[Ultrasonography in the preoperative assessment of candidates for laparoscopic cholecystectomy: examination technique and results]. / L'ecografia nella valutazione preoperatoria dei pazienti candidati a colecistectomia laparoscopica: tecnica d'esame e risultati.

Laparoscopic cholecystectomy needs a more specific preoperative diagnostic approach than open cholecytsectomy. We investigated the role of US in the preoperative assessment of patients candidate to laparoscopic cholecystectomy. Two hundred patients were examined and then submitted to laparoscopic cholecystectomy regardless of US results: the surgical approach had to be changed from laparoscopy to laparotomy only in 10 of them. We focused our study on two major parameters to reduce the surgical risk: the anatomical study of the so-called "Calot's triangle" (the hepatic artery, common duct and cystic duct) and the study of the gallbladder bed and of pericystic structures. In the study of gallbladder walls and bed, US had high sensitivity (100%) and diagnosed no false negatives and 11 false positives of pericholecystitis (94.5% specificity), with a trend toward overstaging; in these 11 cases, gallbladder wall thickening was seen but the organ was not particularly difficult to remove at surgery. In cystic duct studies, we correctly diagnosed 6 abnormalities (3 cystic duct stones, 2 anatomical variants and 1 anatomical variant plus stone), with no false-positive and 2 false-negative diagnoses of abnormal insertion (75% sensitivity and 100% specificity). The common duct was shown along its whole course in 80% of cases; both sensitivity and specificity were 100% in dilatation detection, while the presence of stones was diagnosed with 70% sensitivity and 100% specificity.

[Diagnostic imaging in the evaluation of pelvic complications in intestinal diseases]. / Diagnostica per immagini nella valutazione delle complicanze pelviche da malattie intestinali.

During 12 consecutive months, 680 patients with recent pelvic symptoms were examined with ultrasonography (US). In 44 patients we found evidence of intestinal disease; 19 of them exhibited pelvic complications--11 pelvic abscesses, 3 enterovesical fistulas, 2 enterovaginal fistulas and 1 enterovesicle fistula; in 11 cases the inflammation spread to the surrounding organs. Of these 19 patients, 8 had an intestinal disease in their case history, whereas symptom onset was recent in the other 11 patients. In the latter group US yielded the first diagnostic information showing a bowel disease and other diagnostic examinations with different techniques were therefore performed. In 15 patients US indicated which type of bowel disease had caused the pelvic complications, while in 4 patients US showed a bowel disease without differentiating diverticular disease from neoplasms. In all patients US results were compared with X-ray and CT findings. In 17 patients the diagnoses were confirmed at surgery. The results we obtained from this study indicate US as an accurate method to detect not only the various pelvic conditions but also to differentiate pelvic complications of intestinal conditions from diseases originating in the pelvic organs.