Unusual breakage of a plastic biliary endoprosthesis causing an enterocutaneous fistula.

OBJECTIVE: The objective of our study was to illustrate a case of endoscopically placed biliary stent breakage. METHODS: A72-year-old woman with a prolonged history of cholangitis following laparoscopic cholecistectomy was referred to our institution 8 years ago. Dilatation of the intra- and extrahepatic biliary tree and a benign stricture at the cystic confluence were observed at US and endoscopic retrograde cholangiopancreatography (ERCP). A 12-F gauge plastic endoprosthesis was placed. In the absence of any symptoms, breakage of the stent was revealed 18 months later at plain radiology. Eight years later an enterocutaneous fistula occurred originating from a jejunal loop containing the indwelled distal part of the stent. Surgery was undertaken and the distal part of the stent removed with the perforated jejunal loop. The proximal part was successively endoscopically removed. CONCLUSIONS: Disruption of a biliary endoprosthesis is observed in patients in whom the stent is kept in situ for a long period or consequent to exchange. The removal and exchange is mandatory when the stent disruption is followed by cholangitis. In the current case, because of the absence of any symptoms the removal of the stent was not attempted. Immediate endoscopic removal of the prosthetic fragments seems to be the treatment of choice for replacement of a new stent.

Small bowel schwannoma with diffuse subcutaneous lipomatosis. Case report and literature review.

A case of a small-bowel schwannoma with diffuse familiar lipomatosis is described. This case underlines the rarity of the neoplasm and its probably chance association with subcutaneous lipomatosis. The intestinal neoplasm was diagnosed preoperatively by upper gastrointestinal endoscopy and a small-bowel enema; computed tomography scan confirmed the intestinal lesion. Attention is focused on the morphological features of intestinal schwannomas and their biological behaviour.

Endoscopy in the treatment of benign biliary strictures.

BACKGROUND/AIMS: Operative endoscopy is now the method of choice for treating numerous biliary tree diseases. In the treatment of benign strictures of the biliary tree, endoscopy serves as an alternative to surgical interventions. We evaluated the efficacy of endoscopic biliary stents in the treatment of benign biliary strictures. PATIENTS: Fifty-three consecutive patients with benign strictures of the biliary tree underwent endoscopic placement of one or more 10-12 Fr endoprostheses. Thirty-nine patients (73.6%) had iatrogenic strictures and 14 had inflammatory strictures (in 8 patients due to gallstones and in 6, chronic pancreatitis). Of the 53 patients, 20 (37.7%) had strictures classified as Bismuth type I, 23 (43.3%) Bismuth type II, 7 (13.2%) Bismuth type III and 3 (5.7%) Bismuth type IV. RESULTS: None of the patients died during the study period; three patients (5.6%) had immediate endoscopy-related complications treated conservatively. Late complications developed in 47.1% of the patients: 11.3% had cholangitis amenable to medical therapy, 5.6% had dislodged endoprostheses and 30.2% had obstructed endoprostheses. The reason why blocked stents accounted for most of the long-term complications in this series was that endoprostheses were not changed electively: they were changed only when clinical and laboratory signs indicated obstruction. Follow-up (6-84 months) in 42 of the 56 patients. 20 after stent removal, showed that 71.4% had an excellent outcome, 14.3% good results and 14.3% needed surgery. CONCLUSION: In benign biliary stricture endoscopic stenting is the first approach, providing definitive treatment or preparing patients for surgery.

[Fibrin-glue in the treatment of a bronchocutaneous fistula]. / Trattamento di una fistola bronco-cutanea con colla di fibrina.

The treatment of postoperative chronic thoracic fistulas with fibrin glue can be the non-operative ideal solution for the relative simplicity of the execution technique.

[Malignant fibrous histiocytoma. Two case reports and review of the literature]. / L'istiocitoma fibroso maligno. Presentazione di due casi e revisione della letteratura.

The authors report two cases of malignant fibrous histiocytoma localised in the gluteus maximus and re-evaluate some clinical and biological aspects of the neoplasia. Although its histiogenesis is still unsure, the tumour can be classified into various isotopes: the vorticoid-polymorphous variety (70%), and the myxoid, giant cell, angiomatous and inflammatory varieties. It is the most common soft tissue sarcoma in adults and onset is most frequently observed on the trunk and limbs. Biological behaviour shows a marked tendency to local recidivation, with metastatic diffusion occurring mainly late. The choice of therapy consists of more or less radical surgical removal with or without ratio- and immunotherapy. The results of surgery are influenced by the technique used, and the biological and clinical behaviour of the tumour; in view of the numerous case reports of anomalous behaviour, these factors are only indicative. Therapeutic efficacy is on the whole greater in cases of tumours with diameters of less than 5 cm and more superficial localisations compared to the deep muscular fascia.

[The role of surgery in the treatment of primary carcinoma of the gallbladder. Review of 86 cases]. / II ruolo della chirurgia nel trattamento del carcinoma primitivo della colecisti. Revisione di 86 casi.

The records of 86 patients with primary adenocarcinoma of the gallbladder were reviewed. All patients were staged according to the Nevin classification. Twenty-nine patients underwent resection, 57 were submitted to palliative procedures or exploratory laparotomy. Survival was directly related to tumor staging and modality of treatment. The 5- and 10-year survival expectancy after curative resection was 46.8% in stage II patients, 14.2% and 0%, respectively, in stage V patients. None of the unresectable cases survived beyond 24 months, except for one patients who lived 62 months. No significant difference in survival expectancy was found between resectable and unresectable patients with stage V tumor.

Renal cell carcinoma in adolescents. A case report and review of the literature.

Renal cell carcinoma is rare in adolescents. Observation of a 16-year-old girl with a clear-cell carcinoma prompted us to review 372 published cases in adolescents. The tumor affects the sexes indifferently and has no side predominance. The incidence is higher in white races. The most frequent presenting sign is a palpable mass (52.7%). X-ray films typically show renal calcifications (25%). The most common histotype is the clear cell carcinoma (76.8%) and at diagnosis 59.5% of these tumors already extended beyond the kidney. The overall 5-year actuarial survival rate is 60.4%.