Treatment of rectovaginal fistula after colorectal resection with endoscopic stenting: long-term results.

AIM: To treat patients with rectovaginal fistula after anterior resection for cancer using self-expanding metal stents. METHOD: Ten patients of mean age of 56.3 years with rectovaginal fistula after colorectal resection for cancer were treated with endoscopic placement of a self-expanding metal stent. In three patients a diverting proximal stoma had been performed elsewhere. The rectal opening of the fistula was located from 3 to 10 cm from the anal verge (mean 6 cm). All patients had preoperative radiotherapy. In seven patients the stent was placed as the initial treatment while three referred patients had had multiple failed operations. RESULTS: There were no complications after the procedure. At a mean follow-up of 24 months the rectovaginal fistula has healed without major faecal incontinence in eight patients. In the remaining two the fistula has reduced significantly in size to allow a successful flap transposition. CONCLUSION: Endoscopic placement of a self-expanding metal stent is a valid adjunct to treat patients with rectovaginal fistula after colorectal resection for cancer.

Self-expandable metal stents in the treatment of benign anastomotic stricture after rectal resection for cancer.

AIM: To evaluate the use of self-expandable metallic stents to treat patients with symptomatic benign anastomotic stricture after colorectal resection. METHOD: Ten patients with a benign symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of a self-expandable metal stent. RESULTS: The stent was placed successfully in all 10 patients without any major morbidity. At a mean follow-up of 18 months the stenosis was resolved successfully in 7 out 10 patients (70%). The remaining three patients were subsequently treated successfully with balloon dilatation. CONCLUSION: Self-expandable metal stents represent a valid alternative to balloon dilatation to treat patients with benign symptomatic anastomotic stricture after colorectal resection for cancer.

Self-expanding metal stents for treatment of anastomotic complications after colorectal resection.

Self-expanding metal stents (SEMS) can be used to treat patients with symptomatic anastomotic complications after colorectal resection. In the present case series, 16 patients with symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of SEMS. Seven patients had a "simple" anastomotic stricture and nine patients had a fistula associated with the stricture. The anastomotic fistula healed without evidence of residual stricture or major fecal incontinence in seven of the nine patients. Overall the anastomotic stricture was resolved in 10 of the 16 patients. SEMS placement represents a valid adjunctive to treatment in patients with symptomatic anastomotic complications after colorectal resection for cancer.

High positive predictive value of CT colonography in a referral centre.

AIM: To assess the positive predictive value (PPV) of CTC in the clinical routine of a dedicated referral centre. MATERIAL AND METHODS: All consecutive patients referred for CTC between May 2009 and May 2010 were considered for inclusion in this study. All the patients who, following the diagnosis of a>6 mm polyp or mass at CTC, underwent a post-CTC colonoscopy within eight weeks from diagnosis were included. Per patient PPV for lesions, adenomas and advanced neoplasia was calculated. Chi-square test was used for statistical comparison, and a p value<0.05 was considered to be statistically significant. RESULTS: 516 patients were included in the study. Of them, 76 (14%) patients had at least one lesion≥6 mm on CTC. Overall, 59 (11%) patients were diagnosed at CTC with at least one polyp, 12 (2%) with a flat lesions, and 5 (1%) with a mass. Per-patient PPVs for any lesion>6 mm, neoplasia, and advanced neoplasia were 96% (95% CI: 92-100%), 68.4% (95% CI: 58-79%), and 30% (95% CI: 20-41%), respectively. PPV for neoplasia and advanced neoplasia was substantially higher for >10 mm lesions. CONCLUSION: In dedicated centers, CTC appears to be a highly specific procedure, characterized by a very low rate of false-positive results for >6 mm lesions.

["Strawberry" gallbladder: review of the literature and our experience]. / Colecisti "a fragola": revisione della letteratura e nostra esperienza.

The term "strawberry gallbladder" refers to an anatomo-pathological aspect which is included in the wider chapter of gallbladder cholesterolosis. Introducing their experience, the Authors summarize the hypotheses through the years proposed about the etiopathogenesis of this condition the clinical symptoms that it can produce and the diagnostic strategies used to identify it. Moreover the Authors underline that the "strawberry gallbladder" continues to be reported with a significant frequency. They also confirm the opportunity of surgical treatment of symptomatic patients as a valid alternative to medical therapy which is not always effective, it is long lasting, often complex and not completely side effects lacking.

[A rare case of gastric bleeding due to left-sided portal hypertension]. / Un raro caso di sanguinamento gastrico da ipertensione settoriale.

The authors report an uncommon gastric bleeding rate due to splenic hilum compression by a pancreatic cyst. The syndrome to be brought back to some sectorial portal hypertension form (left-sided portal hypertension) is difficult to diagnose because of absence of esophageal varices and other portal hypertension signs in an unchanged liver functionality patient. To put a correct diagnosis about gastric bottom bleeding varices without hepatic origin, the authors recommend to use arteriography and CT. Surgical treatment is proved to be the election one because of useless attempt of bleeding control through hepatic artery endoscopic sclerosis or embolization.

Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation.

BACKGROUND/AIMS: The purpose of this study was to determine the effects of a high-fiber diet and fluid supplementation in patients with functional chronic constipation. METHODOLOGY: One hundred and seventeen patients with chronic functional constipation (aged 18-50 years) were randomly divided into two treatment groups. For two months both groups consumed a standard diet providing approximately 25 g fiber per day. Group 1 (58 patients) was allowed ad libitum fluid intake, while Group 2 was instructed to drink 2 liters of mineral water per day. Compliance was monitored throughout the study and results were assessed in terms of bowel-movement frequency and laxative use. RESULTS: Fiber intake was similar in the two groups, while total daily fluid intake in Group 2 (mean 2.1 liters) was significantly greater than that of Group 1 (1.1 liters)(p < 0.001). In both groups, there were statistically significant increases in stool frequency and decreases in laxative use during the two-month trial, but both changes were greater in Group 2 (stool frequency: p < 0.001 vs. Group 1; laxative use: p < 0.001 vs Group 1). CONCLUSIONS: A daily fiber intake of 25 g can increase stool frequency in patients with chronic functional constipation, and this effect can be significantly enhanced by increasing fluid intake to 1.5-2.0 liters/day.

Endoscopy in the treatment of benign biliary strictures.

BACKGROUND/AIMS: Operative endoscopy is now the method of choice for treating numerous biliary tree diseases. In the treatment of benign strictures of the biliary tree, endoscopy serves as an alternative to surgical interventions. We evaluated the efficacy of endoscopic biliary stents in the treatment of benign biliary strictures. PATIENTS: Fifty-three consecutive patients with benign strictures of the biliary tree underwent endoscopic placement of one or more 10-12 Fr endoprostheses. Thirty-nine patients (73.6%) had iatrogenic strictures and 14 had inflammatory strictures (in 8 patients due to gallstones and in 6, chronic pancreatitis). Of the 53 patients, 20 (37.7%) had strictures classified as Bismuth type I, 23 (43.3%) Bismuth type II, 7 (13.2%) Bismuth type III and 3 (5.7%) Bismuth type IV. RESULTS: None of the patients died during the study period; three patients (5.6%) had immediate endoscopy-related complications treated conservatively. Late complications developed in 47.1% of the patients: 11.3% had cholangitis amenable to medical therapy, 5.6% had dislodged endoprostheses and 30.2% had obstructed endoprostheses. The reason why blocked stents accounted for most of the long-term complications in this series was that endoprostheses were not changed electively: they were changed only when clinical and laboratory signs indicated obstruction. Follow-up (6-84 months) in 42 of the 56 patients. 20 after stent removal, showed that 71.4% had an excellent outcome, 14.3% good results and 14.3% needed surgery. CONCLUSION: In benign biliary stricture endoscopic stenting is the first approach, providing definitive treatment or preparing patients for surgery.

[Simplifies case record in emergency surgery]. / Scheda clinica semplificata per l'urgenza chirurgica.

The Authors present an original case record simplified for urgency and emergency, with the aim to allow a quick and exact framing of the "acute" and consequently with a great saving of time. This is possible also thanks to the simple but efficacious graphic representation of the human body and his main districts. Moreover, it is possible to report data in a computerized system.

[Renal injury in childhood]. / Il trauma renale in età pediatrica.

The Authors report a case of blunt renal trauma in a nine-year-old boy. Clinical and therapeutic approaches are discussed in the light of a wide review of the literature.

[Signet ring cell adenocarcinoma of the colon (signet ring carcinoma): is it really a rare neoplasm?]. / L'adenocarcinoma del colon a cellule ad anello con castone (signet ring carcinoma): è veramente una neoplasia rara?

The Authors report two cases of primary carcinoma of the colon-rectum largely invasive, characterized signet ring cells. This is an uncommon neoplasm representing only 2% of primary carcinoma of the colon-rectum. The Authors discuss the diagnostic and therapeutic approach through a wide review of the literature.

[Diagnostic and therapeutic approach to kidney injuries]. / Approccio diagnostico e terapeutico ai traumi del rene.

The Authors report a wide review of the literature on open and blunt renal traumas. All the problems related to this pathology as well as all the instrumental and laboratory tests currently available for the correct diagnosis are illustrated. Both conservative and surgical management are also discussed.

[Electrohydraulic intracorporeal lithotripsy in the treatment of "difficult" calculi of the common bile duct. Report of a caseload]. / La litotrissia intracorporea elettroidraulica nel trattamento della calcolosi "difficile" della via biliare principale. Presentazione della casistica.

The Authors report their experience in 38 cases (January 1990-Septembre 1994) of "difficult" gallstone disease of the main bile duct treated with electrohydraulic intracorporeal lithotripsy. Nineteen patients were affected with giant stones of the biliary tree, 6 with multiple stones of the main bile duct, 13 with stones of one or both hepatic ducts. The approach to the biliary tree was peroral transpapillary in 16 patients and transhepatic in the remaining 22. Twenty-five patients were previously submitted to surgery of the biliary tree (13 hepaticojejunostomy, 8 choledochoduodenostony, 4 papillostomy), while 5 had required a cholecystectomy, and 6 a gastroresection according to Billroth II. In 80% of the cases two lithotripsy sessions were enough to achieve the complete clearing of the bile duct. There was no mortality and morbidity was 5.3%. Total clearing was obtained in 97.4% of the cases. 6-48 months after treatment 37 patients still do not show clinical, laboratory or echographic signs of gallstone stasis or disease relapse.

[Septic complications in emergency surgery: our experience and a review of the literature]. / Le complicanze settiche in chirurgia d'urgenza: nostra esperienza e revisione della letteratura.

Surgical infections represent one of the main causes of postoperative morbidity and mortality, especially in emergency surgery, with negative consequences on health costs. The Authors examined 2002 cases of emergency admission for surgical pathologies at the I Surgical Department of the University of Rome ¿La Sapienza¿ from 1987 to 1992. Overall septic complications were 13,7%, with a mortality rate of 1,2%. The Authors underline the lack in Italy of either an accurate system for monitoring septic complications or a useful method for data collection. At last the attention is focused on the main causes of septic complications, their diagnosis and treatment.

[Aneurysm of the celiac trunk: review of the literature and report of a clinical case]. / Aneurismi del tronco celiaco: revisione della letteratura e descrizione di un caso clinico.

After reviewing current and past medical Literature regarding celiac axis aneurysms the case of a 70 year-old emphysematous patient with an aneurysm of the celiac axis measuring 6 cm in diameter is reported. The patient's pulmonary function testing status strongly precluded a surgical option. Angiographic embolization of the aneurysm was then performed. The Authors observed that embolization with immediate occlusion of all afferent vessels of the celiac axis leads to no serious short or long-term consequences as long as an adequate collateral hepatic circulation is maintained through the gastroduodenal and inferior pancreaticoduodenal arteries. This case would appear to be the first described in the Literature and the Authors hold this technique to be a valid alternative whenever a surgical procedure would be difficult or impossible to perform.