[Perineal hernia]. / Ernia perineale.

The authors base this study on a case of perineal hernia referred to their attention. In the light of the scant international literature on this subject, they focus on the topographical anatomy of the pelvic floor in order to gain a clearer understanding of this pathology, as well as their classification into median, lateral, anterior and posterior forms. Above all, the authors draw attention to the importance of the differential diagnosis of perineal hernia from Bartholin cysts or vulvar tumours in relation to anterior perineal hernia, and perianal abscesses in relation to posterior hernia. They underline the value of ultrasonography or TAC during the diagnostic procedure. Lastly, they examine the channels of aggression for this type of hernia which may be abdominal, perianal or combined (abdominal and peri-anal), as well as the repair techniques used, varying from direct suture with non-absorbable material to the use of prolene mesh or flaps if the hernia breech is very large.

[Cholecysto-biliary fistulas]. / Le fistole colecisto-biliari.

Out of a total of 910 cholecystectomies performed on patients suffering from biliary calculosis, from January 1980 to December 1994 the Authors observed two cases of cholecysto-biliary fistulas (0.2%), a complication which can rarely affect biliary stones. In the light of the international literature and of their own, however, limited experience, the Authors take into account the pathophysiologic and clinical aspects of this pathology. They agree with the literature data on the lack of specificity of the clinical signs and uselessness of preoperative diagnostic tools, the only exception sometimes being E.R.C.P. The Authors find Csendes' cholecysto-biliary fistulas classification extremely useful as far as the subsequent surgical treatment is concerned. The latter should be electric, i.e. evaluation of each single case depending on the type of fistula, its size, conditions of its edges, dilatation of the main bile duct. Surgery may range from a simple suture of the fistula edges with endoluminal drainage, associated or not to surgery of the papilla, to a biliary digestive anastomosis.

[Ischemic colitis: a report of 2 cases of ischemic gangrene of the colon]. / La colite ischemica. A proposito di due casi di gangrena ischemica del colon.

Two personal cases of ischaemic gangrene of the colon required emergency surgery. The two cases provide the basis for a discussion of the aetiopathogenetic, anatomo-pathological and clinical aspects of this pathology. Stress is laid on the fact that ischaemic colitis in its various anatomo-pathological signs is not easy to diagnose and needs early treatment of conservative or emergency surgery type depending on its anatomo-pathological expression.

[Synchronous carcinomas of the colon and rectum]. / I carcinomi sincroni del colon-retto.

The authors base their observations on 3 cases of synchronous carcinoma of the large intestine and 1 case of association of cancer on polyps and synchronous colorectal carcinoma. After a short review of the etiopathogenetic and diagnostic aspects, they focus attention in particular on the various types on surgical approach which synchronous carcinoma of the large intestine offer to surgeons. The authors underline that numerous forms of surgery exist which are often complex and difficult, especially if multiple neoplasia involve separate colic segments and above all if they affect the distal rectal section. In conclusion, they affirm that the association of cancer on polyps and synchronous colorectal carcinoma is not rare and should be treated using combined endoscopic and surgical therapy. To the precise colic exeresis should be followed by endoscopic resection in the case of a scissil, villous polyps with high non-differentiated neoplastic tissue laying close on the endoscopic plane of section.

[Carcinoma of the small intestine localized in the ileum. Report of a case]. / Il carcinoma del tenue a localizzazione ileale. Descrizione di un caso.

On the basis of a case of adenocarcinoma of the small intestine which brought to their attention, the authors analyse the etiopathogenetic and clinical aspect of these tumours in the light of the international literature. In particular, they focus on the difficulty of making an early diagnosis due to the fact that the initial symptoms are vague and aspecific and instrumental tests often do not allow a differential diagnosis to be made between adenocarcinoma and chronic inflammatory disease of the small intestine, benign tumours and other neoplasias. Lastly, the authors underline the prime role of surgery in the treatment of this form of cancer despite the fact that the concept of oncological radicality is drastically reduced in relation to the lymphoglandular layout of the jejunum and ileum since it should include the sacrifice of the superior mesenteric artery with imaginable consequences.

[A rare cause of intestinal pseudo-obstruction: Ogilvie's syndrome]. / Una rara causa di pseudo-ostruzione intestinale: la sindrome di Ogilvie.

The authors report four cases of Ogilvie's syndrome, a rare cause of intestinal pseudo-obstruction. After having reviewed the pathogenetic hypotheses reported in the international literature, the authors describe the symptoms, diagnostic iter and conservative and surgical management. With regard to the latter, the authors report their own experience which differs from that reported in the literature since they advocate the use of intraoperative colonoscopy for both decompressive and diagnostic purposes, the use of the cecal fistula instead of mid-canal cecostomy, and the application of a multi-fenestrated endocolic probe inserted through the anus and as far as the left colic angle for further decompressive purposes.

[Acute diverticulitis of the cecum]. / Diverticolite acuta del cieco.

Following a brief introduction regarding the epidemiology of diverticular disease, the authors report a rare case of diverticulitis of the cecum which had developed into an abscess. The patient was a 37-year-old man who was referred to the authors' attention with classic symptoms of acute appendicitis and it was therefore decided to operate. During laparotomy a small paracecal abscess involving a diverticulum with suppurating infection was found on the anterior wall of the cecum, whereas the appendix appeared to be completely unaffected. The diverticulum was removed together with a small area of the surrounding healthy tissue using a double-layer suture of the cecal wall. In the discussion the authors analyse the similarities and rarities of the case and compare it with national and international findings. Special attention is drawn to the problems of differential diagnosis raised by this rare pathology. In conclusion, the authors state that it is difficult to make a preoperative diagnosis and that therefore the decision to operate must be extemporary.

[The spontaneous rupture of a hepatocarcinoma. A rare cause of hemoperitoneum]. / La rottura spontanea di epatocarcinoma. Rara causa di emoperitoneo.

The paper reports four cases of spontaneous rupture of hepatocarcinoma which were brought to the authors' attention together with the resulting hemoperitoneum. Following a short review of the literature, the authors focus on the relations between hepatocarcinoma and liver cirrhosis, on the causes which lead to the rupture of hepatocarcinoma and on its diagnosis, underlining the importance of abdominal scan with ultrasonic-guided needle biopsy. The paper stresses that, where the patient's general and local conditions allow, surgery should take the form of typical or atypical hepatic resection, and affirms that ligature of the hepatic artery associated with local hemostatic measures loads to a high percentage of early peri- or postoperative mortality, as well encouraging the early recurrence of hemorrhage.

[Observations on cancer metastasis from an unknown primary location]. / Considerazioni sulle metastasi da cancro a sede primitiva sconosciuta.

Following a short introduction in which the criteria used to classify patients suffering from cancer metastasis from an occult primary location are defined, the paper reports two cases of this type: an omental metastasis occluding the upper colon and an inguinal lymph node metastasis. Referring to the international literature, the Authors then analyse the reasons for the inability to recognise the neoplasm, its incidence, patients survival, the most appropriate diagnostic course and possible treatment of these cases. In conclusion, over and above the definition of a truly autonomous nosological status of metastasis of unknown origin, it is important to follow a correct diagnostic procedure in order to establish the most appropriate form of therapy.

[Leiomyosarcoma of the duodenum]. / Il leiomiosarcoma del duodeno.

The paper reports the case of a patient with leiomyosarcoma of the duodenum who underwent radical duodenocephalopancreatectomy and survived for 22 months after the operation. Following a review of the international literature on the topic, the diagnostic procedures and prognostic criteria of this uncommon tumour are discussed. In conclusion, leiomyosarcoma always presents considerable problems of diagnosis even with the aid of biopsy and only surgery can lead to recovery in a limited number of cases.

[Submucosal lipomas of the cecum. A case report]. / I lipomi sottomucosi del cieco. Descrizione di un caso.

The paper reports a case of submucous lipoma of the cecum. The difficulty of clinical diagnosis is underlined on account of aspecific symptoms, and in fact it is uncommon for diagnosis to be made on the basis of X-rays. Colonoscopy, in particular using bioptic techniques, allows the nature of the lipoma to be diagnosed, and in addition may act as an excellent therapeutic instrument.

[Spontaneous hematoma of the musculus rectus sheath]. / Ematoma spontaneo della guaina del muscolo retto.

Spontaneous haematoma of the musculus rectus is a rare event and can lead to a clinical picture comparable to what is seen in acute abdomen, thus posing a differential diagnosis problem. Three personally observed cases are reported, stress being laid on the fact that echography, in the light of clinical and laboratory data, made correct diagnosis possible. On the basis of clinical and echographic findings, one patient was subjected to surgical treatment and the others to conservative medical treatment because of the small dimensions of haematoma.

[A case of primary lymphoma of the rectum]. / Considerazioni su un caso di linfoma primitivo del retto.

The Authors describe a case of primary rectal lymphoma. The primitive involvement of this area is infrequent. The Authors emphasize the difficulty of preoperative diagnosis. The therapeutic approach should allow for correct staging which is only obtained by means of diagnostic studies aimed at excluding multicentric localisation. Sensitivity to radiotherapy has led the Authors to propose it as primary treatment, at least in stage I; surgery must be considered elective in stage II or in cases of need. Chemotherapy is indicated alone or in association with radiotherapy or surgery.