[Complex duodenopancreatic injuries]. / I traumi complessi del blocco duodenopancreatico.

Injuries of the duodenopancreatic region are rare and difficult to diagnose and treat. The related high mortality is mainly due to the presence of associated lesions. Complex traumas (AAST grade IV and V lesions) require difficult surgical treatment with high postoperative morbidity and mortality rates. In a review of 200 pancreaticoduodenectomies performed for pancreatic head traumas the postoperative mortality was 31%. The authors present 6 cases of complex duodenopancreatic traumas, treated from 1995 to 1999. The aetiology was blunt trauma in 5 cases (83%) and a shotgun wound in 1 case (17%). In 3 cases, with a grade V lesion of the pancreatic head, a pancreaticoduodenectomy was performed. A case of a grade IV lesion of the tail of the pancreas was treated with distal splenopancreatectomy. Two cases of grade IV lesions of the third part of the duodenum were submitted to duodenal resection with direct anastomosis. One postoperative death was observed in a patient treated with duodenal resection. The overall mortality was 16%. A pancreatic fistula, which healed spontaneously, was observed in a case of pancreaticoduodenectomy.

[Intestinal obstruction due to Meckel's diverticulum. Description of three cases]. / Occlusione intestinale da diverticolo di Meckel. Descrizione di tre casi.

Among 588 small bowel mechanical obstructions operated since January 1982 until December 1996 at the Flajani Surgery Department and Emergency Department of the San Camillo Hospital in Rome, 3 male patients were operated for intestinal obstruction due to Meckel's diverticulum. In one case, obstruction was caused by a small bowel volvulus rolling on a Meckel's diverticulum, whose gangrenous extremity was "blocked" on caecum. In the other two cases, intestinal loops were incarcerated into an internal hernial ring constituted by the same diverticulum whose inflamed extremity was fixed to corresponding mesentery. We examined embryologic and clinical aspects of the pathology here considered, particularly its complications, obstruction being the most common in adult age. Diagnosis is often misunderstood, since a complicated Meckel's diverticulum simulates many other abdominal pathologies. A straight radiography and an ultrasonography of the abdomen may be useful to reach the correct diagnosis. We performed diverticulectomy, using a linear stapler and we underline the opportunity of this method. In young age laparoscopy resection is considered the gold treatment of this pathology by some authors. We didn't observe any mortality, although one of our patients was in a severe septic condition. It is necessary to examine the last ileal 100 centimetres when a suspected acute appendicitis is not initially found by operation. The opportunity of a promptly performed operation is underlined to prevent that such a benign pathology may induce also exitus.

[Problems in reconstruction of digestive continuity in demolition surgery of the stomach]. / Problemi di ricostruzione della continuità digestiva nella chirurgia demolitiva dello stomaco.

The commonest stomach demolition techniques and the chances of re-establishing digestive continuity following gastric exersis are examined. The physiological consequences of gastric surgery - gastric, pancreatic and biliary consequences - are discussed. After analysing general and specific operating complications, early and late postoperative complications and general and metabolic complications, the paper closed with a presentation of the results of a reassessment of 1415 gastroduodenostomies carried out using the same technique over a period of eight years by three teams directed and controlled directly or indirectly by Prof. G. Brancadoro.

[Use of the duodenum in demolition surgery of the stomach. Reconversion gastroduodenostomy in post-resection syndromes following Billroth II operations]. / L'utilizzazione del duodeno nella chirurgia demolitiva dello stomaco. La gastro-duodenostomia di riconversione nelle sindromi post-resezione tipo Billroth II.

Stress is laid on the importance in digestive and absorptive physiology. The methods used for the re-insertion of the duodenum in the digestive circuit in the surgical correction of servious post-Billroth II syndromes are explained. Direct duodenal reconversion by means of the transformation of gastrojejunostomy into gastroduodenostomy is recommended in the light of results obtained in 25 cases of p.o.p.u., dumping syndrome, inflammation of the anastomosis, and ALS. It is suggested that jejunal interposition should be kept for cases in which the particular shortness of the gastric stump makes simple re-insertion of the duodenum into the stomach impracticable.