Small bowel occlusion due to giant perineal hernia: abdominal approach with plastic perineal reconstruction.

A perineal hernia is defined as a protrusion of peritoneal or extraperitoneal content through a pelvic floor defect. A 64-year-old woman with a bowel occlusions due to a giant postoperative perineal hernia was admitted to our hospital. We describe abdominal approach with plastic perineal reconstruction.

Delayed and occult splenic rupture: a diagnostic puzzle.

Splenic rupture is a common complaint encountered in emergency surgery. Trauma is the most common cause of splenic rupture, while non-traumatic or occult splenic rupture (OSR) is a rare condition. The differential diagnosis weighs on treatment that ranges between close monitoring, splenorrhaphy, splenic conservation and splenectomy. We report a case of an 63-year-old man presenting with acute atraumatic left upper quadrant pain. Preliminary diagnosis was subsequently determined to be a hematoma secondary to OSR. More accurate detailed history revealed a previous trauma, which occurred more than one year before and mimicked an OSR. Delayed and occult splenic rupture are as different diagnosis as different treatment. Even in emergency surgery, the key for a target therapeutic strategy should consider an accurate diagnostic time.

[Elective laparoscopic cholecystectomy: the limit of a dream become true]. / La colecistectomia videolaparoscopica elettiva: i limiti di un sogno ormai realtà.

Laparoscopic technique in elective cholecystectomy is the last step in an evolutive time to minimize the abdominal access. From 1st January 2004 to 31th December 2006 we analyzed 5515 cholecystectomy procedures: 4877 laparoscopic cholecystectomy, 635 open cholecystectomy. Complications and supplementary diagnosis have been identified in SDO Lombardia's country database. Morbidity occurred in 82 patients (12.9%) with open technique and 109 patients (2.23%) with laparoscopic technique; mortality occurred in 11 patients (1.73%) with open technique and 1 patient (0.02%) with laparoscopic technique. Mean hospital stay are 14.40 days with open technique and 4.75 with laparoscopic technique. Morbidity in open technique is 6 fold more than laparoscopia technique. The difference between the two technique is present in literature and it's the result of non invasive technique compared with the incision of the laparoscopia technique. This is the critical point in the difference of hospital stay between the two technique all to the good of laparoscopy. The high mortality ratio is due to the selective criteria in laparoscopic technique. First remark is the high quality of our hospital care, compared with hospital teaching in the word. In this hospital the laparoscopic cholecystectomy is the gold standard in cholelitiasis treatment. The second remark is the limit of the open technique in severe cholelitiasis with evidence in high ratio of hospital stay, morbidity and mortality.

Eleven cases of hereditary fructose intolerance in one Swiss family with a pair of monozygotic and of dizygotic twins.

A large pedigree of one Swiss family with 11 cases of hereditary fructose intolerance (HFI) is presented, among them a pair of monozygotic twins with HFI and a pair of dizygotic twins one of whom had the disorder. The clinical course of undiagnosed babies with HFI at home is described. The case histories point out the importance of the mother's awareness of the situation since in none of the 11 cases the corrected diagnosis of HFI was made by a physician.

[Endoscopic sphincterotomy in paraplegic patients: retrospective cases in Geneva]. / Sphinctérotomie endoscopique chez les paraplégiques: rétrospective des cas genevois.

We present a review of 59 spinal cord injury patients with spastic sphincter, treated by external sphincterotomy. Bladder voiding is substantially improved with either twelve o'clock or lateral sphincterotomy. Immediate complications are infrequent. 19% of patients need a second intervention. 78% of patients obtain satisfactory long-term results. Conversely, 12% of patients fail to respond and need an indwelling bladder catheter. Those failures are most likely to be found in patients presenting an impaired detrusor function (40%). 72% of patients have erections before treatment. Among them, 10% report erection loss after sphincterotomy. Fibrosis is present in 71% of sphincter resection piece histologies and appears early in the evolution of the affection. This condition is thought to contribute notably to the formation of a fixed sphincteric obstacle.