Tecnica operatoria di ernioplastica protesica tension-free nelle ernie inguinali intasate nei pazienti anziani.

AIMS OF THE STUDY: With the increasing of the middle age, more and more elderly patients with incarcerated inguinal hernia have to be surgically treated with lower operatory time and lower anesthesiological stress. The Authors present a personal tension-free hernioplastic technique. MATERIALS AND METHODS: Thirthy-seven male patients (range 80-92 years) recovered for incarcerated inguinal hernia (Gilbert II tipe) without vascular injury, underwent to tension-free hernioplastic technique without inguinal canal opening, in local anaesthesia. RESULTS: The average operative time was 33 minutes (range 25-42 min). Follow-up at 10 days, 3 months and 5 years shows a correct position of the plug, no recurrence, no alterations of normal testicular vascolarization in absence of paresthesia or chronic pain. The post-operative pain was absent or trascurable whitout the use of any antalgical therapy

Cryptogenetic intestinal angiodysplasia and elderly aortic stenosis: Heyde's syndrome? A case report.

Gastrointestinal haemorrhage is extremely frequent, but in some cases the aetiology may remain unknown. Haemorrhage from the small bowel especially can create important diagnostic problems. We report the case of a patient admitted to hospital with intestinal bleeding in an ileal site in association with aortic stenosis. Enteric angiodysplasia is a frequent pathology in the surgery of the gastrointestinal tract. Recognizing bleeding lesions in the small intestine can be really difficult. Concerning the case reported here, the most probable diagnostic hypothesis is Heyde's syndrome, which is characterised by valvular aortic stenosis together with gastrointestinal bleeding due to cryptogenetic angiodysplasias. The choice to be made in the therapeutic management of angiodysplasia is still a debatable issue and should be suited to the patient's clinical state and the site and extent of the bleeding. In the literature the link between aortic valvular stenosis and intestinal angiodysplasia is unclear. The physiopathological relationship between the two entities is still mysterious

Pancreatite acuta postoperatoria. Esperienza personale e revisione della letteratura

AIM: Acute postoperative pancreatitis is a rare event, but, at the same time, it represents one of the most frightening complications, because it is associated with high mortality risk. METHODS: From January 1985 to December 2005, we observed 30 cases (12 males, 18 females) of acute postoperative pancreatitis. Twenty cases of low and medium gravity have been treated with only medical therapy, 10 cases, instead, have requested surgical therapy (necrosectomy and application of abdominal drains in 7 cases, necrosectomy and ileostomy in 1 case, necrosectomy and colostomy in 1 case, ligation of pancreatic vessels in 1 case of haemorrhagic pancreatitis). RESULTS: In the form of low and medium gravity, fast and pharmacological support (somatostatin and gabexate mesilate) are enough to resolve the event. In the form of high gravity the early surgical treatment has represented the clinical solution in 7 patients, while 3 others patients have died for septic and metabolic complication. CONCLUSIONS: Still today acute postoperative pancreatitis represents a frightening complication associated with high mortality risk that the surgeon has to treat with great care to avoid each bilio-pancreatic injury

Pseudoaneurisma dell’arteria splenica: insolito caso di emorragia gastrointestinale in paziente con pancreatite cronica

A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. This diagnosis may be very difficult and the optimal treatment remains controversial. We report the case of 80 years old female with calcific pancreatitis and severe intestinal bleeding due to a pseudoaneurysm of the splenic artery treated with interventional radiographic embolization

I carcinoidi intestinali: esperienza personale e revisione della letteratura

The observation of a number of cases of intestinal carcinoid tumours prompted the authors to review the literature in order to define the principal biological and anatomopathological aspects and the current therapeutic choices. The diagnosis is often obtained on the basis of anatomopathological examination. The kind of surgical treatment is still a matter of controversy: minimal or extended resection? A number of criteria may orient the surgeon towards major surgery, such as tumour size, node involvement, infiltration of the serous membrane, and liver metastases