Case Report: Ileo-Ileal Intussusception Secondary to Inflammatory Fibroid Polyp: A Rare Cause of Intestinal Obstruction.

Introduction: Intussusception is a telescoping of a bowel segment into another and it can be a surgical urgency. Most adult intussusceptions arise from a lead point which can be benign or malignant. For this reason, intussusception in adults should undergo surgery. Here we describe a case of ileal inflammatory fibroid polyp (IFP), presenting with ileo-ileal intussusception and obstruction. Case report: A 54-year-old Caucasian woman presented for acute abdominal pain. A radiography and a CT of the abdomen were performed, which showed signs of occlusion due to an ileo-ileal intussusception. An urgent laparoscopy was performed, the intussusception was extracorporeally reduced, the ileal segment involved was resected, and an ileo-ileal anastomosis was performed. The intussusception seemed to be caused by a 3-cm intra-mural lesion. Discussion: Intussusception is a surgical concern. While most cases are idiopathic in children, 90% of adult intussusceptions are caused by underlying diseases. Therefore, intussusception in adults should undergo surgery. Radiology is necessary for the diagnosis: the CT scan helps localizing the lesion and shows pathognomonic signs. This case report analyzes an intussusception caused by an inflammatory fibroid polyp. Accurate diagnosis of IFP is only possible with histopathological examination, helped by immunohistochemistry. The differential diagnosis is important because some lesions are malignant. Conclusion: We reported a case of intussusception caused by an IFP. The diagnosis was made with a CT scan together with intraoperative findings and histopathological examination, which excluded potential differential diagnoses. The patient underwent an explorative laparoscopy, with an ileal resection and anastomosis. Due to the risk of malignancy, surgery is mandatory.

Recurrent oncocytic adrenocortical carcinoma: implementing diagnostic criteria in a case report with the longest survival.

INTRODUCTION: Oncocytic adrenocortical tumors represent a subtype of the adrenal cortex neoplasms. These tumors can be divided into oncocytomas, oncocytic neoplasms of uncertain malignancy and carcinomas (OACs). To date, only 34 cases of OAC have been reported. CASE EXPERIENCE: We reported a case of a 54-year-old male patient with a history of laparoscopic right adrenalectomy for an OAC and subsequent chemotherapy for a recurrence. He was referred to our emergency room for diffuse abdominal pain, vomit, change in bowel habits, fever, asthenia. He underwent a laparotomy and a complete excision of the known bilobate lesion. The histopathological findings matched the features of a recurrent OAC. No chemotherapy was administered after surgery and the patient was disease-free after a follow-up of twenty-eight months. RESULTS - DISCUSSION: The most questionable issue in treating adrenocortical oncocytic neoplasms is the determination of malignancy. According to the Helsinki Score, which is the best prognostic system, the primary lesion was an OAC. We also implemented the score systems to the recurrent lesion, that seemed to be malignant. We believe that the adjuvant treatment can delay a recurrent lesion development, but finally, radical surgical excision is necessary. Moreover, we reported the longest survival after the primary adrenalectomy. CONCLUSIONS: This study described the first case of recurrent oncocytic adrenocortical carcinoma with the longest followup. Adrenocortical oncocytoma is an extremely rare tumor of the adrenal gland with variable biological behavior without definitive consensus about diagnostic criteria. This was also the first case in which different histopathological criteria have been implemented in a recurrence. KEY WORDS: Oncocytic adrenocortical carcinoma, Surgical oncology, Survival.

[Large-bowel obstruction as a result of occult diaphragmatic hernia 11 years after injuries]. / Occlusione intestinale del colon per ernia diaframmatica occulta 11 anni dopo trauma penetrante.

Diaphragmatic injury accompanied by herniation through the thoracic cavity is a well documented complication of penetrating or blunt abdominal trauma. It occurs in 3% of abdominal lesions, with strong prevalence for blunt trauma. In the acute setting the diagnosis may be difficult because of the lack of peculiar clinical signs or the wrong interpretation of radiological findings. For this reason, medical history taking should be very accurate, in order to underline the correlation between a past traumatic event and the present symptoms. If the defect is not promptly recognized, the patient has a considerable increase in morbidity and mortality risk. In our case the presentation of the diaphragmatic injury was delayed and the correct diagnosis was not suspected initially. We report the case of a 28 years old man presenting to our department for sudden abdominal pain associated with bowel obstruction. Patient underwent an urgent laparotomy that revealed a postero-lateral diaphragmatic hernia with incarcerated colon and omentum, which appeared ischemic and were therefore resected, with successive closure of the diaphragmatic breach. During medical history taking the patient signaled a penetrating trauma occurred eleven years before symptoms presentation. .

The use of biological mesh to repair one large, contaminated abdominal wall defect due to neoplastic invasion. Report of a case.

We hereby report a case of use of biological mesh to repair one large, contaminated abdominal wall defect due to a sigmoid tumour presented as an abscess infiltrating the abdominal wall. Our patient was a 48-year-old woman. Her medical history was negative for any previous disease or surgical procedure. Because of the abscence of neoplastic secondarism an en-bloc resection of the interested sigmoid colon and of the infiltrated abdominal wall was performed, thus resulting a large wall defect in the left inguinal region. In order to close the wall defect a biological porcine collagen mesh was used. In our case we used a Permacol mesh made of porcine acellular dermal collagen. Reconstruction of complicated abdominal wall defects is a challenging surgical problem and primary repair is often difficult to achieve without excessive tension in the abdominal wall. The use of a syntethic mesh in this patient could have been inappropriate due to the possibility of creating adhesions with intra-abdominal viscera and fistula formation. We chose to use a biological mesh because of its safer properties in case of infected, inflamed or infiltrated surgical fields, as demonstrated in the literature.

[Colonic metastasis from primary carcinoma of the lung. Case report]. / Metastasi del colon da tumore primitivo del polmone. Caso clinico.

Lung cancer is the most common cause of cancer-related death in both men and women in Western countries. About one-half of patients with lung cancer have metastatic disease at the time of initial diagnosis. Metastasis to the gastrointestinal tract from primary lung cancer has rarely been described. The most common metastatic site is the small bowel whereas large bowel secondary lesions are very rare. The majority of patients are referred to a surgeon only after the intestinal secondary lesion becomes symptomatic posing a threat to the patient's life. Although the outcome is still unfavourable, the development of chemotherapy and of surgical techniques allows aggressive treatment when facing a single intestinal metastasis from lung cancer. We report on a case of a patient who came to our observation for a neoplastic stenosis of the descending colon with a single liver secondarism. Histology proved both lesions to be metastases of primitive adenocarcinoma of the lung.

[Giant angiomyolipoma of the kidney not associated with tuberous sclerosis: a case report and review of the literature]. / Angiomiolipoma gigante del rene non associato a sclerosi tuberosa: presentazione di un caso clinico e revisione della letteratura.

The authors describe a paradigmatic case of a large renal angiomyolipoma not associated with tuberous sclerosis. The lesion was discovered as an incidental finding during abdominal ultrasound for other pathology. Owing to the extent of the lesion and the appreciable risk of spontaneous rupture and bleeding, we opted for surgical treatment. The impossibility of dissecting the angiomyolipoma from the right kidney obliged us to perform a nephrectomy. The clinical interest of angiomyolipoma is in its rapid growth, the difficulty of distinguishing it from malignant lesions, the association with tuberous sclerosis, the presence of numerous aspecific symptoms and the difficulty of establishing the correct diagnosis and treatment strategy.