective study was conducted at Palermo University Hospitals, Italy, over a 2-year period. We reviewed patients’ database (age, sex, type of foreign body and its anatomical location, treatments, and outcomes as complications, success rates, and mortalities). Results: Foreign bodies were found in all of our 67 patients. Almost all were found in the stomach and lower esophagus (77 %). The types of foreign body were very different, but they were chiefly meat boluses, fishbones or cartilages, button battery and dental prostheses. In all patients it was possible to endoscopically remove the foreign body. Complications related to the endoscopic procedure were unfrequent (about 7 %) and have been treated conservatively. 5.9 % of patients had previous esophageal or laryngeal surgery, and 8.9 % had an underlying esophageal disease, such as a narrowing, dismotility or achalasia. Conclusion: Our experience with foreign bodies and food impaction emphasizes the importance of endoscopic approach and removal, simple and secure when performed by experienced hands and under conscious sedation in most cases. High success rates, lower incidence of minor complications, reduction of the need of surgery and reduced hospitalization time are the strengths of the endoscopic approach

ANATOMICAL VARIATIONS OF THE INTERNAL JUGULAR VEIN: THE ROLE OF ULTRASONOGRAPHY

Purpose: In many places, especially in emergency department, central venous catheter is still inserted using anatomical landmark guidance with a success rate up to 97.6% and complications up to 15%. This study was aimed to determine by the support of ultrasono-graphy (US) the anatomical variations of the internal jugular vein (IJV) in relation with other structures of the neck, such as the common carotid artery (CCA). Material and Methods: 830 patients requiring central vein catheterization (CVC) were in-cluded in the analysis. The position of the IJV in relation to the other structures of the neck was demonstrated by portable ultrasonography. Results: The mean diameter of IJV was 10.3 mm in right and 10.5 mm in left side of neck, in male (p > 0.05) and 9.1 mm in right and 10.5 mm in left side of neck, in female (p > 0.05). The mean distance between IJV and CCA was 1.9 mm in right and 1.7 mm in left side of neck in male, and 2.0 mm in right and 2.2 mm in left side of neck in female. The mean distance of IJV from the skin surface was 9.8 mm in right and 10.0 mm in left side of neck in male, and 12.1 mm in right and 12.5 mm in left side of neck in female. On 25.54 % we observed variations of internal jugular vein site. On 3.97 % we observed a small caliber of internal jugular vein that could complicate the catheterization of the vein. On 1.8 % was diagnosed a thrombus of internal jugular vein, that is considered as an ab-solute contraindication for a CVC. Conclusion: Different patients had anatomical variations that are important and should be knowed, in order to reduce the possibility of severe complication

A case of splenic rupture: a rare event after laparoscopic cholecystectomy

Background Laparoscopic cholecystectomy (LC) is generally safe and well-accepted. In rare cases, it is associated with complications (intra- e postoperative bleeding, visceral injury and surgical site infection). Splenic lesion has been reported only after direct trauma. We report an unusual case of splenic rupture presenting after “uncomplicated” LC. Case presentation A 77-year-old woman presented with distended abdomen, tenderness in the left upper quadrant and severe anemia 12 hours after LC. Clinical examination revealed hypovolemic shock. Abdominal computed tomography confirmed the diagnosis of splenic rupture, and the patient required an urgent splenectomy through midline incision. The post-operative course was uneventful and the patient was discharged on 7th postoperative day. Splenic injury rarely complicates LC. We postulate that congenital or post-traumatic adhesions of the parietal peritoneum to the spleen may have been stretched from the splenic capsule during pneumoperitoneum establishment, resulting in subcapsular hematoma and subsequent delayed rupture. Conclusions Splenic rupture is an unusual but life-threatening complication of LC. Direct visualization of the spleen at the end of LC might be a useful procedure to aid early recognition and management in such cases

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF

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, there was no residual lesion. Colonic lipomas larger than 2 cm can be safely and efficaciously removed using electrosurgical snare polypectomy technique. The technique of submucosal injection before resection and using an electrocautery snare appears to be safe and reduces the risk of perforation reported in the literature