Clinical and anatomic features of the inguinal canal during hernia.

Seventy-eight patients affected by inguinal hernia, 33 by direct and 45 by indirect external oblique types, were studied. The morphologic and structural aspects of the inguinal canal including its length, the diameter of the deep inguinal ring and the qualitative features of the fascia transversalis and aponeuroses of the external and internal oblique muscles and of the transversus muscle were investigated. In all 78 patients with inguinal hernia, the length of the canal was 4.7 cm. In the 33 patients with direct inguinal hernia the width of the deep inguinal ring varied from 1.5 to 2.5. The aponeurosis of the external oblique muscle was dense in 19 cases (57.58%), rather laddered in 10 (30.30%) and very laddered in 4 (12.12%). The fascia transversalis was discontinued in 28 cases (84.85%) and velamentous in 5 cases (15.15%). In the 45 patients with indirect inguinal hernia the width of the deep inguinal ring varied from 1.5 to 7 cm. The aponeurosis of the external oblique muscle was dense in 14 cases (31.11%), rather laddered in 23 cases (51.11%), very laddered in 8 (17.78%). The fascia transversalis was dense in 15 (33.33%), elastic in 17 (37.78%) and velamentous in 13 cases (28.89%). Based on the results of this study, a series of therapeutic considerations are set forth. The most important of these include early surgical intervention, which is absolutely necessary, and the use of prostheses in the inguinal canal.

[Our experience with the treatment of cavitary and external biliary fistulas following surgical operations for hepatic echinococcosis]. / La nostra esperienza sul trattamento delle fistole cavitarie e biliari esterne consecutive ad interventi chirurgici per echinococco epatico

Successful treatment of five personal cases of external cavitary and biliary fistulae following radical liver hydatid surgery is reported. Stress is laid on the fact that complications may still occur, even when the latest techniques are employed. These can be avoided if the pathological anatomy and biliary physiopathology associated with the disease are fully understood, so that techniques can be adjusted to the different situations revealed by pre- and intraoperative exploration. Medical or surgical management must be preceded by precise knowledge of the reasons for persistence of the fistula.

[Modern views concerning surgical treatment of psychogenic chronic hepatic abscesses]. / Moderne vedute sul trattamento chirurgico degli ascessi epatici cronici piogenici

A case of paracholecystic pyogenic abscess of the liver discovered intraoperatively in a patient with calculous cholecystitis is reported. Successful management was obtained by means of extensive resection of the protruding cap, scrapping of the wall and suture of the parenchyma, coupled with cholecystectomy. The literature on treatment of liver abscesses is reviewed. The conclusion is drawn that radical removal, with respect for the parenchyma, is best employed in chronic, restricted forms. The pus must, of course, be cultured and an antibiogram run on the germs isolated, as a prelude to planned antibiotic management after surgery.

[An unusual complication of calculous cholecystitis: transparietal migration of a calculus into a circumscribed peritoneal sac without a fistulous passage]. / Una rara complicazione della colecistite calcolosa: la migrazione transparietale di un calcolo in una sacca peritoneale circoscritta senza tramite fistoloso

A rare complication of calculous cholecystitis (calculous that had migrated from the gallbladder and held in a circumscribed peritoneal sac with no fistula between this and the gallbladder) was observed in a woman who had been suffering from dropsy of the gallbladder with calculi for some 13 years. The most recent literature on acute and chronic perforations of the gall bladder and on known pathogenetic mechanisms regarding transparietal migration of calculi and the establishment of bilio-digestive and bilio-biliar fistulas is reviewed. A number of hypotheses are put forward to explain the unusual operative finding but the impossibility of formulating any precise preoperative diagnosis is recognized and it is stressed that many cases are recognized only following surgery.

[Treatment of hydatid cysts of the liver perforated into the intrahepatic bile ducts]. / Trattamento delle cisti idatidee del fegato perforate nei dotti biliari intraepatici

After recalling the latest finding on the pathological anatomy, physiopathology, symptomatology, diagnosis and surgical therapy of hepatic echinococcus with intrahepatic bile duct fistulas, the personal series and that of the Palermo Surgical Pathology School is illustrated. These series included 12 patients. The surgery employed is analysed and results obtained reported. It is concluded that modern diagnostic methods, particularly intraoperatory, the new radical surgery techniques, and the improved post-operative assistance offer better chances of success in this condition, reducing both mortality and postoperative complications.