The impact of BMI on early colorectal neoplastic lesions and the role of endoscopic diagnosis:. An Italian observational study.

INTRODUCTION: CRC often arises from polyps: an early detection and resection are effective in decreasing both incidence and mortality rate. Relation between risk factors, adenomas and CRC have been showed, but there is little evidence for overweight association with preneoplastic lesions. This study analyzed the correlation between body mass index (BMI) and primitive site of polyps. METHODS: We performed a retrospective study, in a period between January 2010 and October 2014. Subjects aged 50 years and older who underwent their first-time screening colonoscopy were included. Reports regarding characteristic of the polyps were collected. RESULTS: 142 patients were enrolled and they were divided into two groups: group I - patients with left sided colonic polyps, and group II - patients who right sided colonic polyps. The ANOVA test-one way, documents a difference between the BMI and the colon localization of polyps. CONCLUSIONS: Patients with overweight had a higher risk to develop lesions in the left colon compared to patients with normal weight. Despite the fact that Italian epidemiological studies have found a prevalence of polyps of 44-53% in rectal-sigmoid segment, 32-36% in transverse segment and of 14-20% in right segment, we showed an incidence of 26.05% for right sided polyps, which maybe related with the eating habits of the territory.

[Congenital diaphragmatic hernia in an adult: case report of acute abdomen]. / Ernia diaframmatica congenita nell'adulto: un caso di addome acuto.

Bochdalek diaphragmatic hernia usually begins during childhood, but may be an occasional finding even in adults. The treatment of choice is surgical repair to avoid herniated bowel complications. The operation often requires a combined approach consisting in thoracotomy and laparotomy. This is a convenient solution to eliminate the vascular risks (if there are additional concomitant embryonic defects, such as intestinal malrotation). We report a case of a female, aged 45 years, with epigastric cramp-like pain for 4 days and tenderness in the right abdominal quadrants during physical examination; the standard laboratory data showed decreased blood levels of calcium and potassium. Chest and abdominal X-rays revealed significant, widespread colic distension and the presence of a colic loop in the chest. We confirmed these results by CT and barium enema and proceeded with urgent surgery consisting in a right hemicolectomy (extended as far as the left part of the tranverse colon) for volvulus and with stitching of the diaphragmatic gap. We also discovered incomplete intestinal malrotation. After surgery, complete remission of the clinical symptoms was achieved. This case report demonstrates that, despite the apparent clinical silence, congenital diaphragmatic hernia in an adult may often manifest itself with particular gravity calling for urgent surgery.