Annali italiani di chirurgia最新文献

{"title":"Management of incidental pancreatic neuroendocrine tumor: a case report with literature review.","authors":"Erasmo Spaziani, Annalisa Romina Di Filippo, Martina Spaziani, Giovanni Traumueller Tamagnini, Piero Francioni, Nello Salesi, Marcello Picchio, Alessandro De Cesare","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic neuroendocrine tumors (PNETs) are rare and accounting for less than 5% of all pancreatic neoplasms. Their management depends on dimension of the lesion, main pancreatic duct (MPD) caliber, tumor malignancy features and evolutive potential.</p><p><strong>Case report: </strong>Incidental finding of a lesion 1.2 cm wide of the pancreatic body, after contrast enhanced total body CT, in a 71 years old obese Caucasian male (BMI>25), during follow-up for cutaneous melanoma. The lesion was confirmed by MRI and 68-Ga pancreatic scintigraphy. EUS showed a second hypoecogenic and hypovascularized lesion compatible with pancreatic tail PNET. After FNB, Ki-67 was below 3%.</p><p><strong>Discussion: </strong>68-Gallium PET-CT was the preferred technique for the staging of the neuroendocrine neoplasm, for treatment planning, for the localization of the pancreatic lesion, excluding the presence of unknown extra-pancreatic lesions. EUS-FNB is indicated in patient with suspicion of PNET, although further investigation is needed to include it as a routine diagnostic examination.</p><p><strong>Conclusion: </strong>Surgery is mandatory in case of PNETs larger than 2 cm, with MPD dilation, Ki-67>20% and compression symptoms.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141449464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liposarcoma of spermatic cord mimicking an inguinal hernia A case report and review of the literature.","authors":"Francesco Paolo Tinozzi, Benedetto Calì, Martina Bertolami, Andrea Rebba, Giovanni Morone, Simone Albertario, Francesca Abbiati, Nadine Osman, Rubina Ruggiero","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>Liposarcoma of the spermatic cord (LSC) is a tumour often mistaken for common inguinal swelling as hernia and the aim of this work is to present our case with a review of the Literature to define the management of this rare condition.</p><p><strong>Material of study: </strong>A systematic review has been realised, considering English language articles published on Pubmed, between 1956 and 2022, using as key words \"Liposarcoma of the spermatic cord\".</p><p><strong>Results: </strong>160 studies described 420 cases of LSC and in 40 cases the patient had undergone surgery with an initial diagnosis of inguinal hernia.</p><p><strong>Discussion: </strong>LSC is a very rare entity of genitourinary malignancies, occurring more often in the spermatic cord and diagnosis can be difficult. Our case and Literature data confirm the role of imaging in not conventional inguinal swelling, to avoid diagnostic mistakes and to define preoperatively the correct surgical management.</p><p><strong>Conclusions: </strong>Imaging is mandatory in case of diagnostic doubt. The recommended treatment is a radical high orchiectomy with clear margins. A long follow-up period is necessary to detect a local recurrence which may occur even several years after the primary therapy.</p><p><strong>Key words: </strong>Inguinal swelling, Liposarcoma, Spermatic cord.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138290096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatogonadal fusion (HGF), a rare cause of undescended testis. 7th case in the Literature.","authors":"Taner Kamaci,&nbsp;Mehmet Sarikaya","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Hepatogonadal fusion (HGF). It is a rare congenital anomaly characterized by the fusion of the liver and gonads in the intrauterine period. We report the 7th hepatogonadal fusion case in the literature and its treatment.</p><p><strong>Case presentation: </strong>In the physical examination of a 4-month-old male patient who applied with the complaint of recurrent swelling in the right inguinal region, a right inguinal hernia was detected and the right testis could not be palpated. The patient underwent laparoscopy. It was observed that the right testis was in the abdomen at the level of the inner ring of the inguinal canal and adhered to the level of the liver segment 6 with a thick band. Hepatogonadal fusion was separated, then hernia repair and orchidopexy were performed. The patient was discharged on the 1st postoperative day. Both testes of the patient were palpable in the scrotum at the 6th month postoperative follow-up.</p><p><strong>Conclusions: </strong>In conclusion, HGF may cause undescended testis with intra-abdominal localization. The use of laparoscopy in intrabdominal testis cases is a very accurate choice in the diagnosis and treatment of rare cases such as HGF.</p><p><strong>Key words: </strong>Hepatogonadal fusion, Intra-abdominal testis, Laparoscopy, Orchidopexy, Undescended testis.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41101416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic fistula: interventional radiological treatment by collection. Jejunal loop internal drainage.","authors":"Maurizio Papa,&nbsp;Vincenzo Tripodi,&nbsp;Antonio P Francioso,&nbsp;Pietro Bisagni","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pancreaticoduodenectomy is a major surgical procedure associated with various and important complications, often difficult to be managed. Pancreatic fistula is due to leakage of pancreatic juice in the abdominal cavity and is the main and most frequent complication after pancreatic surgery. The treatment of pancreatic fistula may change according to degree. Interventional radiology (IR) can offer powerful minimally invasive alternatives in managing pancreatic fistulas. We report the case of a patient affected by ampullar adenocarcinoma who underwent pancreaticoduodenectomy. Surgery was complicated by high-flow pancreatic fistula treated conservatively with CT guided percutaneous transhepatic drainage. Due to persistent leak of pancreatic fluid the abdominal effusion was drained percutaneously in the jejunal loop by Interventional radiology. KEY WORDS: Pancreatic fistula, Jejunal loop internal drainage, Radiological treatment.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41096332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Panniculectomy with bariatric surgery in super morbid obesity patients.","authors":"Caghan Peksen,&nbsp;Talar Vartanoglu Aktokmakyan,&nbsp;Osman Anil Savas,&nbsp;Ozan Okyay,&nbsp;Asli Datli,&nbsp;Necat Elmali,&nbsp;Aziz Sumer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Panniculitis is an inflammation of the subcutaneous fat common in patients defined as super-super obese (>60 kg/m2). Poor hygiene and skin infections are common in the super morbidly obese group due to impaired metabolism of subcutaneous fat tissue, especially at abdominal folding. In our study, we will discuss the short-term results of panniculitis that develops as a result of these, simultaneously with bariatric surgery.</p><p><strong>Material and methods: </strong>In our study, six super morbid obese patients with Body Mass Index (BMI) of 80 kg/m2, 77 kg/m2, 74 kg/m2, 72 kg/m2, 68 kg/m2, 65 kg/m2, respectively, and sub umbilical skin tissue panniculitis were evaluated. These patients underwent bariatric surgery as a result of the obesity council decision. In the preoperative evaluation of the patients, it was observed that the blood supply to the subcutaneous fat tissues under the umbilicus was impaired, and the dermis/epidermis was hypertrophied.</p><p><strong>Results: </strong>Mean BMI of patients 73 kg/m2. Sleeve Gastrectomy (SG) was performed in 4 patients, Mini Gastric Bypass (MGB) was performed in 1 patient, and modified transit bipartition was performed in 1 patient. Infected erythematous lesions were detected on the skin secondary to ischemia, especially in some areas. After the patients performed the operations, a panniculectomy of approximately 70x30x20 cm was performed from under the umbilicus to the transverse line and up to the fascia.</p><p><strong>Conclusion: </strong>Panniculectomy and bariatric surgery are recommended in the appropriate patient group. Extensive prospective studies are required to define further the burden of infectious morbidity and mortality conferred by obesity.</p><p><strong>Key words: </strong>Bariatric surgery, Obesity, Panniculectomy.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41100634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small bowel obstruction due to congenital adhesion bands in the virgin abdomen. There is more than meets the eye.","authors":"Athanasia Mitsala,&nbsp;Konstantinos Romanidis,&nbsp;Michail Pitiakoudis","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Adhesive small bowel obstruction (SBO) represents a common surgical emergency leading to increased hospital admissions. Most patients presenting with adhesive SBO have a history of previous abdominal surgery. Although bowel obstruction secondary to congenital adhesion bands is rare, it should not be ruled out even in patients with a \"virgin abdomen\".</p><p><strong>Case report: </strong>We present two rare cases of adult patients with SBO due to congenital adhesions. The first patient was transferred to the operating room, secondary to a closed-loop obstruction diagnosis. Two congenital adhesion bands were detected intraoperatively, then coagulated and divided. The second patient was surgically treated due to worsening abdominal pain. An adhesive band was identified occluding the ileum on surgical exploration, then ligated and excised. Both patients recovered uneventfully, without any recurrence of symptoms on the follow-up.</p><p><strong>Discussion: </strong>Single adhesive bands are more commonly found in cases with a \"virgin abdomen\". Meanwhile, solitary bands usually lead to bowel strangulation and ischemia, mostly mandating operative management. Interestingly, a computed tomography scan may confirm the diagnosis of bowel obstruction, whereas water-soluble contrast agents may help predict the need for surgical treatment. Besides exploratory laparotomy, laparoscopic surgery is gaining ground as an effective SBO diagnosis and management approach.</p><p><strong>Conclusion: </strong>Adhesive SBO due to congenital bands is a rare condition, particularly in adults, with potentially lifethreatening complications. With the aim of prompt diagnosis and treatment, a high index of suspicion and awareness should be maintained even in patients without previous medical or surgical history.</p><p><strong>Key words: </strong>Small bowel obstruction, Congenital adhesion bands, Virgin abdomen.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41110035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non traumatic right Bochdalek hernia with loss of Domain in adults. Our experience and review of literature.","authors":"Michele Fiordaliso,&nbsp;Agostino Consoli,&nbsp;Shadi Ahmad,&nbsp;Drini Kore,&nbsp;Jonel Ngjelina,&nbsp;Mevlüt Karaorman,&nbsp;Pierluigi Lelli Chiesa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Right-sided Bochdalek hernia (BH) is a rare developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax. To date only 44 reported cases of right-sided BH have been surgically managed in adults in literature. We report one additional case of right-sided BH with loss of Domain. \"Loss of domain\" (LOD) is a term used commonly in the hernia literature to describe the distribution of abdominal content between the hernia and residual abdominopelvic cavity. After repairing hernias with significant LOD, serious physiological complications can arise.</p><p><strong>Methods: </strong>PubMed and Cochrane bibliographical databases were searched (last search: February 2022) for studies concerning BH.</p><p><strong>Case presentation: </strong>We report the case of a 50-year-old woman whose right-sided diaphragmatic hernia strangulated loops of small bowel and who was thus treated via urgent laparoscopy. After reduction of the intrathoracic contents we were unable to primarily close the midline fascia.We performed a staged abdominal wall reconstruction as the chronicity of the hernia led to loss of intra-abdominal domain.</p><p><strong>Discussion: </strong>Bochdalek hernia (BH) is the most common type of congenital diaphragmatic hernia and is usually leftsided. It typically presents in neonates and diagnosis in adults is a rarity. Various surgical repair options include open surgery, laparoscopic repair, thoracoscopic approach and robotic transthoracic approaches.</p><p><strong>Conclusion: </strong>BH should be managed timely regardless of its symptoms to avoid future complications. The closure of the defect can be done by different methods. When, after diaphragmatic hernia repair, it is suspected that the herniated viscera have lost their domain, it is preferable to use a Temporary Abdominal Closure to prevent compartment syndrome.</p><p><strong>Key words: </strong>Bochdalek hernia with loss of Domain, Bochdalek hernia in adults, Non traumatic Bochdalek hernia, Right-sided diaphragmatic hernia.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The HELLP syndrome: clinical issues and surgical management. A Case Experience.","authors":"Giuseppe Massimiliano De Luca,&nbsp;Viviana Danese,&nbsp;Lucia Franzoso,&nbsp;Alessandro De Luca,&nbsp;Francesco Luca De Luca,&nbsp;Antonella Tromba,&nbsp;Miriam Farinelli,&nbsp;Paolo Barbieri,&nbsp;Alessandro Perrone,&nbsp;Giovanni Landolfo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to challenge the current know-how in patients with spontaneous rupture of a liver hematoma, to differentiate amongst patients requiring such specific surgical therapy and avoiding mistakes during surgical operations, in order to terminate pregnancy with beneficial effects on the mother and fetus.</p><p><strong>Materials and methods: </strong>In a emergency scenario we admitted a 37-year-old woman at 35+4 weeks of gestation for emergency cesarean section after the onset of right hypochondrium pain. A diagnosis of hemoperitoneum and severe preeclampsia with liver and splenic bleeding was done and managed with packing of hepatic and splenic hematomas and according to her haemo-dynamic clinical conditions, done in different time.</p><p><strong>Results: </strong>A diagnosis of hemoperitoneum and severe pre-eclampsia with liver and splenic bleeding was done and managed it with 3 xypho-pubic-laparatomy in different time with haemostatic packing.</p><p><strong>Discussion: </strong>In this case report, the patient underwent an emergency caesarean section and was managed with packing of hepatic and splenic hematomas and according to her haemodynamic clinical conditions was operated in different time. The choice of laparotomy and hepatic packing has proved to be a viable option in patients with unstable vital signs and is feasible even in limited resource settings.</p><p><strong>Conclusion: </strong>Short interval between diagnosis and management may enhance the feto-maternal survival rate and prevent further morbidity or mortality. The choice of laparotomy and hepatic packing has proved to be a viable option in patients with unstable vital signs and is feasible even in limited resource settings.</p><p><strong>Key words: </strong>HELLP syndrome, Liver hematoma rupture, Packing.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41098254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neither inguinoscrotal hernia nor hydrocele misunderstood giant testicular neoplasm. Case report and literature review.","authors":"Alessandro De Luca,&nbsp;Lucia Franzoso,&nbsp;Viviana Danese,&nbsp;Francesco Luca De Luca,&nbsp;Giuseppe Massimiliano De Luca","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>This case experience aims to question the current know-how when a masked testicle malignancy occurs, in order to achieve the correct clinical framework and avoid mistakes during surgical procedures. in the evaluation MATERIALS AND METHODS: A 36-year-old male patient was admitted with an incorrect diagnosis of left-sided incarcerated inguinoscrotal hernia, and then discovered a seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge.</p><p><strong>Results: </strong>The surgery was perceived by the patient as the best possible treatment because the symptoms were relieved.</p><p><strong>Discussion: </strong>A 36-year-old male patient was admitted to our surgical department due to an incorrect diagnosis of leftsided incarcerated inguinoscrotal hernia, consequently to a misguided scrotal ultrasound-doppler exam. During the urgent surgical operation, we realized that we were dealing with an enormous 17x10x9 cm seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge.</p><p><strong>Conclusion: </strong>This case report points out that there may be a poor correlation between clinical findings and pathophysiologic processes affecting scrotal structures. Additional radiological investigations, such as CT scan, could clarify and confirm the clinical scenario, improving the preoperative planning and surgical outcomes.</p><p><strong>Key words: </strong>Inguinal Hernia, Seminoma, Testicular Neoplasm.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreas sparing duodenectomy and aortic reconstruction with custom-made bovine pericardial tubular graft for primary aorto duodenal fistula. Case report.","authors":"Mattia De Flaviis,&nbsp;Ilenia Di Sario,&nbsp;Silvio Palermo,&nbsp;Enrico Franceschini,&nbsp;Luca Sacco,&nbsp;Gabriele Pagliariccio,&nbsp;Ettore Colangelo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Primary aorto-duodenal fistula (PADF) is a rare life-threatening condition consisting in a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention. PADF results most commonly from an abdominal aortic aneurism (AAA) or aortic bacterial/mycotic infection, with the fistula forming between the native aorta and the third or fourth portion of the duodenum. Symptoms are nonspecific and the diagnosis is often delayed after AAA rupture with high rate of morbidity and mortality. We present a case of 69-year-old-male with a history of untreated abdominal aortic aneurysm who came to the attention of the emergency department for Abdominal aortic aneurysm rupture (RAAA). The patient was successfully treated with staged therapy: endovascular aneurysm repair (EVAR) to control hemorrhage rapidly, followed by pancreas sparing duodenectomy and aortic reconstruction with xenopericardial tube grafts. KEY WORDS: Biological graft, Bovine pericardial tubular graft, Primary aorto-duodenal fistula, Pancreas sparing duodenectomy.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41100633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}