[Jejunal diverticulosis. Presentation of a clinical case]. / Diverticolosi digiunale. Presentazione di un caso clinico.

Jejunal diverticulosis is a rare and often asymptomatic disease, generally presenting as an occasional finding during laparotomy for other diseases. There are no established criteria for the treatment of such diverticula. Due to the possible onset of acute complications, surgical management must be considered. Personal experience on a case of jejunal diverticulosis in a woman who presented with acute complications of surgical peritoneal adhesions is described. Through examinations of small intestine discovered many diverticula, mainly in the mesenteric side; two diverticula were particularly large. Even though there appeared to be no symptoms due to the diverticula, major diverticula were considered at risk for acute complications. Because their reduction was not easily achievable, they were resected and enterotomies were stitched. Postoperative course was uneventful and after 2 years the patient is alive and well. Features of this rare entity are analyzed with regard to data reported in the literature, with special reference to some pathogenetic theories.

[Angiodysplasia of the right colon]. / Angiodisplasia del colon destro.

Ascending colon angiodysplasia is a frequent cause of colorrhagia or chronic blood loss in old patients, but also possible under the age of 55. Angiodysplasia diagnosis is often underestimated. For a long time colorrhagia or lower intestinal bleeding were generally diagnosed like diverticular bleeding. This conclusion was the result of several conditions: the conservative management of distal gastrointestinal bleeding is in most cases successful; the double dye clysma was the first and the main diagnostic procedure for many years and the result was a not correct diagnosis of diverticular bleeding since large bowel diverticulosis is always present in the elderly. The authors report on three cases of low intestinal bleeding where the diagnosis of angiodysplasia in the first patient was performed by upper mesenteric artery arteriography, in the second by preoperative colonoscopy and after confirmed by the histology of the specimen and in the last one by colonoscopy performed in emergency and after intestinal irrigation. The first patients refused the operation; the second had right hemicolectomy and the third one had a spontaneous stop of bleeding. According to their clinical experience the authors suggest that colonoscopy performed in emergency or intraoperative is the first choice diagnostic procedure: it can detect the source of bleeding between right or left colon. Arteriography often shows vascular images characteristic for angiodysplasia or other vascular malformations but, in our experience, it may be absolutely not diagnostic. Colonoscopy performed in emergency during bleeding or per-operative is the best procedure in order to diagnose the source of bleeding. Emergency colonoscopy can distinguish if the blood is coming from the right or left colon and in our experience, colonoscopy during bleeding is always possible because blood has a cathartic effect. In case of emergency operation pre-operative colonoscopy can usually detect the source of bleeding. A double dye clysma, whether barium or hydrosoluble doesn't give a diagnostic support in low intestinal bleeding; on the contrary it can prevent a correct arteriographic and endoscopic evaluation. At last histopathological findings on the specimen are conclusive for the diagnosis.

[Laparocele in the aged]. / Il laparocele nell'anziano.

Especially in the old patients (over 70 years) the incisional hernias represents an invalidating pathology whose treatment, for the high incidence of associated diseases of respiratory and cardiocirculatory apparatus in the aged, offers difficulties connected both to surgical methods and to the perioperative evaluation and preparation of patients. The infections of the surgical incision are very important in the pathogenesis of these diseases. In order to reduce the incidence of incisional hernias the systematic use of perioperative antibiotic therapy is desirable in every operation of abdominal surgery. In order to offer the best guarantees of recovery and to improve the postoperative course of patients, the perioperative antibiotic prophylaxis, together with the use of synthetic prosthesis material, is also essential at the moment of surgical correction of incisional hernia. Although the incisional hernia may sometimes stay silent and asymptomatic for years, it inevitably ends sup by representing a reason for acute and subacute pathologic events; an early surgical treatment is therefore desirable once the incisional hernia has been diagnosed. By this way it is possible to avoid the treatment in the old patients, as the old age is a less favourable period for people who have to be subjected to a surgical operation.