Barbara Frezza

Pseudoachalasia: A peculiar case report and review of the literature.

Pseudoachalasia is a rare secondary achalasia, which accounts for only a small subgroup of patients. We describe a 77-year-old woman with recent onset of dysphagia and typical esophageal manometric findings of achalasia. Moreover, esophageal manometric findings of vascular compression at 36 cm from the nose were associated with dysphagia. An upper endoscopy showed the absence of lesions both in the esophagus and gastro-esophageal junction, whilst a 15-mm ulcer on the gastric angulus was detected. The gastric ulcer resulted in being a diffuse signet ring cell carcinoma at histology, suggesting pseudoachalasia. An abdominal computed tomography scan showed an irregular concentric thickening of the gastro-esophageal junction wall extending for 7 cm and a dilated ascending thoracic aorta with no presence of the inferior vena cava, with an enlarged azygos as the source of vascular compression of esophagus. Moreover, cardia involvement from diffuse signet ring cell carcinoma of the gastric angulus was also recognized as the cause of dysphagia. The cancer was not suitable for a surgical approach in an old patient with cardiovascular comorbidities and support therapy was started. In our ambulatory series, pseudoachalasia was eventually diagnosed in 4.7% of 234 consecutive patients with esophageal manometric finding suggestive of achalasia. We also reviewed cases in the literature and aimed to evaluate the reported causes of pseudoachalasia.

Hollow viscus injuries: predictors of outcome and role of diagnostic delay

Introduction Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome. Methods From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models. Results Overall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality. Conclusion There is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment.

Colonic Perforations Caused by Migrated Plastic Biliary Stents

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Surgical strategies for duodenal GISTs: Benefits and limitations of minimal resections

Sex e n (%) M 5 (62.5%) F 3 (37.5%) M/F 1.66 Age years Mean; SD 57.3; 14.3 Range 28e76 Location e n (%) D1 2 (25.0%) D2 1 (12.5%) D3 2 (25.0%) D4 3 (37.5%) Symptoms e n (%) Gastrointestinal bleeding/anemia 4 (50.0%) Abdominal pain 1 (12.5%) Diarrhea 1 (12.5%) Incidental diagnosis 2 (25.0%) Resection e n (%) Duodenal resection þ end to end anastomosis 2 (25.0%) Wedge resection 6 (75.0%) Tumor’s diameter e cm Mean; SD 3.7; 2.0 Range 1.5e8 Mitosis e n/50HPF Mean; SD 9.75; 17,3 Range 0e52 Risk Classification e n (%) Very low risk 1 (12.5%) Low risk 4 (50.0%) High risk 3 (37.5%) Dear Editor,