[Intestinal obstruction caused by internal transmesosigmoid hernia: a complication of laparoscopic surgery?]. / Occlusione intestinale da ernia interna transmesosigmoidea: complicanza della chirurgia laparoscopica?

Authors describe a rare case of intestinal obstruction due to a strangulated transmesosigmoid hernia appeared 5 months after laparoscopic cholecystectomy. They underline the rarity of this pathology which is mostly treated in emergency without any possibility of preoperative diagnosis. They analyze the pathogenesis, mainly due to pneumoperitoneum during laparoscopic surgery and surgical treatment. They stress the necessity of a correct knowledge by the surgeon of the anatomical features of this kind of hernias in order to treat them surgically with good results.

[Serous cysts of the transverse mesocolon: a review of the literature in the light of 2 cases brought to our notice]. / Cisti sierose del mesocolon trasverso: revisione della letteratura alla luce di due casi giunti alla nostra osservazione.

Mesenteric cyst is one of the rarest tumours, with about 820 cases reported since 1507. Ultrasound and TC are the most valuable modalities for diagnosis of mesenteric cyst. Surgical resection is the treatment of choice. The authors report two cases of mesenteric cyst of the transverse mesocolon preoperatively diagnosed by ultrasonography and computed tomography (CT). A surgical enucleation was performed.

[Extended resection in locally advanced colon cancer]. / Gli interventi allargati nella chirurgia del cancro del colon localmente avanzato.

Colorectal malignant tumors with a mono o multivisceral involvement have a poor prognosis and surgery is the only treatment with a hope to be curative. Aggressive surgical management of locally advanced colo-rectal cancer seems to be justified by good oncological results. At the Institute of Clinica Chirurgica of the University of Trieste 58 extended resections were performed for advanced tumors of colon and rectum. The specific morbidity rate was 24% for standard and 24.1% for extended resections. Operative morality was 15.2%; hystological specimen confirmed in 31 cases neoplastic infiltration of contigous structures. The 5 year survival rate was 38.5% in right colonic tumors and 53.3% in left colonic tumors. The literature favors an aggressive approach when the tumor adhesions are suspected. The excision of adjacent organs, whether or not they are microscopically involved by the tumor, is necessary to avoid leaving potentially curable disease The authors, analyzing their results, have also reported good results by management including resection of the colon and contigous organs if involved. Palliative therapy must be performed only if liver metastases are detected or in those cases when primary resection is not thecnically feable or in patients not able to tolerate the procedure.

[Results of surgical treatment in Cushing syndrome]. / Risultati del trattamento chirurgico della sindrome di Cushing.

The authors report 10 cases of hypercortisolism studied at University's Surgical Clinic of Trieste (Italy). Comparing their results to the recent Literature, they observe the highly reliability of the instrumental and laboratory investigations to achieve an accurate preoperative diagnosis. The effectiveness of surgical therapy evinces not only from absence of surgical mortality and morbility, but also from optimal results of follow-up: all patients, in fact, heal completely in few weeks or months.

[Colonic diverticulosis complicated with perforation. Analysis of several prognosis variables and criteria for emergency surgery]. / La malattia diverticolare del colon complicata da perforazione. Analisi di alcune variabili prognostiche e criteri di scelta chirurgica in urgenza.

The aim of this study was to analyse the clinical course, surgical strategy and results in patients with perforated large bowel diverticulitis. Over a 15-year period ending in January 1997, 25 patients (13 males and 12 females; mean age 64.1 years) underwent operation for perforation of acute diverticulitis. Depending on the symptoms, the spreading of the peritonitis and the patient general state, different surgical techniques were performed: primary resection and anastomosis with and without defunctioning colostomy (5), primary left hemicolectomy (1), Hartmann's resection (13), Mikulicz's procedure (4), suture and drainage with diverting colostomy (2). The overall mortality was 16%, while morbidity rate was 44%; these results were strictly related to the severity of clinical manifestations and peritoneal contamination. Therefore it must be stressed that a good surgical timing is essential. Our experience and literature data show that primary resection and anastomosis with and without colostomy have good results when the patient is fit, the sepsis is localized and satisfactory bowel preparation is achievable. By contrast, purulent and faecal peritonitis are still usually best treated by Hartamnn's procedure. Finally, it is submitted to surgeons's experience to choose, at any situation, the best procedure regarding age and general state, local findings and extent of peritonitis.

[Endoscopic & histopathologic features of esophageal ulcers. Considerations in 13 cases]. / Caratteristiche endoscopiche ed istopatologiche delle ulcere esofagee. Considerazioni su di una casistica di 13 pazienti.

Chronic, severe reflux esophagitis can be complicated with an esophageal ulcer (EU), whose histomorphological characteristics change sensibly. Between 1983 and 1989, 18 EU were endoscopically identified in 13 (6%) out of 217 patients with chronic gastroesophageal reflux (GER). 2 groups were defined: EU and esophagitis, without columnar-lined esophagus and EU with localized columnar metaplasia or Barrett's esophagus. In the first, 4 Wolf's ulcers (WU) were present; in the second, there were 8 Barrett's ulcers (BU), 2 Savary's ulcers (SU) and 4 ulcers with intermediary characteristics (IU). The 24 h esophageal Ph monitoring demonstrated the reflux pathogenesis in all the patients (57%: alkaline reflux). The histomorphological findings of the EU could support the hypotesis that their variety is related to the different stage of the reflux disease. The EU, started as a peptic lesion on a stratified squamous mucosa (WU), due to an acid, alkaline or mixed reflux, would macroscopically turn into a BU, through intermediary entities (SU, IU), with a progressive extension of columnar metaplasia to the adjacent epithelium and walls. It's not possible to exclude the primitive development of the BU in a Barrett's mucosa, because of an alkaline reflux or because of a low mucosa's resistance (specialized columnar epithelium) to a prolonged acid exposure.