[Rare complications of biliary sepsis]. / Complicanze rare delle sepsi biliari.

The surgical approach to the acute biliary pathologies also today is often controversial. The choice of the right time to operate an acute patient is based either on personal clinical experiences, either under the statement that waiting for the resolution of the acute process could be preferable in the aim of reduce the surgical risk. This is the almost general tendency. Recently, some interesting articles issued by Swedish and German schools conducted as controlled trials on a great base of cases, try to emphasize the advantages of an early surgical therapy, particularly in the elderly patients. In these ones, in fact, the concomitance of cardiovascular, metabolic and immunodepressive pathologies makes more serious the complications too. In this article, the Authors refer on three clinical cases, all of which were quite different, and in which it was possible to identify a former septic hepato-biliary pathology. All the patients, upon hospital admission showed an acute pattern. In two cases it was an hepatic abscess, accompanied in one case by a "satellite" pulmonary abscess on the right lung. These two were treated conservatively, although by a TC-guided drainage of the liver abscesses. The third case, a localized choleperitoneum (biloma saccatus), underwent an operation. The accurate investigation on the clinical records of Authors' Department since 1980 to 1995 and in particular on the three referred cases seems to confirm that the importance of some complications after acute biliary pathology and their great morbidity must stimulate the surgeons to investigate always on the real causes of all clinical patterns, even if uncommon.

Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study.

BACKGROUND: Rapid palliation of malignant dysphagia is usually possible with endoscopic implantation of a plastic prosthesis, but this device has a high rate of complications. Recently, expandable metal stents, a new class of endoprosthesis, have become available and may reduce complication rates. METHODS: Thirty nine patients affected by esophageal thoracic cancer were randomly assigned to treatment with either a plastic stent (20 patients) or expandable metal stent (19 patients). The degree of palliation (expressed as dysphagia score) and incidence of complications (short- and long-term) were compared in both treatment groups. RESULTS: Technical success, as a percentage of successful intubation, was similar in both treatment groups (90% vs 94.7%, p = NS) and dysphagia scores improved significantly and similarly in both treatment groups. Nevertheless, complications and mortality related to implantation were significantly less frequent with metal stents than with plastic prostheses (complications: 0% vs 21%, p < 0.001; mortality: 0% vs. 15.8%, p < 0.001). Late complications included obstruction by food in both treatment groups (four cases with plastic stents vs four cases with metal stents), tube migration only with plastic prostheses (two cases) and tumor ingrowth only with metal stents (two cases). CONCLUSIONS: Expandable metal stents can be considered an effective and safer alternative to conventional plastic prostheses in the treatment of esophageal obstruction caused by inoperable cancer.