Acute abdomen in a 15-year-old patient with Peutz-Jeghers syndrome. Surgical approach.

The natural history of Peutz-Jeghers syndrome (PJS) is characterized by gastrointestinal complications (occlusion, invagination or bleeding), often the first clinical manifestation in young patients. Surgical treatment consists of treating the complication, exploring the bowel and cleaning out all polyps to prevent further emergency operations at brief intervals. For this purpose both the laparotomic and laparoscopic approaches have been proposed, especially in young patients. A 15-year-old girl was admitted for investigation of colicky abdominal pains. When she was 5 years old, PJS was diagnosed. On admission to our department, the patient underwent emergency esophagogastroduodenoscopy and colonoscopy, both negative. At 24 hours after admission peritonitis developed. Given her clinical history, we rejected the laparoscopic approach proposed at admission and decided for an open laparotomy. Laparotomy disclosed a long jejunoileal invagination that caused irreversible ischemic damage of the bowel. We resected about 130 cm of the ileum and did an end-to-end ileo-ileal anastomosis. Meticulous palpation and transillumination of the residual bowel identified no other polyps. In young patients with acute abdomen and with proven or suspected PJS instead of laparoscopy, open laparotomy is a unique occasion to explore the residual bowel thoroughly, manually and, if possible, endoscopically.

[Neutropenic colitis. A case report]. / La colite neutropenica. Descrizione di un caso clinico.

The authors take the opportunity, on the basis of a clinical case examined, to revise an uncommon disease: neutropenic colitis. In the presence of an acute abdominal pain and tenderness localized at right lower quadrant, in a patient affected by hematologic neoplasm or by a solid tumor, at the end of a chemotherapeutic treatment with absolute residual neutropenia, we would be strongly oriented to neutropenic colitis. The treatment according to the primary disease and to the patient's poor conditions, will be where possible conservative, reserving the surgical approach only for those cases of absolute necessity.

[Invasive, non-surgical treatment of post-traumatic pancreatic pseudocyst. Report of a clinical case]. / Il trattamento invasivo, non chirurgico, di una pseudocisti pancreatica post-traumatica. Segnalazione di un caso clinico.

The authors report on a pancreatic post-traumatic pseudocyst treated by a percutaneous drainage under ultrasonographic control, with a good outcome. The introduction in the past decade of new endoscopic techniques and interventional radiology, has increased the opportunity of treatment for pancreatic pseudocyst.

[The Roux loop syndrome: a postgastrectomy syndrome. Description of 2 clinical cases]. / Sindrome dell'ansa alla Roux: una sindrome post-gastrectomia. Segnalazione di due casi clinici.

The Roux-En-Y operation has been used to control enterogastric reflux occurring after previous distal gastric resection and it has been used extensively in the treatment of alkaline reflux. Recently a postgastrectomy syndrome characterized by chronic abdominal pain, persistent nausea and vomiting that is exacerbated by eating and that develops after the Roux-En-Y operation has been described. It has therefore been postulated that the Roux-En-Y limb acts as a functional obstruction and causes the symptoms.

[Treatment of perforation of the cervical esophagus during diagnostic endoscopy]. / Il trattamento della perforazione dell'esofago cervicale in corso di endoscopia diagnostica.

Early diagnosis of esophageal perforation is critical. We believe that the treatment of each case must be individualized. The management of perforation in our series has been "conservative" in two cases, for small perforations; and "operative", suture closure and drainage, in the remainder, for a large perforation with contamination of the mediastinum.