[Self expandable metal stent as bridge-to-surgery in acute bowel obstruction]. / Le protesi colorettali come bridge to surgery nelle occlusioni intestinali acute.

AIM: Self expandable metal stent (SEMS) can be used to relieve malignant colorectal obstruction. The stent serves as a palliative measure for high-risk patients or those with unresectable tumor on subsequent workup. For low-risk patients with resectable disease, SEMS serves as a safe and effective bridge to subsequent laparoscopic surgery. METHODS: From August 2009 to April 2012 we have treated with SEMS 39 patients, 20 of whom with palliative purpose; 19 patients are treated with SEMS for bridge to surgery, out of these patients, 8 were women, 11 men with median age of 61.4 years (range 36-81 years). Technical success, defined as a successful stent placement and deployment in the stricture site, was achieved for 39/40 patients (97.5%). The average duration of the procedure was about 60 minutes (range 15-120). RESULTS: Clinical success was achieved for all the 39 patients, 19 of these could be subjected to bowel preparation and colon resection after 25 days from the positioning. No colostomy was performed. Among patients undergoing the procedure, perforation occurred in 1 case. CONCLUSION: In summary, the colonic stent placement is a complex method that needs qualified medical-nursing team, able to solve any difficult situation, such as the severe, irregular and distal obstruction. SEMS positioning guarantees a high percentage of clinical and technical success; however it is necessary to pay attention to the risk of complications like bowel perforation.

[Colorectal Crohn's disease: indications to surgical treatment]. / Malattia di Crohn colorettale: quando e come operare.

Colorectal Crohns Disease (CRCD) represents the 25% of all cases of Crohns Disease (CD). Between January 1984 and December 2000 we have operated 68 patients with CRCD, that represent 10.3% of the patients operated for CD. Thirtythree patients (48.5%) were men and 35 (51.5%) were women. The median age at diagnosis was 37.3 +/- 13.1 years, with the highest incidence during the fourth decade. In most cases the disease involved the left colon and rectum (65.9%), while in 6.3% and in 3.8% of cases the right and the transverse colon respectively. In the 27.9% of cases the entire colon was involved. At the time of surgery, the disease behaviour was stenosing in 30.9% of patients, inflammatory in 22.1%, and penetrating in 47% of cases with the presence of fistulae (coloenteric in 6 patients, colo-bladder in 2 cases, rectouretral in 1 case, colo-cutaneous in 4 cases and intramesenteric in 2 cases) and abscesses (23.5% of patients). In three patients the CRCD had led to neoplastic transformation. Fourteen patients had undergone an emergency surgical procedure for severe acute colitis, 2 for toxic megacolon, 1 for an intraabdominal abscess and one for intestinal occlusion. In the segmentary forms we have always practiced a resection of the diseased colonic segment without total colectomy. In the cases with diffuse colonic involvement in which the rectum was free from disease a total colectomy with ileorectal anastomosis was performed. In the cases with rectal disease (26 cases) the sphinteric function was preserved with low rectal resection or with colo-anal anastomosis. In 4 patients with rectal disease and in 4 cases with fistulae, we complited the intervention with a permanent stoma. During the median follow-up of 83.7 months (12-207) the surgical relapse was of 27.3%. We suggest to treat CRCD with resections limited to the diseased segment. Moreover, it is possible to preserve the sphinteric function every time the rectum or the anal canal are normal, without postoperative complications or early relapses.