[Perforation of the colon by a foreign body]. / Perforazione del colon da corpo estraneo.

Perforation of the colon carries a high mortality and morbidity. Perforations caused by foreign bodies are relatively rare and appear to be less often associated with postoperative complications than perforations due to organ disease. Depending upon the extent of the perforation and its anatomical site, as well as on the basis of the presence of diffuse or circumscribed peritonitis, the treatment of foreign-body perforation will vary from simple suturing, with or without a protective colostomy, to exteriorization in the form of a colostomy, and the Hartmann operation.

[Gastrointestinal hemorrhage from a duodenal diverticulum]. / Emorragia gastrointestinale da diverticolo duodenale.

Duodenal diverticuli are often asymptomatic and are occasionally found during the course of X-ray tests or autopsy. They are sometimes manifested in the form of symptoms related to a complication (hemorrhage, perforation, occlusion). The paper reports a case of gastrointestinal hemorrhage caused by a duodenal diverticulum which was then successfully operated. The Authors affirm that in these cases the resection of the portion of the duodenum with the diverticulum (provided the papilla is not affected) is preferable to direct hemostasis or duodenocephalopancreatectomy.

[Rupture of the cervical esophagus. Apropos of a case of perforation by a foreign body]. / Rottura dell'esofago cervicale. A proposito di un caso di perforazione da corpo estraneo.

The Authors describe a case of perforation of the cervical oesophagus by a foreign body (dental prosthesis). After outlining the clinical and instrumental elements which may be useful in the diagnosis, the Authors go on to tackle the topic of the most appropriate choice of therapy in the course of foreign-body perforation and in perforation of the oesophagus in general.

[A splenic autograft in omental pockets following splenectomy for trauma. The authors' personal experience of 10 cases]. / Autotrapianto splenico su tasche omentali dopo splenectomia per trauma. Esperienza personale su 10 casi.

Personal experience on 10 patients splenectomised for trauma and subjected to splenic autotransplantation on omental pockets is reported. After describing autotransplant candidate selection criteria and the surgical technique followed, the flattering results are reported. Particularly interesting was the fact that no local suppuration was encountered and the transplant took in all patients, as demonstrated by scans carried out with labelled red globules and radiocolloid.

[Hemorrhages of the lower digestive tract: the diagnostic and therapeutic approach]. / Emorragie del tratto digestivo inferiore: approccio diagnostico e terapeutico.

The authors describe their experience with colo-rectal haemorrhage. They stress the tendency towards spontaneous arrest of such haemorrhages (92.6% of cases) as the usefulness of emergency colonoscopy in diagnosing the cause and/or site of the haemorrhagic lesion (85.7% of positive results in the present series). Therapy may be conservative (endoscopic or in the course of angiography) or surgical. Surgery is indicated in cases failing to respond to conservative therapy and in cases of unarrestable haemorrhage and usually consists in segmental resection of the portion of the intestinal tract involved.

[Endometriosis on a cesarean cicatrix. Apropos of 3 cases]. / Endometriosi su cicatrice per cesareo. A proposito di tre casi.

Endometriosis on a caesarean scar is a well-known, though not frequent event. The lesion generally presents as a painful nodule of the abdominal wall during the menstrual cycle. Pain cyclicity is a useful sign for diagnosis. Treatment consists of removal. Three cases are reported.

[Non-traumatic colic perforation in free peritoneum. Apropos of 61 cases]. / Perforazioni coliche non traumatiche in peritoneo libero. A proposito di 61 casi.

Sixty-one non-traumatic perforations in free peritoneum are reported. The principal aetiology is diverticulitis (35 cases) followed by cancer (22 cases). 18 derivations were carried out, 34 colectomies without anastomosis, 5 ideal colectomies and 4 diverticulectomies. Total mortality was 19.7-14% for diverticulitis, 22.2% for perforations at the cancer site, 50% from diastasic perforations. Stress is laid on the need to treat colic perforation by colectomy without anastomosis, confining derivation openeum. Sixty-one cases.

[Leiomyosarcoma of the Meckel's diverticulum (presentation of a new case)]. / Il leiomiosarcoma del diverticolo di Meckel (segnalazione di un nuovo caso).

A new case of Meckel's leiomyosarcoma is described. The rarity of the disease, the problems of differential diagnosis and the difficulty of establishing the malignant nature of the condition and thus the prognosis justify the report together with a review of the most recent literature.

[Intra-abdominal rupture of varices of the round ligament: a rare cause of hemoperitoneum in patients with cirrhosis]. / La rottura intra-addominale di varici del ligamento rotondo: rara causa d'emoperitoneo nel cirrotico.

The authors report two cases of haemoperitoneum due to intra-abdominal rupture of the round ligament in cirrhotic patients with portal hypertension. A review of the literature on the subject reveals the rarity of such observations. The eventuality must be borne in mind, however, in the treatment of the haemorrhagic complications of portal hypertension in view of the associated high mortality. Simple ligature of the bleeding varix is the operation which offers the greatest possibility of survival.

[Lesions caused by the ingestion of caustics]. / Lesioni da ingestione di caustici.

The diagnostic and therapeutic approach to the maiagement of lesions caused by ingestion of caustic substances has made substantial progress in the past few years and has now been codified. The linch-pins of the present approach are emergency endoscopy for an immediate assessment of the lesions and total parenteral nutrition to reduce the morbidity in patients whose lesions may be expected to take a long time to heal or may require surgical repair. The diagnostic and therapeutic protocol advocated derives from a close examination of the literature and from personal experience.

[Recent traumatic rupture of the diaphragm in patients with multiple injuries]. / Le rotture traumatiche recenti del diaframma nei politraumatizzati.

The authors report on 16 cases of recent traumatic diaphragmatic lesions in polytraumatized patients referred to them over the period 1979-86. After examining the diagnostic problems relating to this type of lesion, the authors describe the anatomico-topographical, clinical and therapeutic aspects. They conclude by stressing the need to explore the diaphragmatic cupulae systematically in the course of surgery for blunt abdominal trauma.

[Traumatic lesions of the rectum)]. / Le lesioni traumatiche del retto.

The authors report on their experience with the treatment of 12 cases of traumatic lesions of the rectum. They stress the need for early diagnosis, early systemic antibiotic treatment and prompt, appropriate surgery. In the cases described in this report, the latter consisted mainly in suture of the perforation, construction of a colostomy above the lesion and adequate drainage. Satisfactory results were obtained, i.e. zero mortality and a 41% overall postoperative morbidity.

[Agenesis of the gallbladder (diagnostic considerations. Apropos of a case]. / L'agenesia della colecisti (considerazioni diagnostiche. A proposito di un caso).

The authors show a case of gall-bladder agenesis, in the preoperative diagnostics of which both echotomography and T.A.C. were used. From the data of the literature, as well as from the personal experience, one can understand the preoperative diagnosis presuming gall-bladder agenesis can be placed in presence od manifestations of biliary nature added to gall-bladder nonopacity at oral cholecystography and to absence of gall-bladder at echotomography and T.A.C. The certainty diagnosis, however, can be only obtained at laparotomy with the hand exploration, with the preoperative cholangiography and eventually the selective arteriography of hepatic artery.

[Traumatic chylothorax (apropos of a case following a closed vertebral-thoracic injury)]. / Chilotorace traumatico (a proposito di un caso consecutivo a trauma chiuso vertebro-toracico).

The authors report a case of chylothorax due to blunt trauma with fracture of the spine in a man aged 60. After mentioning the possible pathogenesis and clinics of the case shown, the Authors explain the treatment successfully adopted, that is, the ligature of thorax duct at his inlet in the thorax through right thoracotomy on the 5th intercostal space.

[Complications of primary malignant tumors of the small intestine]. / Le complicanze dei tumori maligni primitivi del tenue.

6 cases of small bowel adenocarcinomata are described. In 5 cases out of 6 the diagnosis was only possible at the moment of operation, which became necessary for the complications of the tumour. Five patients were urgently operated on for intestinal obstruction, and one for peritonitis. The reserved nature of the prognosis of such tumours is emphasized, as well as the fact that their diagnosis is often interoperative.