A Rare Case of Perforated Descending Colon Cancer Complicated with a Fistula and Abscess of Left Iliopsoas and Ipsilateral Obturator Muscle

Perforation of descending colon cancer combined with iliopsoas abscess and fistula formation is a rare condition and has been reported few times. A 67-year-old man came to our first aid for an acute pain in the left iliac fossa, in the flank, and in the ipsilateral thigh. Ultrasonography and computed tomography revealed a left abdominal wall, retroperitoneal, and iliopsoas abscess that also involved the ipsilateral obturator muscle. It proceeded with an exploratory laparotomy that showed a tumor of the descending colon adhered and perforated in the retroperitoneum with abscess of the iliopsoas muscle on the left-hand side, with presence of a fistula and liver metastases. A left hemicolectomy with drainage of the broad abscess was performed. Pathologic report findings determined adenocarcinoma of the resected colon

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

La sindrome compartimentale addominale ed il ruolo della re-laparotomia decompressiva

Premessa. La Sindrome Compartimentale Addominale (ACS) è una complicanza la cui insorgenza è sempre più riconosciuta sia nei pazienti medici che in quelli chirurgici. La World Society of the Abdominal Compartment Syndrome definisce Ipertensione Intra-Addominale (IAH) la presenza di una Pressione Intra-Addominale (IAP) ≥ 12mmHg e definisce la ACS una condizione caratterizzata da una IAP ≥ 20mmHg (con o senza una pressione di perfusione addominale < 60 mmHg) associata alla disfunzione o al danneggiamento di uno o più organi non presenti precedentemente. La IAH contribuisce alla disfunzione d'organo nei pazienti con trauma addominale e sepsi e porta alla formazione di ACS. Obiettivo. In questo studio si è cercato di valutare la reale incidenza della sindrome compartimentale addominale nei pazienti sottoposti a laparotomie d’urgenza e si è valutato il ruolo della re-laparotomia decompressiva. Pazienti e metodi. Lo studio include 10 pazienti, 4 uomini e 6 donne con un'età media di 68 anni (range, 38-86), sottoposti a laparotomia dal gennaio 2007 al settembre 2008. In accordo alle indicazioni dettate dalla WSACS (World Society of the Abdominal Compartment Syndrome) abbiamo misurato la IAP in maniera indiretta attraverso l'uso di un catetere vescicale di Foley. Risultati. Dei 10 pazienti , in 8 la pressione intraaddominale rientrava nei valori compresi tra 8 mmHg e 20 mmHg e, non essendo stati riscontrati sintomi clinici significativi correlati all’aumento della IAP, non è stato necessario eseguire una re-laparotomia decompressiva. Nei 2 pazienti in cui la pressione intra-addominale era superiore ai 20 mmHg la sintomatologia era caratterizzata da tensione della parete addominale, instabilità emodinamica, oligo/anuria, modificazioni respiratorie e squilibrio acido-base per cui sono sati sottoposti a re-laparotomia decompressiva d’urgenza. Conclusioni. In base alla nostra esperienza ed ai risultati della letteratura riteniamo indispensabile il monitoraggio della pressione intraaddominale nei pazienti sottoposti a re-laparotomia addominale. Nelle re-laparotomie decompressive eseguite d’urgenza la sutura solo cutanea ha permesso una rapida chiusura dell’addome in pazienti instabili ed a rischio

Il linfonodo sentinella nei tumori del colon

Introduzione. I tumori maligni possono dare metastasi seguendo il sistema linfatico in modo sequenziale. In ogni catena linfatica al primo linfonodo che drena la regione dove si è sviluppato il tumore viene dato il nome di “linfonodo sentinella’’ (LS). Obiettivo dello studio. L’obiettivo principale del presente studio è la determinazione del valore predittivo della metodica del linfonodo sentinella nella stadiazione del cancro colico non metastatico. Pazienti e metodi. Abbiamo effettuato uno studio prospettico arruolando pazienti con adenocarcinoma del colon che soddisfacessero i seguenti criteri: - età minima di 18 anni; - stadiazione con colonoscopia, Rx torace, ecografia o TC addome completo per selezionare pazienti con adenocarcinoma del colon T2-T3 senza metastasi linfonodali ed epatiche; - rischio anestesiologico ASA 1-3; - consenso informato. A seguito della resezione colica con linfadenectomia è stata eseguita un’iniezione sottomucosa di colorante vitale (patent blue) che ha permesso di identificare il linfonodo sentinella. I linfonodi sono stati sottoposti ad esame istologico con ematossilina-eosina e successivamente con tecnica immunoistochimica. Risultati. Dal gennaio a dicembre 2008, 26 pazienti sono stati arruolati in questo studio prospettico. Di questi sono stati considerati elegibili per il nostro studio solamente 14 pazienti. L’esame con ematossilina - eosina dei linfonodi ha evidenziato: a) in 4 casi su 14 (28,57%) erano presenti metastasi sui linfonodi contenuti nel mesocolon, b) in 10 casi su 14 (71,42%) erano assenti metastasi sui linfonodi contenuti nel mesocolon. Nei casi in cui non erano presenti metastasi, all’esame con ematossilina-eosina, nei linfonodi del mesocolon è stato eseguito l’esame istologico dei linfonodi sentinella con tecnica immunoistochimica; in 2 casi è stata evidenziata la presenza di micrometastasi. In un caso sono state identificate linee aberranti di drenaggio mesenterico (skip metastasis); il linfonodo sentinella (negativo all’esame con ematossilina eosina) è stato studiato con tecnica immunoistochimica che non ha evidenziato la presenza di micrometastasi. Conclusioni. È possibile affermare che l’esame del linfonodo sentinella è fattibile con la metodica ex vivo. Nel 20% dei casi da noi studiati a livello dei LS sono presenti micrometastasi non evidenziate al classico esame con ematossilina-eosina. Lo studio dei linfonodi sentinella con sezioni multiseriate e tecniche immunoistochimiche consente un miglioramento della stadiazione patologica

Robotic pancreaticoduodenectomy in a case of duodenal gastrointestinal stromal tumor

BACKGROUND: Laparoscopic pancreaticoduodenectomy is rarely performed, and it has not been particularly successful due to its technical complexity. The objective of this study is to highlight how robotic surgery could improve a minimally invasive approach and to expose the usefulness of robotic surgery even in complex surgical procedures. CASE PRESENTATION: The surgical technique employed in our center to perform a pancreaticoduodenectomy, which was by means of the da Vinci™ robotic system in order to remove a duodenal gastrointestinal stromal tumor, is reported. CONCLUSIONS: Robotic technology has improved significantly over the traditional laparoscopic approach, representing an evolution of minimally invasive techniques, allowing procedures to be safely performed that are still considered to be scarcely feasible or reproducibl

Robotic distal pancreatectomy with or without preservation of spleen: a technical note

BACKGROUND: Distal pancreatectomy (DP) is a surgical procedure performed to remove the pancreatic tail jointly with a variable part of the pancreatic body and including a spleen resection in the case of conventional distal pancreatectomy or not in the spleen-preserving distal pancreatectomy. METHODS: In this article, we describe a standardized operative technique for fully robotic distal pancreatectomy. RESULTS: In the last decade, the use of robotic systems has become increasingly common as an approach for benign and malignant pancreatic disease treatment. Robotic Distal Pancreatectomy (RDP) is an emerging technology for which sufficient data to draw definitive conclusions in surgical oncology are still not available because the follow-up period after surgery is too short (less than 2 years). CONCLUSIONS: RDP is an emerging technology for which sufficient data to draw definitive conclusions of value in surgical oncology are still not available, however this techniques is safe and reproducible by surgeons that possess adequate skills

Mechanical bowel preparation in elective colorectal surgery: a propensity score-matched analysis of the Italian colorectal anastomotic leakage (iCral) study group prospective cohorts

Retrospective evaluation of the effects of mechanical bowel preparation (MBP) on data derived from two prospective open-label observational multicenter studies in Italy regarding elective colorectal surgery. MBP for elective colorectal surgery remains a controversial issue with contrasting recommendations in current guidelines. The Italian ColoRectal Anastomotic Leakage (iCral) study group, therefore, decided to estimate the effects of no MBP (treatment variable) versus MBP for elective colorectal surgery. A total of 8359 patients who underwent colorectal resection with anastomosis were enrolled in two consecutive prospective studies in 78 surgical centers in Italy from January 2019 to September 2021. A retrospective PSMA was performed on 5455 (65.3%) cases after the application of explicit exclusion criteria to eliminate confounders. The primary endpoints were anastomotic leakage (AL) and surgical site infections (SSI) rates; the secondary endpoints included SSI subgroups, overall and major morbidity, reoperation, and mortality rates. Overall length of postoperative hospital stay (LOS) was also considered. Two well-balanced groups of 1125 patients each were generated: group A (No MBP, true population of interest), and group B (MBP, control population), performing a PSMA considering 21 covariates. Group A vs. group B resulted significantly associated with a lower risk of AL [42 (3.5%) vs. 73 (6.0%) events; OR 0.57; 95% CI 0.38-0.84; p = 0.005]. No difference was recorded between the two groups for SSI [73 (6.0%) vs. 85 (7.0%) events; OR 0.88; 95% CI 0.63-1.22; p = 0.441]. Regarding the secondary endpoints, no MBP resulted significantly associated with a lower risk of reoperation and LOS &gt; 6 days. This study confirms that no MBP before elective colorectal surgery is significantly associated with a lower risk of AL, reoperation rate, and LOS &lt; 6 days when compared with MBP