[A rare cause of intestinal obstruction]. / Cause rare di occlusione intestinale.

Three-hundred-thirteen cases of small and large bowel obstructions surgically managed, from May 1974 to September 1995, are reviewed. Particularly, 10 uncommon cases are described: 3 hernias in anomalous recesses, 1 small bowel spontaneous hematoma, 2 Ogilvie syndromes, 1 obstruction due to cholecystitis, 1 left diaphragmatic hernia, 1 encapsulating peritonitis, 1 incarcerated Spigelian hernia. Their aetiopathogenetic and clinical patterns are examined. The Authors conclude, in agreement with Literature, that small bowel obstructions need urgent operation because of high risk of ischemic lesions. In large bowel obstructions operation is suggested after more careful diagnostic researches and adequate patient preparation. In some uncommon obstructions the purpose is to restore normal anatomical conditions.

[Bilateral thrombosis of a femoral pseudoaneurysm]. / Trombosi bilaterale di pseudoaneurisma femorale.

One case has been described of acute thrombosis of bilateral femoral anastomotic pseudoaneurysm. The clinical finding of bilateral acute ischemia of the lower limbs required urgent surgical treatment. The operative technique consisted of excision of anastomotic aneurysms and replacement by a new segment of prosthesis with an end-to-end anastomosis to the deep femoral artery. Pathogenesis of the pseudoaneurysms at the femoral anastomosis generally recognized numerous factors such as mechanical, graft or suture defects, hypertension, wound complications. Recognition of femoral anastomotic aneurysms is usually simple, when a pulsative mass is noted. In such a case (reported) of thrombosis of bilateral femoral pseudoaneurysms, preoperative diagnosis was more difficult. Anastomotic aneurysms of little size that occur later after original intervention require observation by echography and angiodinography. When rapid enlargement arises, urgent surgical treatment is required, before rupture or thrombosis. The surgical intervention consists of excision of the anastomotic aneurysm and replacement by a new segment of prosthesis between the prosthesis and the common or deep femoral artery. If the reconstruction at the level of femoral artery is not possible, the anastomosis is performed more distally, at the level of popliteal artery. The results are affected by the degree of urgency of surgery, with significant difference in favour of the patients Who underwent elective procedures.

[Aneurysm of the iliac artery]. / Aneurismi dell'arteria iliaca.

The authors consider isolated iliac artery aneurysms. While the incidence of isolated iliac lesion is, as literature reports, quite low, it rises up to 20% when associated with aortic lesions. The clinical findings are often characterized by effects of compression on the intrapelvic structures, by neurological symptoms and decreased venous flow. Diagnosis is based on ecography, CT and angiography for the definition of side and extension of the aneurysmatic lesion. From the technical point of view, the surgical approach is based on the dimensions of aneurysm and its mono- or bilateral extension. The most common approach in case of bilateral aneurysms or aorto-iliac lesions is transperitoneal, while it's limited to extraperitoneal way, when isolated iliac lesion. If the aneurysm involves the hypogastric artery, mostly when bilateral, the risk of bowel ischemic complications becomes more significative.

[Emergency surgery in patients over eighty]. / L'urgenza chirurgica nell'ultraottantenne.

The authors describe a series of 139 over-eighty patients (M = 53, F = 86), who underwent emergency surgery between 1-1-1987 and 30-6-1993. They consider diagnosis, copathology, type of surgical procedures, postoperative complications and final results. In this series they study 73 large bowel obstruction and 48 peritonitis. They notice important copathologies in 78% of patients, in particular cardiovascular diseases. They performed 74 mayor surgical procedures with 48% of postoperative complications and exitus in 24% of cases, due overall to exacerbation of coexisting diseases. The authors underline the direct between mortality rate and number of copathologies, and analyze the basic rules to follow in surgical indications and during the postoperative period.

[Perforated colonic diverticulitis. Surgical technique]. / Le perforazioni diverticolitiche del colon. Tattica chirurgica.

Emergency surgery is required for performed colonic diverticulitis. Surgical indications are not uniform in literature. In the experience of the authors the operations have been performed in the case of peritonitis subsequent to the perforation or in the case of failure of the conservative treatment. Twenty-four patients underwent surgical intervention because of diffuse (17 cases) or localized peritonitis (7 cases). Exitus were related to cardiovascular complications in patients over seventy. Postoperative results are related to the age, the general conditions of the patient and to the intraoperative finding, of localized or generalized peritonitis. Operations may be divided into two groups: conservative procedures or primary resections. In the first one it is possible to suture the colonic wall without resection; in the second one the intraoperative finding or the extensive necrotic lesions indicates colonic resection or exteriorization. The surgical treatment adopted is correlated both to the age and cardiorespiratory conditions and to the other associated diseases.