[Emergency surgery for neoplastic left colon obstruction: resection and primary anastomosis (RPA) versus Hartmann resection (HR)]. / Chirurgia d'urgenza per occlusione neoplastica del colon sinistro: resezione ed anastomosi primaria (RPA) versus resezione secondo Hartmann (HR).

UNLABELLED: This retrospective study compares: hospitalization time, morbidity and mortality (patients operated for neoplastic occlusion of the left colon in emergency, without perforation), considering hanestesiologic risk and surgical technique (RPA versus RH). MATERIALS AND METHODS: From April 1999 to February 2003 the Emergency Surgery of AORN of Caserta has operated, in urgency, 60 neoplastic patients with left colon occlusion realizing: 46 (76.5%) RPA [36 ASA < or = III, low hanestesiologic risk (LAR), 10 ASA = or > IV high hanestesiologic risk (HAR)], 12 (20%) RH (2 LAR and 10 HAR) 2 (3.5%) palliative colostomics. RESULTS: 36 LAR patients with RPA had 5% of specific complications and 5% of medical complications. 2 LAR patients with R-H: no complication. 10 HAR patient with RPA brought 10% of specific complications and 10% of medical complications. 10 HAR patients with RH had 20% of specific complications and 10% of general complications. The middle hospitalization of LAR patients with RPA was 11 days versus 9 days of RH pz. (equal hanestesiologic risk ). The HAR pz., treated with RPA, had as middle hospitalization 15 ggs in comparison to the 9 ggs of the HRA pz. treated with RH. MORTALITY: 1/36 for LAR pz. with RPA (3%), and 0/0 for LAR pz. with RH; 1/10 for HAR pz, with RPA (10%) and 1/10 for HAR pz. with RH (10%). CONCLUSIONS: Resection and primary anastomosis, (correct indications and expert surgeon), gives prevalence of complications and mortality similar to the repeated surgical procedure, a better life quality, but an higher number of post-operating hospitalisation days.

[Complication of acute diverticulitis: colo-vesical fistula (a clinical case)]. / Una complicanza della diverticolite acuta: la fistola colo-vescicale (Caso Clinico).

BACKGROUND: A patient presenting a colo-vescical fistula together with a number of other pathologies, and the absolute absence of a set scheme for the treatment of septic diverticular complications has prompted us to publish this case. PATIENT AND METHODS: The patient aged 80 was admitted urgently, diagnosed with intestinal occlusion. Generally poor conditions: renal insufficiency, abdomen globose and hypertympanic, systaltic mass in the epigastric site. The patient had experienced abdominal pains for about 4 months; severe tenesmo during evacuation: fever temperature as high as 38.5 degrees C; dysuria; aero-hydro levels; stenosis of the sigmoid. A decision was taken to operate. SURGERY: The presence of a large mass at the level of the sigmoid, which subsumed the ileal ansae, the vescical and the sigmoid itself. While isolating the pelvic anatomical structures, a purulent sac in the Douglas was uncovered, which united the bladder and the sigmoid. It was thought appropriate only to fit a colostomy, thus excluding the descendents. DISCUSSION: Surgery must resolve the peritonitis and the fenestration itself. Due to the existing septic conditions, it was not believed advisable to perform a primary anastomosis; a Hartmann's or a simple colostomy was thought preferable. CONCLUSIONS: This case underlines the difficulty in standardising operational conduct when this in turn will depend on the experience of the operator and the circumstances met at the time.

The first-reported case of diffuse purulent peritonitis in a patient with retroperitoneal Hodgkin disease (etiopathogenetic hypotheses).

We report a case of purulent diffuse peritonitis in a patient who was affected by Hodgkin lymphoma, with no evidence of other abdominal diseases. This is a 54 y. old. white male who was admitted to our department with a history of asthenia, recurrent fever, dysphagia and abdominal pain. In the plain abdominal radiology pneumoperitoneum was evident. Duodenal perforation suspicion was confirmed by anamnesis and plain radiology which showed the presence of intra abdominal air. Emergency exploratory laparotomy showed a purulent diffuse peritonitis, which relapsed after multiple surgical toilettes and peritoneal lavage. A postoperative abdominal CT scan and histology of a biopsy taken during the second surgical operation showed a retroperitoneal Hodgkin lymphoma, which went to remission after chemotherapy. Considering the two simultaneous clinical manifestations (retroperitoneal Hodgkin lymphoma and peritonitis), we made two pathogenetic hypotheses: a) The retroperitoneal disease produced lymphatic stagnation and peritoneal transudation, which then was infected; b) The abnormal lymph nodes were infected and the abdominal cavity was contaminated from retroperitoneum from blood/lymphatic stream or by contiguity.

A rare gastric ulcer complication: the gastrocolic fistula. A case report.

We report a case of gastrocolic fistula following a benign gastric ulcer, which is now a truly exceptional finding, due to the widespread use of H2-receptor antagonists and proton- pump inhibitors. A review of the literature shows that this condition warrants a complete diagnostic work-up to exclude more ominous underlying diseases. Careful attention to the symptoms of peptic ulcer and particular care with patients undergoing long-term treatments with drugs potentially harmful for the stomach are recommended.