When a postsurgical dehiscence becomes a serious problem.

Therapeutic management of nonhealing wounds is often a challenging condition. Postlaparotomy wound dehiscence can become a serious problem in patients affected with chronic pain and abdomen distension. In this case report, negative-pressure wound therapy with the Chariker-Jeter method was used to treat a dehiscence in a patient affected with type I spinocerebellar ataxia.

Adenocarcinoma arising in an elderly patient's large ileal duplication.

Bowel duplications are rare congenital anomalies commonly found in pediatric patients; few cases may remain undetected until adulthood. Malignant carcinomatous changes are rare complications in intestinal duplications. An 88-year-old female patient was referred to our surgical unit with the diagnosis of a large abdominal mass. An explorative laparotomy was performed, revealing a large (22 × 11 cm) neoplasm strictly connected to the lowest ileal segment and completely filling the pelvis. Definitive histology revealed a moderately differentiated adenocarcinoma developing in a duplication of the terminal ileum. The hypothesis of a gastrointestinal duplication should be evaluated in the differential diagnosis of large, complex, indeterminate masses located in or near the bowel; the possibility of neoplasm within the duplication should be considered.

Necrotizing fasciitis: a surgical emergency.

Accurate assessment and timely interventions are critical in the treatment of patients affected with necrotizing fasciitis, a rare, fulminating, potentially life-threatening, infectious process of the soft tissues. Understanding the natural history and unique characteristics of this disease is crucial to achieve early recognition, effective management and a favorable patient outcome. Classic symptoms include severe pain, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, bullous formations and edema in the affected area and fever. This article aims at reviewing the information known about this disease, collected from various sources. Radical surgical debridement, broad-spectrum antibiotics, negative pressure wound therapy and hyperbaric oxygen therapy are considered to be the cornerstones of treatment.

Jejuno-jejunal invagination due to intestinal melanoma.

Cutaneous melanoma is one of the most studied neoplastic lesions in biology and clinical oncology. It has been well documented that this type of neoplasm presents a high metastatic rate, and is able to involve nearly every tissue. Non-cutaneous melanoma represents an unusual pattern of melanoma, and the small intestine is an uncommon anatomic localization. Herein we report an extremely rare clinical case of a young woman affected by a bleeding jejunal melanoma, whose early clinical presentation was an intestinal invagination.

Sclerosing encapsulating peritonitis: a rare complication of peritoneal dialysis. A case report.

Sclerosing encapsulating peritonitis is a typical, but at the same time, not so frequently observed complication of peritoneal dialysis. The aim of this article is to report on the authors' clinical and surgical experience with this disease. After a review of the international literature and a description of the typical clinical features of this disease, the authors describe a case of sclerosing encapsulated peritonitis observed in their surgical department, on its mode of onset (intestinal occlusion), clinical behaviour and surgical treatment. The treatment of the patient consisted in the removal of fibrous tissue, resection of a necrotic ileal loop and intestinal reconstruction by an end-to-end ileo-ileal anastomosis. From the technical point of view the result was good and resolution of the intestinal occlusion was obtained. Cardiocirculatory complications arose on 6th postoperative day were the cause of the patient's death. Sclerosing encapsulating peritonitis is a rare complication of peritoneal dialysis, but it should be borne in mind whenever a patient with a history of peritoneal dialysis reports episodes of abdominal pain, nausea and vomiting associated with weight loss. This kind of peritonitis may require surgical and non-surgical treatment, though laparotomy provides us with a reliable diagnosis and may be considered essential to resolve the intestinal obstruction.