[Perforated jejunal diverticulitis: a case report]. / Diverticolite digiunale perforata: caso clinico.

The authors present a case of midgut perforated diverticulitis in a 78-year-old patient, associated with a colovesical fistula and sigmoid obstruction of diverticular origin. Surgical resection of the small bowel segment affected together with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. In complicated midgut diverticulitis the preoperative diagnosis is a challenge: the symptoms are aspecific and imaging techniques are of no use. As a result, the diagnosis of complicated jejunoileal diverticulitis can be quite difficult, and a definitive diagnosis may often be made only after surgical exploration.

[Acute abdomen due to primary small bowel neoplasm. Diagnostic approach and therapeutic modalities]. / Addome acuto da neoformazioni primitive del tenue. Approccio diagnostico e modalità terapeutiche.

We report our experience over the period 2000-2004 with the diagnosis and treatment of primary small bowel neoplasms in the emergency setting, stressing the importance of a correct preoperative diagnosis for the implementation of specific treatment. From January 2000 to September 2004 we treated 5674 patients, 8 of whom (0.8%) presented a primary small bowel neoplasm emergency. The diagnosis was made using small bowel ultrasound. We detected 8 cases of primary small bowel neoplasms using ultrasound. This examination was specific for the small bowel and enabled us to obtain an accurate preoperative diagnosis. A correct diagnosis of primitive small bowel neoplasm is necessary in order to institute the right treatment. The main treatment is surgery in our experience, the gold standard being laparoscopy but only when performed by expert surgeons.

[Endothoracic localization of the Von Recklinghausen disease. A case report]. / Localizzazione endotoracica della malattia di Von Recklinghausen. Caso clinico.

OBJECTIVE: A case of a 45 years old man affected by the Von Recklinghausen disease with a rare neurofibroma of the thoracic wall is reported. MATERIALS: Starting from 2000 the Authors are using the V.A.T.S. (video assisted thoracic surgery) in their Department of surgery, as minimally invasive approach to diagnosis and treatment of some thoracic diseases: initially the patient was studied by a standard chest x-ray followed by tomography and magnetic resonance to determine the localization of the neoplasm of the chest wall. RESULTS: The neurofibroma was removed by V.A.T.S., through a minimal thoracic access. After treatment we observed the complete remission of symptoms. DISCUSSION: Single localization of the neurofibroma in the Von Recklinghausen disease can transform into a malignant neoplasm. The indication to surgery, in the case presented, was determined by the intense thoracic pain and by the risk of malignant degeneration. The minimally invasive approach showed to be the best option according to the dimensions of the neurofibroma. In the actual literature this approach represents the gold standard in the treatment of small intrathoracic neoplasm. CONCLUSION: In the chest wall localization of the Von Recklinghausen disease the Authors recommend the minimal surgical treatment by using V.A.T.S.