Fistula Between a Primary Sigmoid Large B-Cell Lymphoma and an Ovarian Teratoma.

Primary colorectal lymphoma is a rare neoplasm. We report the case of a fistula between a diffuse large B-cell lymphoma of the sigmoid colon and an ovarian teratoma. An emergent laparotomy for an acute abdomen in a 90-year-old woman was performed. A pelvic mass of 12 × 9 cm fistulized in the left colon was found with the presence of gas and free liquid within the abdomen. This is an extremely rare condition, and as far as we know, no cases of a fistula between a large B-cell colonic lymphoma and an ovarian teratoma are present in the literature.

Laparoscopic giant hiatal hernia repair with absorbable mesh.

Background: The best operative approach to large hiatal hernias still remains controversial between suture cruroplasty and prosthetic hiatal herniorrhaphy. This study aims at analysing results from a single institution in Italy in terms of subjective and objective outcomes. Methods: Retrospectively collected data of all patients that underwent laparoscopic hiatal hernia repair since 2011 were considered. Sixty-five patients were included overall; 17 of them fit the criteria of large hiatal hernia. Follow-up (FU) was assessed by visit, questionnaires and X-ray imaging. Results: No major complications occurred in the post-operative course. No patient was lost during the FU period. Out of all the patients included, 13 agreed to have an X-ray with water-soluble contrast. The questionnaires showed a 76.5% rate of satisfaction (13 patients), and the recurrence rate demonstrated by radiology was 29.4% (five patients). There were no major mesh-related complications. Conclusion: The best operative approach for large hiatal hernias remains far from standardised: There is a lack of evidence on the use of a mesh for this kind of surgery as well as substantial controversy over the definition of what a giant hiatal hernia is. Nevertheless, the results from this study and the main studies in the literature seem to be encouraging in improving giant hiatal hernia repair outcomes.

Right sided diverticulitis in western countries: A review.

BACKGROUND: Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia. AIM: To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries. METHODS: MEDLINE and PubMed searches were performed using the key words "right-sided diverticulitis'', ''right colon diverticulitis'', ''caecal diverticulitis'', ''ascending colon diverticulitis'' and ''caecum diverticula'' in order to find relevant articles published until 2021. RESULTS: A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases. CONCLUSION: The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.

Colonic splenic flexure carcinoma: is laparoscopic segmental resection a safe enough oncological approach?

BACKGROUND: The surgical approach to the colonic splenic flexure cancer (SFC) is yet to be technically standardized. The aim of this study has been to retrospectively evaluate the oncologic long-term results of our cases comparing our data with other authors' experiences. METHODS: Clinical data of patients with SFC operated on at our institute were retrospectively analyzed. The laparoscopic approach was used in the whole series, with limited resection distally and proximally to splenic flexure and the origin ligation of left colic artery and left branch of middle colic artery. Data on the oncological long-term safety were compared to our laparoscopic series of extended right colectomy for proximal two-third transverse colon cancer and high anterior resections for sigmoid-high rectal cancer and to the main evidences in the literature, found after a comprehensive review. RESULTS: From March 2008 to May 2018, we completed 53 laparoscopic splenic flexure resections (26 female and 27 male, age 71.5 ± 15.4 years). The conversion rate was 3.8%. Most of the cases were stage II (pT3 73.5%, the mean number of lymph nodes harvested was 19.1, with positivity for malignancy in 45.3%). During the FU (43.5 months), 2 patients dropped out. Out of the 51 residual cases, 37 were alive (72.5%) and 14 are deceased (27.5%). DISCUSSION: Compared to the literature, our survival rate does not show significant differences. The other oncological outcomes seem to be comparable with the data evaluated. CONCLUSIONS: More extended resections seem not to confer an increase of the overall survival rate.

A minimally invasive approach with a 3d imaging system for the treatment of esophageal perforation due to Boerhaave syndrome.

Boerhaave's syndrome is a rare life-threatening condition that requires urgent surgical management. There are various methods of managing it, with the main principles of limiting sepsis, draining the area and maintaining nutrition. Although the gold standard is open thoracotomy and/or laparotomy, mostly in patients with sepsis, we present a case of a 53-year-old man treated with a combination of laparoscopic suture (3D imaging system) of the oesophageal perforation site, decompressive percutaneous endoscopic gastrostomy and feeding jejunostomy. We conclude that this approach is a safe and a viable option in the management of Boerhaave syndrome in a septic patient presenting early. KEY WORDS: Boerhaave's syndrome, Laparoscopy, Minimally invasive surgery, Oesophageal Rupture, Surgery, 3D-laparoscopy.