Surgery for severe idiopathic constipation: a report of personal experience

Discute-se protocolo para estudo de tratamento de constipacao idiopatica severa (CIS); 108 pacientes foram assim classificados: 58 com constipacao colica cronica, 30 com transito lento, quatro com megacolon idiopatico, 24 com sindrome de intestino irritavel, 45 com constipacao retal, 21 com obstrucao intestinal baixa, 12 com megareto e 12 com hipertonia do esfincter anal interno, alem de cinco casos de formas mistas. Em sete pacientes com CIS colica (cinco com transito lento e dois com megacolon idiopatico) foi indicado tratamento cirurgico, com realizacao de colectomia subtotal e anastomose ileo-retal. Todos esses doentes evoluiram satisfatoriamente no pos-operatorio...

[Subphrenic abscess. Importance of its pathology and ever present diagnostic and therapeutic problems]. / Gli ascessi subfrenici. Interesse di una patologia dalle problematiche diagnostiche e terapeutiche sempre attuali.

Even today subphrenic abscesses constitute a major problem for the surgeons who are at times their involuntary cause. These abscesses are characterised by a high mortality rate and difficulty of treatment. A careful review of the literature and a fortunately modest experience form the basis for an assessment of what has been achieved and what problems still remain with particular reference to new diagnostic and therapeutic techniques.

[Hydatid cysts of the liver]. / Le cisti idatidee del fegato.

Single or multiple hydatid cysts of the liver are frequently observed in Italy and the Mediterranean countries. They are swellings caused by the hexacanth larva of a small cestode, Echinococcus granulosus. This must be distinguished from E. multilocularis, which is responsible for alveolar cyst, and is common in central-eastern Europe, but rare in Italy. An account is given of the development cycle of the intermediate and final host, the protean symptomatology (dependent on the siting of the cyst in the liver and the presence of complications), and the radiological, ultrasound, biological and anatomical diagnosis of this form. Diagnosis is much dependent on the examinations of first choice (currently echotomography, plus immunoelectrophoresis and immunofluorescence that permit epidemiological control of the community and serological follow-up after surgery). Computed tomography is of assistance in the approximately 25% of cases in which echotomography is not conclusive, while angiography is called upon to provide very precise mapping of the supramesocolic region. Surgery requires two fundamental stages: sterilisation of the parasite and treatment of the pericystium. It involves external or internal shunting, or partial or total resection, depending on various factors, particularly the thinness or thickness of the pericystium, the absence or presence of infection, and the site, volume and number of the cysts. Medical management with mebendazole and its derivatives is still chancy, both on the strictly therapeutic plane and with regard to the prevention of secondary, spontaneous or postoperative dissemination.

[A case of aneurysm of the celiac trunk ruptured into the duodenum]. / Su un caso di aneurisma del tronco celiaco rotto in duodeno.

A case of repeated, exsanguinating gastrointestinal haemorrhage in a 36-yr-old man, due to rupture in the duoedenum of an arteriosclerotic aneurysm of the coeliac artery, is described. Selective arteriography enabled the cause of bleeding to be established. The pictures for the coeliac and superior mesenteric arteries showed good hepatic arterial vascularisation via the vessels issuing from the right hand side of the superior mesenteric, immediately after its point of origin. Successful aneurysmectomy was not performed until the fifth operation, when the cause of bleeding had thus been made clear.