Intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis. Clinical report and review of literature.

The sclerosing peritonitis (SP) is a rare illness secondary to the peritoneal dialysis or due to intraperitoneal chemotherapy or the positioning of a peritoneal-jugular shunt in cirrhotic patient with refractory ascites or due to unknown other factors (idiopathic form) like in our patient. The clinical pattern is various and insidious, but when an intestinal occlusive symptomatology is presents an urgent operation is mandatory. The surgical operation is often not easy and asks for a lot of attention especially in the dialyzed subject or in patients with cirrhosis, due to the possibility of postoperative bleeding and other serious complications that can result in fatal outcome. In this report we describe surgical treatment, pathologic pattern and clinical findings of this rare disease.

[Tension-free prosthetic videolaparoscopic repair of adult Morgagni-Larrey hernia]. / Frenoplastica protesica tension-free con approccio videolaparoscopico nell'ernia di Morgagni-Larrey dell'adulto.

A symptomatic case of diaphragmatic hernia through the foramen of Morgagni-Larrey in an adult patient is presented. Etiology, diagnosis and particularly, indications of differences between open and laparoscopic repair of diaphragmatic hernia are discussed. In the case presented laparoscopic technique was carried out by means of tension-free closure of the defect using extraperitoneal prolene-mesh. The recovery was quick and uneventful. Four years after surgery no compliants were noticed.

[Chordoma. Diagnostic and therapeutic problems]. / Il cordoma. Problematiche diagnostiche e terapeutiche.

The chordoma is a rare mesodermic tumor derived from the notochord which arises and growths inside the vertebral bodies. It is a slow development tumor with late clinical manifestations, rarely metastatic often with local reoccurrences. The treatment of choice of this tumor is surgical and the access must be individualized to the single clinical case: anterior, posterior or combined antero-posterior respect to the spine. Recently videolaparoscopy has been proposed when an anterior approach is indicated without increased morbidity or mortality. Chemotherapy is not indicated because low tumoral responsness. Radiotherapy is indicated as a palliative procedure when a surgical approach ca't be radical. Its application is useful to treat pains and to control the post-operative course increasing the disease-free interval. The authors report the case of an old symptomatic lady with a chordoma in the sacral region. The patient underwent subtotal absportation an anterior transperitoneal approach. Because the extension of the tumor, its biological characteristics and the patient's age the authors adopted this less invasive approach.