Idiopathic adult colo-colonic intussusception: Case report and review of the literature.

INTRODUCTION: Acute colonic intussusception occurring in the absence of organic cause is uncommon in adults. PRESENTATION OF CASE: We report acute colonic intussusception in a 46-year-old female; clinical evidence of a palpable mass, abdominal pain and bloody mucoid stools appeared a few hours after hospital admission. Multislice CT-scan confirmed the clinical diagnosis and surgical exploration revealed right colonic obstruction caused by intussusception of the cecum into the ascending colon. Right hemicolectomy was performed and histopathological examination did not reveal any causative pathology. DISCUSSION: Intussusception remains a rare condition in adults, representing 1-5% of bowel obstruction and accounting for 0.003-0.02% of all hospital admissions. Intussusception occurs more frequently in the small (50-80%) than in the large bowel (12-50%). It is estimated that approximately 90% of intussusceptions in adults are secondary to an anatomical or pathological condition, of which more than half are malignant. Idiopathic cases are the exception in adults. The clinical presentation of adult intussusception differs considerably from the classic pediatric presentation of abdominal pain, palpable mass, and blood per rectum, which is rarely seen in adults. A pre-operative CT-scan showed a 10cm intussuscepted segment of right colon. Surgical resection was considered mandatory because of severe bowel obstruction, and the theoretical possibility of occult malignancy. This approach was vindicated by the presence of widespread ischemic lesions in the wall of the resected bowel, without any obvious lead point. CONCLUSION: There are few reports in the medical literature of acute colonic intussusception occurring in the absence of organic cause in adults.

A case report of double filtration plasmapheresis in an acute episode of multiple sclerosis.

Plasma exchange has been proposed as support therapy in both acute and chronic forms of multiple sclerosis (MS). For the first time, we aimed to assess whether double filtration plasmapheresis (DFPP) could be clinically efficacious. We describe the case of a patient affected by MS who developed a severe crisis refractory to conventional steroids, and immunosuppressive and immunomodulating therapy. The patient underwent 12 sessions of DFPP. In each session 3000 mL of plasma was treated. Before and immediately after each session the routine laboratory parameters were assessed. Before the apheresis cycle and one month after the end of treatment, encephalic magnetic resonance imaging (MRI) was performed. A neurological examination and assessment of the extended disability status scale (EDSS) were made once each week from the beginning of treatment until one month after the end of the cycle. No therapy was administered during the course of the apheresis cycle, with the exception of a scaled dose of steroids, that was completely withdrawn half-way through the cycle. The immunoglobulin (Ig) G, IgA and IgM values declined from 465 +/- 104 mg/dL, 69 +/- 18 mg/dL, 34 +/- 16 mg/dL, respectively, pre-apheresis to 331 +/- 76 mg/dL, 42 +/- 5 mg/dL, 15 +/- 6 mg/dL, respectively, post-apheresis; C3 and C4 decreased from 105 +/- 27 mg/dL and 21 +/- 5 mg/dL to 75 +/- 9 mg/dL and 15 +/- 4 mg/dL, respectively; fibrinogen went from 228 +/- 72 mg/dL to 128 +/- 28 mg/dL. The EDSS dropped from a value of 6 before the cycle to 5.5 one month after the end of the treatment. As compared with the pretreatment conditions, post-apheresis MRI showed stabilization of the lesions already present, the reduction of one lesion and a complete absence of enhancement of all lesions. DFPP, adopted for the first time in MS, seems to foster a short-term improvement in both the clinical and magnetic resonance images during an acute MS episode.

Massive gastrointestinal bleeding due to splenotic nodule of the gastric wall. A case report.

Splenosis results from autotransplantation of splenic tissue after traumatic splenic rupture or surgery. Usually asymptomatic, splenosis is an incidental finding at surgery, unrelated to the splenosis, for intestinal obstruction or suspected appendicitis or gynaecological pathology. This article describes a unique case of massive gastrointestinal bleeding caused by deep invasion of a splenotic nodule into the gastric wall.

[Acute appendicitis: is this common pathology still of interest?]. / Appendicite acuta: c'è acora interesse per una patologia così comune?

Despite the indisputable progress of technology (laboratory analyses, scintigraphy, ultrasonography, computed tomography), the diagnosis of acute appendicitis often remains uncertain, with a rate of useless appendectomies amounting to almost 20% of cases. The ideal diagnostic test has yet to be discovered and, in any case, clinical observation remains the cornerstone of any decision-making algorithm. Thus, acute appendicitis continues to offer food for thought in relation to the aetiology of the condition, which is still unknown, the primacy of the clinical diagnosis, and the learning of the surgical skills required. In the present study, the authors compare their personal experience with the relevant data in the international literature, emphasising a number of issues such as the problem of diagnosis, acute appendicitis in pregnancy, laparoscopic therapy, and the so-called "useless appendectomies" and presenting their own point of view.

Small bowel obstruction due to intramural hematoma during anticoagulant therapy. With regard to two cases treated conservatively.

Hemorrhage following prolonged oral anticoagulant administrations is a well recognized hazard of therapy, and hemorrhagic complications are said to occur in 10-30% of patients. Following the presentation of the cases, the authors examine the current literature concerning the problems with anticoagulants, and recommend models of diagnosis and treatment of complications by bowel obstruction. Authors report on two cases of small bowel obstruction due to intramural hematoma during anticoagulant therapy. It is extremely important to recognize this syndrome in order to avoid unnecessary operative intervention. Therefore, laparotomy is not indicated.