Cystic intestinal pneumatosis of the small gut: Etiopathogenesis and review of literature.

Cystic intestinal pneumatosis (CIP) is the presence of gas bubbles inside the wall of the intestine. In literature it has been reported to be associated with a variety of clinical conditions such as: superior mesenteric ischemia, intestinal perforation, bowel necrosis, infections which can cause mucosal alterations and therefore increasing its permeability, necrotizing enterocolitis in babies, trauma, intestinal obstruction, autoimmune and pulmonary pathologies. Its presence is usually documented by radiological techniques such as abdominal X-ray, CT scan and endoscopy and are usually characterized by the typical pattern of gas bubbles in the wall of the intestine. Majority of cases may be managed conservatively but intramural gas resulting from bowel necrosis represents a surgical emergency. We admitted an 86- year old man who presented with mild to moderate and persistent non-specific abdominal pain recurring for the last three weeks. No history of previous surgery was recorded. On examination, bowel sounds were dull and rare, general tenderness on the left of the abdomen but no particular resistance was noted, breath sounds were reduced and right hemi-thorax had reduced expansion as well. The patient was dehydrated and no central or peripheral neurological deficits were observed. Chest X-ray was performed and showed the presence of free air beneath the diaphragm. A complete abdominal CT scan was then done and documented the presence of pneumoperitoneum and multiple cystic like structures containing air in the right peri-splenic and para-renal regions. Laparotomy was then done for suspected perforation of the gut. The small gut was entangled with adhesions and presence of cystic structures with bubbles of air along the wall of the gut. The affected part of the small gut was then resected. The histology result confirms the presence of cystic pneumatosis of the small gut without any sign of intestinal wall perforation. KEY WORDS: Cystic pneumatosis, Pneumoperitoneum, Radiological investigations, Surgical approach.

Diaphragmatic hernia Report of two cases, classification, and review of literature.

Morgagni-Larrey hernia is uncommon congenital disease in the adults and presents with mild to severe clinical symptoms. In literature, about 80% of Morgagni -Larrey hernia are found on the right side of the chest cavity and have usually a peritoneal sack. Only 2-3% of patients at birth are symptomatic and therefore eligible for urgent surgery. Less severe forms of the disease are characterized by persistent epigastric and subcostal pains sometimes associated with vomiting and are frequently mistaken for dyspeptic disturbances. We present two case reports; the first one is a patient of 74 years who presented with persistent epigastric pain, vomiting, slight to moderate dyspnea on exertion associated with tachycardia, tachypnea and dyspeptic symptoms. Such symptoms have been going on for the last 6 months. The second patient is a 90 year old woman who was admitted in our ward for abdominal pain and distension associated with vomiting. In both cases a Morgagni-Larrey diaphragmatic hernia was discovered by using esophagogastroduodenoscopy, gastrographyn swallow and CT scan in the first case and only CT scan in the second one. KEY WORDS: Morgagni-Larrey hernia, Radiological investigations, Symptoms in adults, Surgical approach.

Voluminous bleeding stomach GIST: reflections on etiopathogenesis, diagnosis and therapy.

Gastrointestinal stromal tumours (GIST) constitute a heterogeneous group of neoplasms which, although rare (around 1% of the total number of malignant tumours), are the most common mesenchymal tumours of the gastrointestinal tract. In the past they were not very well known, whereas today, thanks to the remarkable progress made in the immunohistochemical and molecular fields, considerable knowledge has been acquired, offering new opportunities for classification and, above all, for a more adequate multidisciplinary treatment of this pathology. In this study, the authors report a case of a bleeding GIST of the stomach which they recently observed and discuss it in the light of recent reflections on the aetiopathogenesis, diagnosis and therapy of these tumours in the literature.