[Pancreatic trauma: a case report]. / Il trauma del pancreas: a proposito di un caso clinico.

Pancreatic trauma is a rare event, accounting for approximately 3% of all blunt abdominal traumas. The related mortality is quite high, around 5-30%, mostly due to the associated haemorrhagic lesions and to the delay in establishing the diagnosis, while pancreatic damage is directly responsible for death in only 5-10% of cases. We report here on a case of severe pancreatic trauma, underestimated initially and treated surgically at a later stage. The literature shows that the main difficulty in cases of pancreatic trauma is still related to failure recognizing the injury or to the frequent delay in diagnosing the condition, above all in haemodynamically unstable patients. In these cases, as in the one treated in this report, the clinical evidence and the priority accorded to the treatment of the shock are factors that tend to limit thorough examination. In haemodynamically stable patients, on the other hand, the multislice CT-scan and MR pancreatography-wirsungography are useful for the diagnosis. The treatment can be either conservative or surgical, depending on the extent of the damage, especially to the Wirsung duct. Surgical treatment with preservation of the entire pancreatic parenchyma, as performed in our case, even if technically demanding, makes it possible to maintain the function of the pancreas, thus reducing the risk of metabolic complications.

Thermic ablation with RF of liver metastases from colorectal cancer.

Aim of this study was to evaluate the role of radiofrequency ablation in the treatment of the hepatic metastasis of colorectal cancer. From November 1997 to July 2002 49 radiofrequency ablations have been performed in 19 patients (11 male and 8 female; mean age 65 years: range 50-78 years). The disease-free period was between 5 and 32 months. Nodules had a diameter <3 cm in 4 cases while in 3 cases a single lesion was present. One patient had a single lesion after 2 courses of intravenous systemic chemotherapy which had a reduced greater lesion (from 6 to 3 cm) while a 2 cm lesion had disappeared. In the remaining 12 patients the mean number of lesions is 3 (range 1-13) with a diameter between 3 and 12 cm. The radiofrequency ablation has been performed during laparotomy and vascular exclusion through clampage of the liver hilum in 4 cases and percutaneously under ultrasound guide in the remaining 15 cases. All patients underwent follow up by computed tomography, CEA level and ultrasound every 3 months. One patient only has completed a 4 year follow up and is alive without local recurrence but with a cerebral metastasis. The other 18 patients have a 32 months follow up with a survival of 50% (9 on 18). In conclusion in our experience the radiofrequency ablation is a valid alternative method in the treatment of the hepatic metastasis of colorectal cancer.