Acute ischaemic colitis: outcome in elderly patients.

The Authors report the results of the management of ischaemic colitis in a surgical unit dedicated to elderly patients. Sixty-two elderly patients affected by ischaemic colitis were observed consecutively in the Surgery Unit of the University of L'Aquila from 1986 to 2004. The clinical records of the patients were retrospectively reviewed in order to assess clinical, biohumoral, endoscopic and x-ray findings pre- dictive of the most suitable type of treatment. Clinical follow-up was performed to evaluate the long-term prognosis after a mean period of 8 years post-treatment. Forty-six patients (74.1%) were treated by medical therapy only for a mean period of 7 days with a positive outcome and no mortality. Sixteen patients (25.9%) underwent surgery. Postoperative morbidity and mortality rates were 62.5% and 43.7%, respectively. Absence of bowel sounds (chi2 = 61.9, p < 0.001), ileus (chi2 = 17.8, p < 0.001) and air fluid levels in plain abdominal x-rays (chi2 = 18.6, p < 0.001) were risk factors for surgery. At follow-up a favourable outcome, without findings of recurrent acute or chronic ischaemic colitis, was observed in 55 patients. In conclusion, the results seem to suggest that medical therapy is the mainstay of treatment for acute ischaemic colitis in elderly patients with good clinical results. Peritonitis is an indication for surgery.

Spontaneous hematoma of the mesocolon.

Spontaneous hematoma of the mesocolon is a rare condition, mainly due to the rupture of a colic artery aneurysm. The authors report on two cases of spontaneous hematoma of the mesocolon and examine the relevant literature. The clinical presentation in our patients was, as indicated in the literature, non-specific, with the occurrence of acute abdomen (case 1) or mild abdominal pain (case 2). Only diagnostic imaging (contrast-enhanced CT scan) is capable of yielding an accurate diagnosis, specifying the size and location of the hematoma. A palpable mass or hemoperitoneum due to rupture should be regarded as late signs of presentation. Early diagnosis is of the utmost importance in order to avoid the by no means negligible mortality reported in such instances or ischaemic bowel wall complications.

[Postoperative pain as complication of hernia surgical repair with mesh and plug]. / Il dolore postoperatorio come complicanza dell'ernioplastica inguinale con mesh e plug.

The authors assess the incidence of locoregional chronic pain after inguinal hernia repair. One hundred consecutive patients, with a mean age of 65.4 years, suffering from primary monolateral inguinal hernia, underwent suture-less mesh-plug hernioplasty. In all cases the inguinal nerves were identified. In the early postoperative period, a questionnaire was given to all patients in order to assess the frequency, type and intensity of postoperative locoregional pain and the impact of the pain on their quality of life. Sixty patients were available for follow-up with clinical examination and these were given the same questionnaire 2-4 years after hernioplasty. Pain intensity was scored by means of a visual-analogue scale (from 0 to 10). The incidence of locoregional pain after hernioplasty was 13.0% in the early postoperative period and 25.0% after a longer period of follow-up. None of the patients presented recurrent hernia. The symptomatic patients reported mild or moderate neurogenic pain. Severe pain was not reported. On the whole, the presence of mild-to-moderate chronic pain had no impact on the patients' quality of life. Our study confirms the high incidence of locoregional chronic pain even after sutureless mesh-plug hernioplasty, but that this has no serious effects on the patients' quality of life.