Christian Galatioto

Is laparoscopic sonography a reliable and sensitive procedure for staging colorectal cancer? A comparative study

AbstractBackground: Laparoscopic colectomy has developed rapidly with the explosion of technology. In most cases, laparoscopic resection is performed for colorectal cancer. Intraoperative staging during laparoscopic procedure is limited. Laparoscopic ultrasonography (LUS) represents the only real alternative to manual palpation during laparoscopic surgery. Methods: We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal cancer. Preoperative staging included abdominal US, CT, and endoscopic US (for rectal cancer). Laparoscopy and LUS were performed in all cases. Pre- and intraoperative staging were related to definitive histology. Staging was done according to the TNM classification. Results: LUS obtained good results in the evaluation of hepatic metastases, with a sensitivity of 100% versus 62.5% and 75% by preoperative diagnostic means and laparoscopy, respectively. Nodal metastases were diagnosed with a sensitivity of 94% versus 18% with preoperative staging and 6% with laparoscopy, but the method had a low specificity (53%). The therapeutic program was changed thanks to laparoscopy and LUS in 11 cases (33%). In four cases (12%), the planned therapeutic approach was changed after LUS alone. Conclusions: The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal cancer, providing a useful and reliable diagnostic tool complementary to laparoscopy.

Gastrointestinal stromal tumour of the duodenum in childhood: a rare case report

BackgroundGastrointestinal stromal tumours (GISTs) are uncommon primary mesenchymal tumours of the gastrointestinal tract mostly observed in the adults. Duodenal GISTs are relatively rare in adults and it should be regarded as exceptional in childhood. In young patients duodenal GISTs may be a source of potentially lethal haemorrhage and this adds diagnostic and therapeutic dilemmas to the concern about the long-term outcome.Case presentationA 14-year-old boy was referred to our hospital with severe anaemia due to recurrent episodes of upper gastrointestinal haemorrhage. Endoscopy, small bowel series, scintigraphy and video capsule endoscopy previously done elsewhere were negative. Shortly after the admission, the patient underwent emergency surgery for severe recurrence of the bleeding. At surgery, a 4 cm solid mass arising from the wall of the fourth portion of the duodenum was identified. The invasion and the erosion of the duodenal mucosa was confirmed by intra-operative pushed duodenoscopy. The mass was resected by a full-thickness duodenal wall excision with adequate grossly free margins. Immunohistochemical analysis of the specimen revealed to be positive for CD117 (c-KIT protein) consistent with a diagnosis of GIST. The number of mitoses was < 5/50 HPF. Mutational analysis for c-KIT/PDGFRA tyrosine kinase receptor genes resulted in a wildtype pattern. The patient had an uneventful course and he has remained disease-free during two years of follow-up.ConclusionDuodenal GISTs in children are very rare and may present with massive bleeding. Cure can be achieved by complete surgical resection, but even in the low-aggressive tumours the long-term outcome may be unpredictable.

Leiomyosarcoma of the right ovarian vein

The case of a 70-year-old patient with a leiomyosarcoma of the right ovarian vein is presented. For this rare entity, complete surgical excision is believed to offer the best chance of cure.

Percutaneous management of multiple bilateral liver abscesses complicating Crohn disease.

Liver abscess is a rare complication of Crohn disease. A case of multiple, bilateral, pyogenic liver abscesses appearing as a recurrent manifestation of Crohn disease in a 34-year-old man is reported. Conservative management with antibiotics, double-catheter drainage, and multiple aspirations was successful. The liver abscesses disappeared with no recurrence during a 5-year follow-up period.

Laparoscopic treatment of appendico-cecal intussusception.

Laparoscopy is a therapeutic possibility in pediatric surgery. A case of appendiceal intussusception treated laparoscopically in a 27-month-old girl is presented. The postoperative course was normal.

Multiple bowel perforations complicating imatinib treatment for advanced gastrointestinal stromal tumor.

m f a d p b n 82-year-old woman presented with acute abdominal ain, vomiting, and fever (38.8°C). One year earlier, she ad an advanced gastrointestinal stromal tumor (GIST) ith multiple intestinal and endoperitoneal localizations, ot suitable for operation. Since then, she was treated with matinib-mesylate, 400 mg once daily. On examination, er abdomen was diffusely tender with bulky elastic masses alpable in the middle and lower abdomen. Laboratory ests revealed moderate anemia (Hb 9.8 g/dL) with a white lood cell count of 16,200. Plain supine x-rays of the abomen apparently showed some fluid levels with a marked

Acute abdomen caused by greater omentum torsion: A case report and review of the literature. Omentum majus torsiyonunun neden olduğu akut batın: Olgu raporu ve literatürün gözden geçirilmesi

Torsion of the greater omentum is a rare cause of acute abdomen. Based on etiopathogenesis, it can be classified as primary or secondary. However, regardless of the cause, segmentary or diffuse omental necrosis will follow. Preoperative diagnosis is not easy, though abdominal ultrasound and computed tomography (CT) scans may show peculiar features suggestive of omental torsion. Laparoscopic resection of the affected omentum is the treatment of choice. Presently reported was a case of primary omental torsion, in addition to a comprehensive literature review.

Less is more: an outcome assessment of patients operated for gallstone ileus without fistula treatment

Highlights • In this study, 1.9% patients were diagnosed with gallstone ileus among those admitted for small bowel obstruction.• 85% of them underwent a conservative surgical approach mainly consisting in the enterolithotomy.• Only one complication exceeded grade II in each group and no deaths were reported.• Mean follow-up was 50 months and only one patient without fistula treatment had recurrent disease; no gallbladder cancer were identified.• Enterolithotomy without fistula closure proved to be safe and effective for the management of gallstone ileus both on a short and long-term basis.

Perfore apandisitte pulmoner sekestrasyonun neden olduğu hemoptizi: Seyrek görülen bir olgunun raporu

Pulmonary sequestration is a rare and usually asymptomatic congenital anomaly. Optimal management of this condition is still a subject of debate, including superiority of surgical resection or angiographic embolization of the aberrant arterial vessel. Presently described is rare case of a 51-year-old male who presented with hemoptysis related to pulmonary sequestration associated with acute right lower quadrant abdominal pain caused by perforated appendicitis.

Emoperitoneo da lacerazione post-traumatica di una frangia epiploica e della sierosa della flessura colica destra attivamente sanguinante

1. Emoperitoneo (freccia tratteggiata) da lacerazione traumatica di frangia epiploica e della sierosa della flessura colica destra con raccolta emorragica rifornita per via arteriosa (freccia continua). 2. Trauma diretto da impatto; rapida decelerazione con produzione di lacerazioni tra le porzioni fisse e quelle mobili dell’intestino; brusco incremento della pressione endoluminale del viscere con lesioni da scoppio. 3. Perche sono gravate da elevata morbilita e mortalita, necessitano di terapia chirugica d’urgenza e precludono, pertanto, la possibilita di un trattamento conservativo delle lesioni traumatiche degli organi parenchimatosi. 4. MDCT con mdc e.v..