Gerota's fascia flap: a technique for autogenous packing in major liver injuries.

Hepatic trauma occurs in ∼ 5% of patients admitted to emergency rooms and nonoperative management has become the standard of care in hemodynamically stable patients with blunt trauma, for most of the injured solid organs. However, the staged surgery represents the first line of treatment in hemodynamically instable patients. The abdominal packing is considered the first step of this surgical policy. The authors describe a new surgical technique consisting of Gerota's fascia dissection that provide an autogenous pedunculated flap to obtain a definitive hemostasis of the injured liver with a permanent packing system

Laparoscopic Colorectal Surgery in Urgent and Emergent Settings

Laparoscopic colectomy (LC) is slowly becoming the standard of care for elective resections. The use of LC in the emergency setting is relatively unstudied. Authors describe their experience with a series of 34 emergent and urgent LC cases for a variety of benign and neoplastic colorectal diseases, admitted from 2007 to 2009 at Emergency Department of a tertiary level hospital, comparing laparoscopic group with matched control open group. Twenty-one LC was performed for benign complicated disease, 12 for malignant disease and 1 for iatrogenic perforation during colonoscopy. Two cases were converted to open procedure (5.8%), the average operative time was 188 minutes (SD 61.84). The average postoperative length of hospital stay was 6.57 days (SD 1.75), with no postoperative mortality and no major morbidity. Results of laparoscopic group compared with 61 patients treated with open colorectal procedure confirm the advantages of laparoscopic approach similar to those established in elective colorectal surgery. With increasing experience, LC would be a feasible and an effective option in nonelective situations lowering complication rate and length of hospital stay

The alterations of the sigmoid-rectal junction in diverticular disease of the colon revealed by MR-defecography

The sigmoidorectal junction (SRJ) has been defined as an anatomical sphincter with particular physiological behavior that regulates sigmoid and rectum evacuation. Its function in clinical conditions, such as diverticular disease has been advocated. The aim of our study is to identify the SRJ and to compare the morphometric and dynamic features of the SRJ between patients with diverticular disease and healthy subjects using MR-defecography. Sixteen individuals, eight with uncomplicated diverticular disease and eight healthy subjects, were studied using MR-defecography to identify the SRJ and to compare the morphometric and dynamic features observed. In each subject studied, MR-defecography was able to identify the SRJ. This resulted in the identification of a discrete anatomical entity with a mean length of 31.23 mm, located in front of the first sacral vertebra (S1) and at a mean distance of 15.55 cm from the anal verge, with a mean wall thickness of 4.45 mm, significantly different from the sigmoid and rectal parietal thickness. The SRJ wall was significantly thicker in patients with diverticular disease than the controls (P = 0.005), showing a unique shape and behavior in dynamic sequences. Our findings support the hypothesis that SRJ plays a critical role in patients with symptomatic diverticular disease; further investigation may clarify whether specific SRJ analysis, such as MR-defecography, would predict inflammatory complications of this diffuse and heterogenic disease

Ectopic liver nodules: a rare finding during cholecystectomy

The ectopic liver (or choristoma) is a rare condition found during autopsy or abdominal exploration for various indications. The authors report two cases of ectopic liver found during laparoscopic cholecystectomy for acute cholestytis. The ectopic liver tissue has been reported to develope in several sites as thoracic cavity, gastrohepatic ligament, adrenal glands, pancreas, esophagus and, above all, gallbladder. The Authors review the literature and report their experience as a contribution to the knowledge of this rare pathological entity

Treatment of esophageal perforations. Considerations on a clinical case. [Trattamento delle perforazioni esofagee. Considerazioni su un caso clinico.]

Gli Autori, partendo dalla descrizione di un raro caso di perforazione esofagea insorta in un paziente di 68 anni due ore dopo l'esecuzione di un Ecocardiogramma TransEsofageo (TOE), prendono in esame questa patologia, non frequente ma grave, tema di discussione per le problematiche di diagnosi e di strategie terapeutiche che essa comporta. Gli Autori ne descrivono le cause, tra le quali l'Ecocardiogramma TransEsofageo (TOE), un esame semi-invasivo utilizzato sempre di più in cardiologia e nel corso di interventi chirurgici cardiaci, e il trattamento, che dipende dalla localizzazione della perforazione, dalla presenza di concomitanti patologie esofagee e dall'intervallo di tempo intercorso tra l'insulto e l'inizio del trattamento. Nell'ambito del trattamento chirurgico la riparazione primaria della perforazione è considerata, quando ne sussistano le condizioni , il trattamento chirurgico più idoneo ed è il tipo di intervento scelto dagli Autori per risolvere, con successo, il caso clinico descritto