Diagnosis of intra-abdominal injuries can be challenging in multitrauma patients with associated injuries. Our experience and review of the literature

ntroduction. Trauma is the most common cause of death and disability among patients during the first four decades of life. Abdominal trauma is reported to be the 3rd most common injured region. Clinical examination may be unreliable in the evaluation of these patients especially in the presence of associated injuries. Therefore the use of diagnostic tools is essential in the management of the injured patient with abdominal trauma and additional injuries. Patients and Methods. During 1 year period from December 2010 to November 2011 we recorded the patients that presented to the emergency department of our hospital and were found to suffer from intra-abdominal injuries. These patients were divided in two groups depending on whether they had additional comorbid injuries or not. Several parameters were recorded and compared between the two groups, such as mechanism of injury, general status and hemodynamic stability of the patient on presentation, physical examination, use of imaging modalities and concomitant findings, need for surgical intervention and mortality rates. Furthermore the discrepancy between physical findings and final diagnosis after the use of diagnostic adjuncts is reported. Results. We recorded 31 patients with abdominal trauma. 13 (42%) patients were found to suffer from abdominal trauma and associated injuries (Group I), whereas 18 (58%) presented with abdominal trauma alone (Group II). The patients of the first group presented hemodynamic instability in 38% of cases while the patients of the second in 22% of cases. Reduced consciousness was present in 38% in group I versus 17% in group II. Signs of abdominal injury during clinical examination were present in only 15% in group I versus 72% in group II that represented a remarkable difference between the two groups. Conservative treatment was possible in 15% of patients with additional injuries and in 22% of patients with abdominal injury alone. In group I there were two deaths whereas in group II all patients survived. Conclusion. In patients with abdominal trauma, associated injuries seem to add to the severity of injury and indicate a worse prognosis. Clinical examination is unreliable and misleading in the majority of these patients and the use of diagnostic tools cannot be overemphasized

Ostruzione intestinale secondaria a mucocele appendicolare: descrizione di un caso e revisione della letteratura

Per mucocele appendicolare si intende un gruppo di lesioni nelle quali il lume dell’ appendice si dilata con accumulo di muco nel suo interno. È una patologia rara che si presenta nello 0,2-0,3% di tutte le appendiciti asportate. Presentiamo un caso di mucocele appendicolare gigante, con occlusione intestinale secondaria, in un paziente di 73 anni di sesso maschile e una revisione della letteratura sull' argomento

Isolated giant mesenteric fibromatosis (intra-abdominal desmoid tumors). Case report

A rare case of isolated giant mesenteric fibromatosis is presented. The tumor originated from the fibrous mesenteric tissue. The patient underwent laparotomy because of abdominal discomfort and subocclusive symptoms due to the giant mass. Differential diagnosis of mesenteric masses is discussed and the Authors also review the literature concerning this rare disease

Colon bleeding from both arteriovenous malformation and inflammatory bowel disease. Case report

Introduction. Although endoscopy and angiography have changed the management of lower gastrointestinal bleeding and the majority of patients respond to conservative treatment 10-20% of cases have no recognizable site of hemorrhage. About 10-30% of all patients will require operative intervation. A very rare case of massive lower gastrointestinal bleeding in a young patient who was found to suffer from two causes of gastrointestinal hemorrhage in the same time is reported. The patient had to undergo surgery for the control of bleeding. Case report. A 23 years old male Greek patient presented to the emergency department of our hospital because of three episodes of hematochezia during the last 10 hours. He was admitted to the surgical department for monitoring of his condition. In the next 10 hours the hematochezia continued and the patient although being transfused with three units of packed red blood cells, started to become unstable with his vital signs affected, having also a syncoptic episode. Emergent colonoscopy could not recognize the site of hemorrhage or any other pathology in the colon, but revealed an intestinal lumen full of blood from the anus to the cecum. It was decided that the patient should undergo operation to stop bleeding. An extensive right hemicolectomy was performed. After that the patient remained stable and showed no signs of hemorrage. The histopathological examination of the specimen showed an arteriovenous malformation but also lesions of the mucosa compatible with early inflammatory bowel disease. Conclusions. In young patients with massive lower gastrointestinal bleeding of unknown origin, extensive right hemicolectomy provides a good and safe therapeutic choice that will control hemorrhage in most cases with the advantage of lower mortality and morbidity rates compared to subtotal colectomy. Close monitoring of the patient postoperatively is essential

Metastasi in sede di trocar (port site metastasis) dopo chirurgia oncologica laparoscopica. Presentazione di un caso e revisione della letteratura

First success of laparoscopic surgery promoted the application of this technique in the treatment of malignancies. The technique has been associated with less postoperative pain, a better cosmetic result and a shorter period of hospitalization. The early optimism has been followed by the doubts based on the observation of port site metastasis after laparoscopic surgery for neoplastic deseases. Port site metastases have been reported without a sure explanation of their cause: gas turbulence and exfoliated cells, contaminated instruments or limited experience of surgeon. In this study we present a case of a woman that underwent laparoscopic cholecystectomy; 12 months later she presented with port site metastasis from an unsuspected ovarian cancer. We review in the literature about this complication of the laparoscopic surgery