Double intestinal duplication and incidental neuroendocrine tumor of appendix, a rare case of acute abdomen.

INTRODUCTION: Intestinal duplication is rarely reported in adulthood and often remains undiagnosed until onset of complications. We describe the case of a 39 year old woman who came to our observation for acute abdomen due to a combination of double intestinal duplication (colon and ileum) and an incidental neuroendocrine tumor of the appendix. MATERIALS AND METHODS: A 39 year old woman who was admitted at with upper abdominal pain. Multisliced spiral CT scan showed a cystic lesion suggestive of an inflammed Meckel's diverticulum.The patient was underwent an urgent explorative laparoscopy. The intraoperative findings revealed a cystic lesion of the anti-mesenteric side of transverse colon, apparently dissectable from the bowel and a second lesion with a strongly adherent and unresectable from the anti-mesenteric aspect of the small bowel. A combined appendectomy was also performed. The histological diagnosis was consistent with a typical intestinal duplication for both intestinal lesionsand an incidental 2mm carcinoid tumor was also found in the appendix. The postoperative course was uneventful and the patient was discharged on p.o. day 5. At the presenttime she is well and following a regular oncologic follow-up. DISCUSSION: The rarity of this case is due to the concomitant presence of an incidental, sincronous, appendiceal NET. The elective treatment is surgical resection. CONCLUSION: Intestinal duplication in the adulthood is extremely rare and may either have an acute presentation as acute abdomen or represents an incidental finding of mass. We suggest that, once the diagnosis is suspected patient must undergo surgery.

[Gastrointestinal stromal tumors (GIST). Update and indications for treatment: our experience]. / Tumori gastrointestinali stromali (gist). Attualità e indicazioni al trattamento: nostra esperienza.

The gastrointestinal stromal tumors (GISTs) represent 1% among bowel diseases. Their clinical history is unknown, and it seems to develop from muscolar or nervous tissue in the bowel wall. The grade of malignancy is directly correlate to the dimension of tumor and the number of mythosis for field. We report our experience in diagnosis and treatment.

[Mirizzi's syndrome. Evaluation of 3 cases]. / Sindrome di Mirizzi. Analisi di 3 casi.

OBJECTIVE: Evaluation of three cases of Mirizzi's syndrome (MS), a rare condition of non neoplastic biliary tree obstruction. MATERIALS AND METHODS: We reviewed three cases of MS, operated from July 1998 to December 2000 in our institution. All patients were preoperatively evaluated by clinical examination, Ultrasound (US) and Endoscopic retrograde colangiopancreatography (CPRE) for jaundice. Computed Tomography (TC) was also performed in two. RESULTS: Abdominal pain was the main symptom in two patients, jaundice in one (17 mg/dl); Courvoisier-Terrier sign, suggestive for a biliopancreatic neoplasm, was present in two patients. US was sensitive for gallbladder stones and biliary tree dilatation but not specific for MS; TC only excluded a malignancy in the biliopancreatic area but wasn't useful for diagnosis. CPRE visualized a gallbladder stone obstructing the biliary tree in two cases, but failed to show the fistula between gallbladder and hepatic duct in one. Operations were performed with an "open" approach; in two patients colecystectomy was sufficient to relieve the obstruction, in one patient the biliary fistula was closed with a gallbladder tissue flap over a T tube. DISCUSSION: Mirizzi's syndrome is a rare condition, but surgeons must be aware of it, particularly in the laparoscopic era were dissection of the Calot triangle may lead to a damage of the hepatic duct. Suspect of MS is mandatory in all cases of jaundice with non neoplastic biliary obstruction. Preoperative diagnosis of MS is not easy; US is sensitive for gallbladder stone and biliary tree dilatation, but not specific for choledochal stone compression and biliobiliary fistula. TC is useful for exclusion of pancreatic or liver neoplasms but is non specific for MS. CPRE represents the "gold" standard for MS, showing the hepatic duct compression caused by the stone impacted in gallbladder neck. CPRE is not only diagnostic but also operative; sphyncterotomy and stones extraction give a temporary relief of hyerbilirubinemia waiting for operation. When only a gallbladder stone causing the biliary tree obstruction is found simple cholecystectomy is curative, but a large colecysto-choledocal fistula needs a biliary tree reconstruction, also with a bilio-digestive anastomosis. CONCLUSIONS: Mirizzi syndrome is a rare condition, but surgeons must be aware of it. Surgical approach to MS in the "laparoscopic era" may be complicated by the presence of a colecysto-biliary fistula; in these cases dissection of the Calot triangle may difficult or impossible. When a MS is suspected the "open" approach is preferable, also for the reconstruction of biliary tree. CPRE is the most important diagnostic tool, showing the stone compressing the biliary tree.

[Hepatic and renal trauma: importance of arteriography in diagnosis and treatment]. / I traumi del fegato e del rene: importanza dell'arteriografia in diagnosi e terapia.

OBJECTIVES: The aim of this study was to show the importance of non-invasive approach in diagnosis and treatment of renal and hepatic trauma, using arteriography as primary treatment in moderate-severe grade injury. MATERIALS AND METHODS: We observed 24 cases of hepatic and renal trauma in four hospitals in Rome in the 1996. Trauma were classified about their type and gravity (11-19) and ATLS classification for emodinamical conditions (1) were used to classify patients (Tab. I). RESULTS: 12 patients were treated with surgery because of their unstable haemodinamical conditions (III IV classes of ATLS classification) (1). Four patients were treated by arteriographical embolization (in two cases arteriography was primary used) with complete solution of sintomatology. DISCUSSION AND CONCLUSION: Arteriography was an importance procedure in non surgical treatment of hepatic and renal trauma in haemodinamically stable patients. In our study patients treated with arteriographic embolization were definitively restored from hemorrhage. In diagnosis and treatment of these injuries was essential the team collaboration between radiologists and surgeons.

Partial 9p monosomy in a girl with a tdic(9p23;13p11) translocation, minor anomalies, obesity, and mental retardation.

We report on a case with a partial monosomy for the regions 9p23 --> pter and 13p11 --> pter as a result of a de novo translocation (9p23;13p11). The patient, a 16-year-old girl, has mental deficiency, obesity, and minor anomalies, including trigonocephaly, hypertelorism and a short, broad neck. Cytogenetic and microsatellite marker analysis allowed us to assign the breakpoint to the chromosomal region 9p23, flanked by the markers D9S144 and D9S157. In an attempt to establish a phenotype-genotype correlation, the clinical manifestations present in our patient are compared to those with partial 9p monosomy and breakpoint in p23, referred to in the literature.