[Retroperitoneal abscesses: clinical and therapeutical aspects]. / Gli ascessi retroperitoneali. Aspetti clinici e terapeutici.

The authors explain the clinical and anatomical features of retroperitoneal abscesses, which occur less commonly than peritoneal infections. Retroperitoneal abscesses arise chiefly from injuries in adjacent structures, but they may be primary when caused by hematogenous bacterial spread. The pyogenic bacteria have replaced Mycobacterium tuberculosis as the major causative organism. Retroperitoneal abscesses may be symptomless, but fever and abdominal pain are prominent features. The differential diagnosis includes retroperitoneal tumors and hematomas. These lesions are best delimited by CT scanning which localizes them accurately. The treatment consists in a prompt and adequate drainage and systemic antibiotics therapy. Drainage by catheter, however, has a lower success rate than the surgical approach. The surgical mortality rate is about 25%.

[Our experience in diagnosis and surgical treatment of duodenal diverticula]. / La nostra esperienza in tema di diagnosi e trattamento chirurgico dei diverticoli duodenali.

In view of the proteiform symptoms of duodenal diverticula, the Authors underline the diagnostic precision and surgical value of e.g.d. scopy. Indications for surgery in cases of symptomatic or complicated diverticula are also stressed, and the value of mechanical suturing is confirmed.

[Gallbladder torsion. A case report]. / Torsione di colecisti. Descrizione di un caso.

INTRODUCTION: The unusual anatomical position of the organ, generally suspended by a mesentery, allows the rare possibility of its torsion with necrosis and even perforation. CASE REPORT: A woman, aged 78, who presented signs and symptoms similar to those of severe acute cholecystitis: abrupt onset of pain and a large palpable mass below the right costal margin. Immediate laparotomy with detorsion and easy cholecystectomy was performed. CONCLUSIONS: Should a greatly enlarged mass be palpable below the right costal margin within a few hours from the abrupt onset of unremittant abdominal pain the possibility of torsion should come to mind not to delay operation in the supposition of acute cholecystitis.

[Vesico-vaginal fistula after abdominal hysterectomy. Use of the Legueu technique]. / Fistole vescico-vaginali dopo isterectomia addominale. Applicazione della tecnica di Legueu.

Vesicovaginal fistulas are commonly seen as a complication of abdominal (or vaginal) Hysterectomy. The signs and symptoms of a vesicovaginal fistula depend upon its size and location. Identification of a vesicovaginal fistula includes an intravenous urogram; cystoscopy may be performed in order to evaluate the possibility of immediate or delayed repair. Case report. Principles of surgical repair. The principles of surgical closure are similar: 1) total separation of the tissues comprising the wall of the vagina and the wall of the bladder; 2) sharp excision of the fistulous tract between to two structures; 3) closure of the defects with non-overlapping suture lines; 4) where possible, interposition of alternative tissue between the two suture lines. The intervention proposed by Legueu allows an abdominal transperitoneal approach to the fistula and is comprehensive of these principles. With such a procedure we have treated successfully two cases which required surgical closure. CONCLUSIONS. In patients who develop vesicovaginal fistulas as a complication of abdominal hysterectomy, we have applied the intervention proposed be Legueu, which allows closure of the fistula via a transperitoneal route. Preliminar diagnostic evaluation and following of the foundamental principles of correct surgical closure are indispensable to accomplish a successful intervention.

[A case of perforated diverticulum of the right colon]. / Su un caso di diverticolo perforato del colon destro.

Diverticulum of the right colon is a rare disease which is often wrongly diagnosed and asymptomatic. It affects young individuals and is manifested by symptoms similar to appendicitis. The paper reports a case of a young man with an isolated perforated diverticulum of the right colon which was clinically manifested as acute appendicitis with peritoneal reaction. It is extremely difficult to make a preoperative diagnosis of cecal diverticulitis. Even the anatomosurgical appearance sometimes makes it difficult to distinguish from neoplasia. For this reason the most frequent operation is right hemicolectomy which is however well tolerated by young patients.

[Postoperative pulmonary thromboembolism]. / Osservazioni sulla tromboembolia polmonare postoperatoria.

The authors report their finding concerning the frequency of postoperative pulmonary thromboembolism in an autopsy series of subjects who had died with 15 days of surgery. In all cases the relationship was evaluated between death and age, sex, the underlying pathology and the type of surgery.

[Use of ultrasonic surgery in laparoscopic cholecystectomy]. / L'uso della chirurgia ad ultrasuoni nella colecistectomia per via laparoscopica.

INTRODUCTION: Laparoscopic cholecystectomy now represents a valid alternative to traditional surgery in the treatment of gallstone diseases. For the past twenty years laparotomic cholecystectomy has represented the golden standard of gallstone treatment given its extremely low mortality rate (0.5%) and equally acceptable morbidity rate. Laparoscopic cholecystectomy now appears to have taken over the position of elective treatment. Sophisticated techniques, such as ultrasound scalpels make this form of surgery particularly safe. MATERIALS AND METHODS: The authors report a series of 50 patients who underwent laparoscopic cholecystectomy in which ultrasound surgery was used in 40 cases using the CUSA system. The gallbladder hilus is prepared using ultrasound manipulation following the secure identification, respect and clipping of the cystic artery and duct. DISCUSSION AND CONCLUSIONS: Laparoscopic cholecystectomy appears to be the ideal treatment for gallstone diseases. In the series reported here the use of the ultrasound scalpel allowed the gallbladder hilus to be reach skeletization, preserving the main structures and keeping the operating field clean and blood-free, without increasing operating times. The possibility of severe accidents, such as vascular lesions to the hepatic artery or vena portae, or damage to the common bile duct or other abdominal organs are reduced using this technique.

[The surgical procedure in a case of accidental lesion due to impalement]. / Tattica chirurgica in un caso di lesione accidentale da impalamento.

The authors describe a case of intraperitoneal anorectal injury. Such injuries now have an improved survival rate as a result undoubtedly of superior resuscitation, early operative management and early use of antibiotics. Civilian life rectal wounds are usually of the penetrating type. Major complications, both of intra and extraperitoneal injuries, are related to infection. The surgical management of these lesions is primarily a proximal diversion of the fecal stream. This is accomplished by a divided--end colostomy. Local wound care must be given for the inevitable infected foreign tract. When sepsis occurs, the surgeon must be prepared to handle it adequately by appropriate incision and drainage.

[Carcinoma of the large intestine following ureterosigmoidostomy in a patient with bladder exstrophy]. / Carcinoma del grosso intestino insorto di seguito a ureterosigmoidostomia in paziente con estrofia vescicale.

The paper reports a case of intestinal occlusion due to adenocarcinoma of the large intestine as a sequel to ureterosigmoidostomy for exstrophy of the bladder which was subsequently converted to ureteroileocutaneostomy. Inadequate follow-up did not allow an early diagnosis to be made. The authors underline the need for annual colonoscopy in all patients suffering from or with previous ureterosigmoidostomy given the high incidence of malignant transformation of the colon.

[A note on surgical technics. The treatment of pilonidal disease in the chronic phase. Our methodology]. / Nota di tecnica chirurgica. Il trattamento della malattia pilonidale in fase cronica. La nostra metodica.

The authors propose a method of suturing the wound caused by the removal of pilonidal cysts and fistulas. The technique is noninvasive, uses a minimum amount of foreign material, and places the margins of the wound under very slight tension.

[Endoscopic resolutions of volvulus of the sigmoid colon]. / Le risoluzioni perendoscopiche del volvolo del colon sigmoideo.

The flexible colonoscope has brought considerable advantages to the diagnosis and nonsurgical treatment of volvulus. In the case of repeated recurrences that make surgery vital because of the onset of signs of vascular trouble on the twisted ansa, preoperative resolution permits correction of hydroelectrolytic imbalances and the preparation of the colon with the possibility of operating with no need for protective colostomy. It also allows resolution of the acute situation in the presence of contraindications to intervention.

[Multiple perineal fistulas caused by suppurative hidrosadenitis (Verneuil's disease)]. / Fistole perineali multiple conseguenti a idrosoadenite suppurativa (malattia di Verneuil).

The attention of all those having to deal in any way with diseases of the perianal region is called to a particular pyodermatitis known as suppurative hidradenitis, or Verneuil's disease, frequently confused with other inflammatory pathologies. A clinical case exemplifying the diagnosis and treatment of the disease is reported.

[Use of intraoperative transcystic choledoscopy in calculosis of the main bile duct]. / L'uso della coledocoscopia transcistica intraoperatoria nella calcolosi della via biliare principale.

Choledochoscopy is complementary to peroperative cholangiography in exploration of the main biliary way. Transcystic access is proposed in choledocholithiasis. The cystic duct, in fact, is frequently transitable owing to the dilatation produced by the migration of gallstones and because of the increasing miniaturisation of instruments. This examination of the MBW is less traumatic and risky than transcholedochotomic choledochoscopy.

[Intraoperative colon irrigation in emergency surgical treatment of lesions of the left colon and rectum]. / Il lavaggio intraoperatorio del colon nel trattamento chirurgico delle lesioni del colon sinistro e del retto in emergenza.

The Authors propose the use of intraoperative colon irrigation in emergency surgery of left-sided lesions of the colon. This technique allows the colon to be decompressed and cleaned at the same time with the possibility of performing a resection or hemicolectomy without having to resort to protective colostomy and its related problems of morbidity.

[A bleeding jejunal schwannoma. The complications of a rare neoplasm of the small intestine]. / Schwannoma digiunale sanguinante. Complicanze di una rara neoplasia del tenue.

The authors report a rare case of jejunal Schwannoma which appeared as hematemesis and melaena. No preoperative test, even selective angiography, enabled a correct clinical diagnosis to be made. Only after explorative laparotomy and careful palpation of the small intestine was the bleeding lesion located. Resection and termino-terminal anastomosis were then performed. The preparation of immunohistochemical reactions now allow forms which were previously diagnosed in different terms to be precisely classified.

[Total gastrectomy: a comparison between manual and mechanical sutures]. / Gastrectomia totale: confronto tra suture manuali e meccaniche.

The authors report their experience of the use of mechanical staplers in total gastrectomy. The advantages of their use can above all be seen in anastomosis, in particular in high-risk areas like esophago-jejunal anastomosis, in which there is a lower incidence of dehiscence and mortality than when manual suturing techniques are used.

[La Peyronie's disease. Our experience]. / Il morbo di La Peyronie. Nostre esperienze.

Following an aetiopathogenetic review of I.P.P., diagnostic and therapeutic possibilities are assessed. Medically, stress is laid on the value of orgotein, an SOD which, used in time, reduces pain and penis curving and permits satisfactory sexual activity. In the case of inveterate forms or of large plaques, the use of a silastic prosthesis is proposed. This support enables a normal sex life to be continued, so resolving psychological and family stress.