Blunt abdominal trauma: current management.

Management of blunt abdominal trauma has evolved over the last decade and non-operative management (NOM), initially viewed with scepticism, has now become widely used. The aim of this retrospective study was to examine the results of liberal utilisation of NOM of blunt abdominal trauma. For that purpose we examined the charts of 119 patients admitted to our Department of Surgery from January 1998 to July 2006 for blunt abdominal trauma. NOM was opted for in cases of haemodynamic stability. When surgery was mandatory, it consisted in exploratory laparotomy or laparoscopy. Six of the NOM patients (7%) needed surgical exploration during the 24 hours following the trauma. Thus, the success rate for NOM was 93%. Mean length of hospital stay was 12.5 days (range: 2-78); for emergency surgery patients it was 17 days (range: 2-78), and for NOM patients 14.5 days (range: 2-45). In conclusion, NOM may be safely used in cases of blunt abdominal trauma. Haemodynamic instability, suspicion of hollow viscus perforation and multiple transfusions are contraindications to this approach.

Surgical treatment of a double splenic artery aneurysm.

Splenic artery aneurysms account for the majority of splanchnic artery aneurysms. These constitute a uncommon pathology, but with a mortality rate greater 70%. We report a case of a double symptomatic aneurysm of the splenic artery with a proximal and distal localization. The patient was a 65-year-old woman with chronic abdominal pain of the left hypochondrium, irradiating to the ipsilateral iliac fossa. In this case, the particular anatomical characteristics, which prevented a conservative endovascular treatment, were well suited to surgical treatment, performed successfully. In conclusion, in the case of a low-risk patient, in the presence of aneurysms with favourable anatomical characteristics one should prefer surgical rather than endovascular treatment, despite the widespread use of the latter.

Aggressive sebaceous carcinoma of the head.

Cutaneous sebaceous carcinoma (SC) is a rare malignancy deriving from the adnexal epithelium of the sebaceous glands. Periorbital SC is approximately three times more common than extraorbital cutaneous SC. Extraocular SC is reported to be less aggressive than orbital sebaceous carcinoma and rarely metastasizes. We report a case of sebaceous carcinoma of the scalp, characterised by highly aggressive behaviour and huge invasion of the intracranial space. The patient was a 79-year-old woman who developed an infiltrating sebaceous carcinoma followed by lymph-node metastases shortly after excision of the primary lesion, resulting in death. In this case, aggressive biological behaviour was observed in a carcinoma arising in an extraorbital area, although it has traditionally been considered a less aggressive neoplasm.

[Reconstruction of the inguinal ligament in recurrent inguinal hernia using the "three-sheet" technique]. / Ricostruzione del legamento inguinale nelle ernie in g nalirecidive mediante la tecnica a "tre fogli".

Destruction of the groin ligament is an unusual occurrence, often of traumatic or surgical origin. In the event of recurrent inguinal hernia with a destroyed inguinal ligament, the reconstruction of the wall with the surgical techniques currently available yields prognostically unfavourable results with frequent recurrence in only a short space of time. The aim of this report was to present a hernioplasty technique using the "three-sheet" implant involving reduction of the hernia sac and the affixing of two reinforcement nets in Prolene in an attempt to reconstruct the destroyed groin ligament. The three-sheet prosthesis simply consists of three sheets positioned in such a way (two polypropylene prosthesis are sutured one on top of the other perpendicularly and medially) as to form a new inguinal ligament; the first sheet reinforces the wall, reconstructing the posterior wall of the canal, and the second and third sheets support the peritoneum as in a hammock. From September 1995 to July 2006, 11 patients underwent such reconstruction operations in our division, 8 of them for recurrent inguinal hernia for multiple failure, 1 for an inguinal hernia with Cloquet's adenopathy and 2 secondary to femoro-femoral and iliac-femoral by-passes. To date, after a mean follow-up of 5 years, no recurrence has taken place. This method has proved safe and effective, with minimal risk of trauma and complications, and may therefore be indicated for the management of recurrent inguinal hernia with rupture of the inguinal ligament.