Wireless capsule endoscopy years after Michelassi stricturoplasty for Crohn's disease.

The use of wireless capsule endoscopy in Crohn's disease has been a matter of debate. We report the case of a 27-year-old woman operated for Crohn's disease with a Michelassi stricturoplasty presenting with anaemia. We tested the patient with a patency capsule before undertaking a wireless capsule endoscopy. Although the absorbable capsule was successfully expelled, the wireless capsule was retained next to the distal edge of the Michelassi stricturoplasty, where it revealed an otherwise undetected stenotic recurrence. We successfully treated the recurrence with a Heineke-Mikulicz stricturoplasty on the stenotic outlet of the previous Michelassi, extracting the capsule. We found our treatment effective. We believe that capsule endoscopy can be performed in patients operated on for Crohn's disease, although further studies are needed to clarify its role in patients with long-stricturoplasties and to establish which examination could be the most effective in selecting patients.

[Rubber band ligation of hemorrhoids. 5-year follow-up]. / Legatura elastica delle emorroidi. Follow-up a cinque anni.

The Authors quickly reviewing the various surgical ambulatorial methods of hemorrhoids, considered the rubber band ligation, technique. The purpose of this study is that to define the real advantages of the before said technique through the analysis of the cases operated. From December 1992 through 1997 100 patient with hemorrhoids were observed. Of these, 37 have been submitted to rubber band ligation, for a total of 135 bindings. In 26 cases (86%) the Authors observed disappearance of the bleeding and the local troubles. In eight patients complete reduction of the mucous prolapse was obtained. Two patient have continued to complain even if with small intensity, the subjective symptoms, that induced the Authors recommend surgical therapy. The last two patients have been submitted with success to hemorrhoidectomy and reduction of the concomitant prolapse. The advantages of the rubber band ligation are indisputable: it offers the possibility of a definitive, ambulatorial with least risk solution to without necessity of hospitalisation and anesthesia, repeatable in the time and with an overall percentage of complications (0.4%) inferior to that of the surgical hemorrhoidectomy.