Gastrojejunocolic fistula after gastric surgery for duodenal ulcer: case report

Gastrojejunocolic fistulae, a late complication of gastroenterostomy, are presently uncommon. Patients can present with symptoms of a fistula 20 years or more after their original gastric surgery. The knowledge of this rare condition can allow prevention, through a better operative strategy and a medical treatment at the phase of stomal ulcer with proton pump inhibitor and Helicobacter pylori eradication. We present a case of gastrojejunocolic fistula and discuss the modern management of this condition. Its etiological, clinical, and surgical features were briefly discussed

Traumatic avulsion of the intrapancreatic common bile duct: case report

Injuries of the extra hepatic biliary tree following blunt trauma to the abdomen are rare.We present a case of avulsion of the intrapancreatic common bile duct. Very often the lesion is not identifiable until the signs of jaundice and biliary ascites occur. Intraoperative cholangiography is mandatory for the diagnosis, but the noninvasive magnetic resonance cholangiopancreatography could readily depict the injury of the extrahepatic bile duct preoperatively. When the diagnosis is late the corner stone of treatment is biliary diversion and definitive repair after complete resolution of sepsis with a choledochojejunostomy. Versione Italiana Le lesioni dell?albero biliare extraepatico per trauma addominale chiuso sono rare. Presentiamo un caso di avulsione del coledoco intrapancreatico. Molto spesso le lesione non è identificabile fino a quando non compaiono i segni di ittero e ascite biliare. La colangiografia intraoperatoria è fondamentale per la diagnosi, ma la meno invasiva colangio-RMN è efficace nell?individuare preoperatoriamente una lesione del coledoco. Quando la diagnosi è tardiva gli obiettivi del trattamento sono la diversione biliare e la riparazione definitiva con una coledocodigiunostomia dopo completa risoluzione della sepsi

I tumori infiammatori del cieco in urgenza: considerazioni di terapia chirurgica e caso clinico

Una tumefazione ciecale di origine incerta riscontrata in corso di intervento chirurgico per appendicite acuta pone al chirurgo dubbi sia diagnostici che terapeutici. La diagnosi differenziale di una massa ileociecale inaspettata deve includere le neoplasie, la malattia diverti - colare, le malattie infiammatorie intestinali e un’appendicite severa o trascurata che interessi la regione ileociecale. L’emicolectomia destra risulta essere il trattamento di scelta per le masse ciecali inaspettate. Gli Autori presentano un caso di tumore infiammatorio del cieco di origine appendicolare in un giovane adulto

Role of Leptin in Neoplastic and Biliary Tree Disease

Background/Aim: Leptin is a small hormone of protein nature, it is strongly involved in the regulation of lipid metabolism and its functioning mechanism is not yet well known or whether or not it is actually secreted by cholangiocytes, nor if the biliary tree expresses its receptors. In the past, various studies have tried to correlate leptin levels with certain neoplasms. The aim of this study was to demonstrate that serum leptin values can become a new sensitive and specific serum marker for cholangiocarcinoma. Materials and Methods: Seventy-two patients with gallbladder stones, hepatolithiasis with benign biliary stenosis, cholangiocarcinoma, and a group of patients without epatobiliary diseases were enrolled in the study. In all cases blood and bile samples were collected for evaluation of leptin levels and liver biopsies were performed to confirm diagnosis. In all patients, both ultrasound and cholangio-magnetic resonance imaging (MRI) were performed to complete the diagnostic procedure. Results: Twenty-two patients were affected by cholangiocarcinoma, 50 by benign biliary disease (35 cholelithiasis and 6 hepatolithiasis and 9 by inflammatory biliary stenosis). The mean values of serum leptin in patients with cholangiocarcinoma were 19.28±8.76 ng/ml, significantly higher than those observed in non-neoplastic biliary diseases. Conclusion: Serum leptin levels might be a useful marker to differentiate patients with cholangiocarcinoma from those with biliary lithiasis and inflammatory stenosis

A prospective cohort analysis of the prevalence and predictive factors of delayed discharge after laparoscopic cholecystectomy in Italy: the DeDiLaCo Study

Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC. Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units. Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P <0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours. Conclusions: The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge