Matteo Gregori

Intra-operative ultrasound for detection of liver metastases from colorectal cancer

Objective: The aim of this study was to evaluate the accuracy of intra‐operative ultrasound (IOUS) imaging in detecting liver secondaries at the time of primary colorectal surgery and to evaluate the impact of IOUS on patient management.

Metastasis to the Pancreas from Breast Cancer: Difficulties in Diagnosis and Controversies in Treatment

Background: Metastasis to the pancreas originating from malignant tumours is a rare event and, in the literature, we have found only 11 reported cases of solitary pancreatic metastases originating from breast cancer. Case Report: We report a case of a 51-year-old woman with primary breast cancer who developed obstructive jaundice and epigastric pain after 2 years without any symptoms. The pancreatic mass revealed by computed tomography (CT) scan and magnetic resonance imaging (MRI) was not recognised as a metastasis from breast cancer and the patient underwent cephalic pancreaticoduodenectomy. Conclusions: We discuss all aspects of the case management, stressing the importance of a careful evaluation of the clinical history and the primary cancer features and the usefulness of a multi-disciplinary approach. These aspects are of main importance for a correct diagnostic process and an appropriate therapeutic choice when a pancreatic lesion develops in a patient with prior neoplasm.

Ghost ileostomy: Real and potential advantages

Loop ileostomy is created to minimize the clinical impact of colorectal anastomotic leak. However, a lot of complications may be associated with ileostomy presence and with its reversal. Moreover, patients hardly accept the quality of life resulting from ileostomy. We describe a simple technique (ghost ileostomy) to combine all the advantages of a disposable ileostomy without entailing its complications in patients submitted to low rectal resection. In case of uneventful postoperative course, the ghost ileostomy prevents all complications related to defunctioning ileostomy. At the same time, in case of anastomotic leakage, the ghost ileostomy is easily and safely converted into a defunctioning ileostomy.

Emergency Hartmann’s Procedure and Its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis:

Background. Hartmann’s procedure (HP) followed by reversal restoration is the first choice for treatment of diffuse diverticular peritonitis. There is no unanimous consensus regarding the use of laparoscopy to treat the same condition. Methods. Data from 60 patients with diverticular diffuse peritonitis who underwent urgent HP followed by laparoscopic reversal were retrospectively analyzed. Patients were divided into 2 groups according to the open or laparoscopic HP (OHP, 24 patients; LHP, 36 patients). Outcomes were measured in terms of functional recovery, morbidity, mortality, and length of hospital stay. Results. HPs showed no differences among the groups in terms of operative time, blood loss, and length of intensive care unit stay. Overall morbidity was significantly lower in LHP than in OHP, corresponding to 33.3% and 66.7% respectively (P = .018). The incidence of both surgical and medical complications was higher in OHP than in LHP (41.7% vs 22.2% [P = .044] and 45.8% vs 24.3% [P = .023], respectively). Mortality was 16.6% for each group. LHP showed a faster return to bowel movements and a shorter hospital stay than OHP. The secondary intestinal reversal was possible in 92% of cases, successfully completed laparoscopically in 91.3%. No patients of LHP group required a conversion to open intestinal reversal. Conclusion. LHP for treatment of diverticular diffuse peritonitis showed significantly lower morbidity, faster recovery, shorter hospital stay, and higher rates of successful laparoscopic reversal when compared with OHP.