Simultaneous early surgical repair of post-cholecystectomy major bile duct injury and complex abdominal evisceration: A case report.

BACKGROUND: Major bile duct injuries (BDIs) are hazardous complications during 0.4%-0.6% of laparoscopic cholecystectomies. Major BDIs usually require surgical repair, ideally either immediately or at least six weeks after the damage. The complexity of our case lies in the coexistence of early BDI followed by 2-week biliary peritonitis with massive midline evisceration which, in combination, has over 40% mortality risk. METHODS & CASE REPORT: We describe the case of a 65-year-old male, transferred to our tertiary HPB service on day 14 after common bile duct complete transection during cholecystectomy and postoperative laparotomy. The patient presented with biliary peritonitis along with full wound dehiscence and extensive evisceration. During emergency peritoneal wash-out surgery we deemed immediate BDI repair feasible by primary Roux-en-Y hepaticojejunostomy (HJ), with multi-stage abdominal closure. In the following days we performed progressive abdominal wall closure in multiple sessions under general anesthesia, aided by vacuum-assisted wound closure and intraperitoneal mesh-mediated fascial traction-approximation (VAWCM) with permeable mesh. An expected late incisional hernia was eventually repaired through component separation and biological mesh. DISCUSSION & CONCLUSION: The simultaneous use of Roux-en-Y HJ and VAWCM has proven safe and effective in the treatment of BDI and 2-week biliary peritonitis with massive midline evisceration.

[Gastric carcinoid: case report and review of the literature]. / Carcinoide gastrico. Presentazione di un caso e revisione della letteratura.

Carcinoids are rare tumour of neuroendocrin origin, characterized by argyrophylic silver stain reaction, positive immunohistochemical reaction with neuron-specific markers, a typical growth pattern; they can express different peptides and biogenic amines. Gastric carcinoid tumours have been classified on the basis of susceptibility to gastric trophic stimulus and characteristics mucosal surrounding into 3 different types. This classification is important with respect to therapeutic strategy (type adapted treatment), but the option of endoscopic or surgical treatment is influenced by the impossibility to distinguish clearly the benignity or malignity of these lesions. A review of international literature and a rare case of gastric carcinoid tumour associated with chronic athrophic gastritis, developed in a female 65-years old, with anaemia and treated by subtotal gastrectomy, are presented.