Hemoperitoneum as severe and unusual complication in the stapler recto-anopexy for hemorrhoidal prolapse. Case report.

We report unusual but severe complication after Longo recto-anopexy for hemorrhoidal prolapse, i.e. large intramural hematoma of the rectum and subsequent hemoperitoneum. We make some assessment about the technique.

Idiopathic myenteric ganglionitis underlying acute 'dramatic' intestinal pseudoobstruction: report of an exceptional case.

Inflammation of the myenteric plexus of the gastrointestinal tract is a very rare pathological condition, with few reports in the medical literature. This pathological condition causes atonic gut motor dysfunction and is principally secondary to other diseases, being reported nearly solely as a paraneoplastic phenomenon in neuroendocrine lung tumors, including small cell carcinomas or neuroblastomas. In addition it can also be associated with disorders of the central nervous system, although it has rarely been described in Chagas disease. It has been named 'idiopathic myenteric ganglionitis' because no apparent causes can be demonstrated. We report the clinicopathologic findings of an exceptional case of a young woman affected by severe chronic constipation suddenly changing into acute intestinal pseudoobstruction with dramatic evolution. Relationships between ganglionitis, idiopathic constipation and acute intestinal pseudoobstruction as well as therapeutic implications are discussed.

Anal GIST in older old patient: a case report.

UNLABELLED: GIST are a group of quite rare neoplastic pathologies. This type of pathology is currently the subject of discussion as for their origin and treatment. It is generally difficult to determine if they are to be considered as a benign or malignant neoplastic disease. We present the case of a patient with recurrence of anal GIST who was examined 8 years after the first treatment. CASE REPORT: C.M., female, 81 years old, came to our Clinic in March 2001 complaining of rectal haemorrhage and abdominal pain in the lower quadrants; she had also suffered from constipation for 1 month. During rectal exploration we found a mass spreading inside the lumen 3 cm from the anal verge. Colonoscopy showed that the tumour, which was 7 x 5 cm in size, was inside the wall with normal mucosa. EUS revealed that the origin was within the muscular layer; therefore we chose transanal excision as surgical treatment. The patient was discharged 5 days after surgery and is alive; she only showed a small local recurrence of disease 30 months after treatment. Histological examination confirmed that the tumour was a GIST This case provides the basis for a discussion about characteristics and the evolution of this group of pathologies.

Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial.

BACKGROUND AND AIMS: The notable success of stapled prolapsectomy in recent years led us to compare this technique with Milligan-Morgan hemorrhoidectomy in terms of the results obtained both in the immediate postoperative period and in the long term. PATIENTS AND METHODS: We performed conventional hemorrhoidectomy on 50 randomly selected patients and operated on a further 50 using the stapler technique. The patients were monitored over the immediate postoperative period (e.g., type of anesthesia, mean duration of operation, mean hospitalization time, analgesic administration, time before returning to work) and over a long-term follow-up period of 48 months (later complications such as prolapse relapse, bleeding, stenosis, incontinence). RESULTS: The stapled group experienced significantly less pain (mean number of analgesic tablets 2.60 vs. 15.9) and returned to normal activity sooner (8.04 vs. 16.9 days), as reported by other authors. In the long-term follow-up at 48 months, stapled hemorrhoidectomy was found to control prolapse, discharge, and bleeding, with no stenosis or significant incontinence, in 94% of cases. CONCLUSION: Our conclusions confirm the excellent advantages of stapled hemorrhoidectomy which allows the rapid recovery of patients and also promises the complete resolution of hemorrhoidal prolapse in the long term.