Life-threatening bleeding for a large cameron ulcer. A novel description of a tailored-surgical strategy: report of a case and literature overview.

Hiatal hernias (HHs) are usually divided into two main groups: sliding and para-esophageal (torsional) ones. Sometimes patients presenting HHs experience progressive anemia, whereas rarely an acute anemia with melena or hematemesis can occur. In such cases a Cameron ulcer should be suspected and a careful esophago-gastro-duodenoscopy (EGDS) with a meticulous inspection of the mucosal folds along the neck of the hernia is the best examination in order to find out the ulcer itself. In front of massive hemorrhage due to a Cameron erosion, the first aim should be the control of the bleeding itself, in order to ree1Romastablish hemodynamic stability. The Authors report the case of a 72-year-old man presenting a severe bleeding secondary to a large Cameron ulcer in a para-esophageal hiatal hernia. Firstly, a combined medical-endoscopic therapy was tried; the patient underwent transfusions of pooled red blood cells and endovenous anti-acid therapy combined with an operative endoscopic treatment; unfortunately this initial approach failed, therefore the patient was referred to surgery. The surgeons realized a minimally invasive atypical gastric resection associated with the HH repair; the post-operative course was uneventful and no other rebleeding episodes occurred. The urgency treatment of a life-threatening bleeding for Cameron ulcers remains a very challenging problem as no univocal and standardized recommendation has been described in literature since now. In this case-report the Authors make an overview of the current literature on the treatment of Cameron ulcers, describing a novel surgical technique for massive upper gastro-intestinal bleeding secondary to these lesions.

Efficacy and safety of full-thickness resection device based on over-the-scope clip system for resecting of gastric lesions in selected patients. Case series from a referral center for gastrointestinal diseases treatment and literature overview.

Since gastroduodenal FTRD system is commercially available, several data have been reported in Literature concerning duodenal full-thickness resections, whereas few cases of gastric full-thickness resections has been described. In this case series We report three patients treated with this innovative tool for resecting lesions of the gastric wall. The indications ranged notably: a neuroendocrine tumor in a difficult to treat environment in the first case, a recurrent adenocarcinoma in a poorly surgical candidate patient in the second case and a pre-pyloric lesion for the third patient. In the third patient, a complete pyloric stenosis due to the clip deployment occurred. Clinical success rate was 100%. Even if current Literature is still poor of articles dealing with gastric full-thickness resection device based on over-the-scope-clip system. Our case series show how this novel tool might be take into consideration for whenever both surgery and standard endoscopic resection techniques are poorly feasible.

[Proposal for update of Bassini's procedure in the treatment of inguinal hernia under local anesthesia]. / Proposta di un aggiornamento della tecnica di bassini per la riparazione dell'ernia inguinale in anestesia locale. Nota preliminare.

Inconvenience due to tension along the suture, a relative high recurrence rate, the availability of optimal prosthetic materials and the tendency to reduce hospital stay are the motivations which induced many surgeons to adopt alternative techniques instead of the traditional ones for inguinal hernia repair. Among these latter it is worthwhile to add a personal update of the Bassini's technique: the plasty tailored upon the polypropylene mesh performed in local anesthesia. Thanks to the use of the prosthetic mesh, the plasty is performed using only four stitches tied loosely without much high tension on the conjoined tendon. Such technical expedients reduced postoperative pain and give better warrant for the plasty and allow hernia repair in local anesthesia and on a daily basis.