[A gastrocutaneous fistula secondary to the percutaneous drainage of a pancreatic abscess. A case report]. / Fistola gastrocutanea secondaria a drenaggio percutaneo di ascesso pancreatico. Descrizione di un caso.

Pancreatic abscesses are a frequent complication of acute pancreatitis and their percutaneous drainage is usually accepted. A 76 years-old male patient admitted for acute pancreatitis (Ranson 3 at admission) has been treated with conservative therapy and percutaneous US directed drainage of the abscess, located between the tail of the pancreas and the gastric fundus. This kind of drainage was able to empty the abscess satisfactorily but it caused the onset of a gastrocutaneous fistula. This one was sutured on the gastric side by metal clips placed by gastroscopy. The patient was discharged on the 60th day in a good condition. An X-ray investigation with gastrografine before the drainage removal is therefore recommended.

Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction.

PURPOSE: The study contained herein was undertaken to verify if immediate resection with anastomosis with on-site lavage in emergency treatment of left colon obstruction is a safe alternative to the multistage procedure, to look for solutions to practical problems outlined by previous authors, and to check the hospital stay. METHOD: Between 1991 and 1995, all patients (61) admitted with left colon obstruction were treated with intraoperative colonic lavage and primary anastomosis. Personal development of Dudley's technique is reported. Complications and mortality are pointed out. Later, endoscopy was performed to check the status of all survivors. RESULT: Low mortality (2 percent) and major complication rates (3 percent) and short hospital stay (11 days, except for patients with major complications) are reported in our series. CONCLUSION: One-stage surgery with intraoperative lavage is a safe procedure. Patients have a better quality of life (no stoma occurred) with an effective cost-savings.

[Surgical treatment of Crohn's disease. Indication and management in 20 patients]. / Trattamento chirurgico del morbo di Chron. Indicazioni e tattica chirurgica in 20 pazienti.

MATERIALS AND METHODS: Sixty-seven patients with Crohn's disease underwent surgery in our department in the period 1989-1996. In this paper we evaluated only the first 20 patients. Ten were female and 10 male. There was single localization in 13 patients and multiple in 7. Surgery was limited to the macroscopically involved intestinal segment. Reconstruction of the intestinal tract has been carried out with a double layer polyglycolic acid end-to-end manual anastomosis. RESULTS: We had no operative deaths and early morbidity. In the follow-up we observed 2 anastomotic recurrences respectively three and five years after the operation; none of them required surgical treatment. One patient of 20 had a colocutaneous fistula four months after operation because of the relapse of the disease at preanastomotic level. CONCLUSIONS: The results obtained in our limited experience allow us to affirm that, when elective surgery is possible, the most reliable surgical behaviour is a limited resection of the diseased segment. Quality of life improved after surgery in all patients.

[Metastasis and hepatic resection surgery. Our experience]. / Metastasi e chirurgia resettiva epatica. Nostra esperienza.

The authors' experience of the surgical management of liver metastasis is discussed. Failure in preoperative assessment influenced surgical procedures and led to questionable choices. However morbidity and mortality were rather good.