Colon bleeding from both arteriovenous malformation and inflammatory bowel disease. Case report.

INTRODUCTION: Although endoscopy and angiography have changed the management of lower gastrointestinal bleeding and the majority of patients respond to conservative treatment 10-20% of cases have no recognizable site of hemorrhage. About 10-30% of all patients will require operative intervation. A very rare case of massive lower gastrointestinal bleeding in a young patient who was found to suffer from two causes of gastrointestinal hemorrhage in the same time is reported. The patient had to undergo surgery for the control of bleeding. CASE REPORT: A 23 years old male Greek patient presented to the emergency department of our hospital because of three episodes of hematochezia during the last 10 hours. He was admitted to the surgical department for monitoring of his condition. In the next 10 hours the hematochezia continued and the patient although being transfused with three units of packed red blood cells, started to become unstable with his vital signs affected, having also a syncoptic episode. Emergent colonoscopy could not recognize the site of hemorrhage or any other pathology in the colon, but revealed an intestinal lumen full of blood from the anus to the cecum. It was decided that the patient should undergo operation to stop bleeding. An extensive right hemicolectomy was performed. After that the patient remained stable and showed no signs of hemorrage. The histopathological examination of the specimen showed an arteriovenous malformation but also lesions of the mucosa compatible with early inflammatory bowel disease. CONCLUSIONS: In young patients with massive lower gastrointestinal bleeding of unknown origin, extensive right hemicolectomy provides a good and safe therapeutic choice that will control hemorrhage in most cases with the advantage of lower mortality and morbidity rates compared to subtotal colectomy. Close monitoring of the patient postoperatively is essential.

[Port site metastasis: a problem in oncologic laparoscopic surgery. Case report and review of the literature]. / Metastasi in sede di trocar (port site metastasis) dopo chirurgia oncologica laparoscopica. Presentazione di un caso e revisione della letteratura.

First success of laparoscopic surgery promoted the application of this technique in the treatment of malignancies. The technique has been associated with less postoperative pain, a better cosmetic result and a shorter period of hospitalization. The early optimism has been followed by the doubts based on the observation of port site metastasis after laparoscopic surgery for neoplastic diseases. Port site metastases have been reported without a sure explanation of their cause: gas turbulence and exfoliated cells, contaminated instruments or limited experience of surgeon. In this study we present a case of a woman that underwent laparoscopic cholecystectomy; 12 months later she presented with port site metastasis from an unsuspected ovarian cancer. We review in the literature about this complication of the laparoscopic surgery.

Isolated giant mesenteric fibromatosis (intra-abdominal desmoid tumors). Case report.

A rare case of isolated giant mesenteric fibromatosis is presented. The tumor originated from the fibrous mesenteric tissue. The patient underwent laparotomy because of abdominal discomfort and sub-occlusive symptoms due to the giant mass. Differential diagnosis of mesenteric masses is discussed and the Authors also review the literature concerning this rare disease.

[Intestinal obstruction secondary to appendiceal mucocele: case report and review of literature]. / Ostruzione intestinale secondaria a mucocele appendicolare: descrizione di un caso e revisione della letteratura.

Appendiceal mucoceles are a group of lesions in where the appendiceal lumen becomes distended with mucus. These are rare conditions. Approximately 25% of mucoceles are asymptomatic and discovered incidentally at surgery. The appendiceal mucocele accounts only the 0,2-0,3% of all appendicectomies. This condition usually requires surgical treatment, either appendicectomy or right colectomy under specific circumstances. In this article we present the case of a male patient 73 years old who developed subacute intestinal obstruction secondary to giant appendiceal mucocele. We also review the international literature on this subject.

[Dynamic ultrasonography in the assessment of candidates to laparoscopic cholecystectomy]. / L'ultrasonografia dinamica nella valutazione del candidato alla colecistectomia laparoscopica.

Laparoscopic surgery has opened a new era in the management of surgical diseases. But, on the other hand, has created problems relating to the technological and to the technico-surgical aspects. In the preoperative evaluation of laparoscopic cholecystectomy candidates it is very important to know about the pathological state of the gallbladder, which may become the cause of very difficult or impossible laparoscopic operation, and the convert in an open procedure will be forced. Recurrent gallbladder inflammations provoke alterations of the normal structure of the wall (oedema, fibrosis) and normal elasticity and contraction after stimulation is last. Adhesion with neighbouring organs hinder contraction as well, and surgical difficulties increase. Choledocholithiasis must be known before operation, to plan surgical strategy. The presence of choledochus disease does that allow us to modify its calibre after stimulation. 100 patients who underwent laparoscopic cholecystectomy, in our Department, were evaluated before with dynamic ultrasonography (DUS), and the results were compared with operating finds. In this paper are exposed the used method of evaluation and the results of this work. These results allow as to state that the method is effective and trustworthy.