[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.

[Congenital duodenal stenosis. A case treated in adulthood]. / Stenosi duodenale congenita. Su di un caso trattato in età adulta.

The authors report their experience the diagnosis and management of congenital duodenal malformation in adults. They emphasize problems and difficulties in this disease of pediatric age and the physiopathological adaptation in these years. They point out that surgery can modify important metabolic functions and sub-clinical pathological conditions that the malformation made up.

[A rare pathologic association: an appendiceal mucocele in a strangulated properitoneal hernia]. / Una rara associazione di patologia: mucocele appendicolare in ernia properitoneale strozzata.

The authors refer about a case of mucocele contained in a strangled properitoneal inguinal hernia and they discuss its pathogenesis.

[Influence of lymphostasis on healing processes of intestinal anastomoses. Experimental research]. / Influenza della linfostasi sui processi riparativi delle anastomosi intestinali. Ricerca sperimentale.

The Authors studied the healing of the intestinal anastomoses in rats with mesenteric and celiac lymph-vessels coagulated and cut. The experiment was realized utilizing 104 rats, divided in fours groups: after the induction of the lymphostasis, in the first group an end-to-end ileal anastomosis was made by polyglycolic acid suture, 6/0 in diameter. The control groups consisted of rats with ileal anastomoses, with lymphostasis solely and sham operated. The macroscopic observation and the histological findings were studied 7 and 14 days after the anastomoses' performance. Only in the animals with lymphostasis was observed an anastomosal leakage of 19% at 7th day control. In the same period the histologic sections showed a modified anastomosal healing, related to the significant reduction of the granulomatous tissue formation in presence of the lymphostasis.

[Comparison between lymphangiovenous and adeno-lymphovenous anastomoses in the rat with mesenteric lymphostasis]. / Confronto tra anastomosi linfangiovenose ed adeno-linfo-venose nel ratto con linfostasi mesenterica.

A comparison between lymphangiovenous and lymphadeno-venous anastomoses has been realized in rats with mesenteric lymphostasis. The lymphangiovenous anastomoses have showed a better patency than lymphonode-venous shunt owing to technics and biologic problems. Their function was verified until 15th p.o. day, while all lymphonode venous shunt were closed at 10 th p.o.. The shunt occlusion may be related with lymphatic newborn vessels, which exclude the anastomoses from lymph flow.