[Isolated jejunal rupture after closed thoraco-abdominal trauma]. / Rottura isolata del digiuno dopo trauma chiuso toraco-addominale.

INTRODUCTION: Short bowel disruption following blunt abdominal trauma is rare and hard to diagnose and to treat. Death rate depends both on timing of surgical procedure and on associated lesions. MATERIAL AND METHODS: We show a case of short bowel isolated lesion following fall from mountain bike, III degree in O.I.S. Classification. Abdominopelvic US and helicoidal CT scan were performed, reveling pneumoperitonaeum due to hollow viscus disruption. Surgical procedure was performed within five hours from trauma. RESULTS: No complications occurred in postoperative period. Upper alimentary tract X-ray proved a regular transit, without any fistula. Patient was discharged on 13th day. CONCLUSION: Laparotomy must not be delayed if there is any doubt about bowel conditions: it's demonstrated that timing of surgical procedure is related to prognosis. If haemodynamic status of the patient allows, careful abdomen CT evaluation is mandatory; adequate nutritional support in postoperative period is also very important.

[The videolaparoscopic treatment of cholecystic common bile duct lithiasis: review of 827 cases]. / Il trattamento videolaparoscopico della litiasi colecisti-coledocica. Studio retrospettivo su 827 casi.

BACKGROUND: The aim of this retrospective study is to verify the progress of the results in 827 patients submitted to videolaparoscopic treatment for cholecysto-choledochus lithiasis during the period >March 1994 - September 2000. METHODS: All the patients had recurring biliary colic, dyspepsia and pain in the upper abdominal quadrants. All clinical forms of cholecystitis were treated. RESULTS: The laparotomic conversions in the case of lithiasis of the gallbladder alone were 8 (0.9%) and 13 (1.5%) as it occured simultaneously with lithiasis of the common bile duct. Mortality was null and morbidity was found in 4 cases, equal to 0.4%. CONCLUSIONS: On the basis of the results obtained cholecystectomy can be implemented on a large scale to include patients of all ages and those in the high risk groups provided that the operating team include expert and skilled surgeons in the laparoscopic method as well as the conventional methods.

[Laparoscopical marsupialization of symptomatic lymphoceles following kidney trans-plantation]. / Marsupializzazione videolaparascopica di linfocele sintomatico secondario a trapianto renale.

Personal experience in the laparoscopic treatment of a lymphocele following kidney transplantation and a review of the literature are presented. We have treated a symptomatic lymphocele, which occurred a month after renal transplantation. It compressed the iliac vessels and obstructed the urine flow. Physical examinations revealed it consisted of two chambers; it measured 12 x 8 x 6 cm. A US-guided puncture was performed and a drainage tube out in place. A continuous flow of lymphatic liquid derived, and therefore we decided on surgical intervention, which was conducted in laparoscopy. A puncture of blue through the drainage tube was performed; under US-guidance, we made an opening in the peritoneal wall and in the wall of the lymphocele. A cauterization of the edges was conducted. An immediate improvement in subjective and objective symptoms was achieved. A four-month follow-up showed minimal residual effusion, slowly disappearing. Literature data and clinical evolution of the patient show that the laparoscopic approach is to be considered the "gold standard" for the treatment of symptomatic lymphocele following kidney transplantation. The authors recommend the use of US-guidance to single out anatomic structures, particularly for surgeons not trained in this procedure.

[Unusual cause of ileal occlusion: a coconut bezoar]. / Una causa insolita di occlusione ileale: un bezoario da noce di cocco.

A coconut phytobezoar was detected in the distal ileum of a 4-year-old boy, admitted for suspected appendicitis. While persimmon or citrus fruit ingestion has been previously reported as cause of phytobezoar intestinal occlusion, it is the first time that coconut pulp is described to cause ileal obstruction in children. No predisposing factor as previous gastric surgery or Meckel's diverticulum was present. The bezoar was successfully milked past the ileocecal valve into the right colon.

[Recurrent thrombosis of the venous supply of the upper extremity]. / Trombosi ricorrente del distretto venoso dell'arto superiore.

The incidence of DVT in axillo-subclavian district is rather low. Up-to-date reports show however it is progressively increasing, owing to the widespread diffusion of intravenous prosthetic devices. While the opportunities of a correct diagnosis are becoming various, particularly because of the development of echo color-Doppler and imaging techniques, there is indecision for the treatment: the question is about a medical and a surgical therapy. Neither the former nor the latter are well established. This case report is about a 61-year-old woman affected by a recurrent DVT of the subclavian and axillary veins, who never underwent operation and/or handling of the venous district. Clinical tests didn't show any well determinate cause of thrombosis. It was decided not to treat the patient surgically, so a medical therapy was undertaken. Now she is completely recovered.