Matteo Maternini

Circumferential anal giant condyloma acuminatum: a new surgical approach.

INTRODUCTION: Perianal giant condyloma acuminatum is a rare clinical condition related to human papillomavirus infection and characterized by a circumferential, exophytic, cauliflower-like mass with an irregular warty surface localized in the anal region. TECHNIQUE: A circular incision with a diathermocoagulator was performed on macroscopically healthy skin, 1 cm from the margin of the lesion. The dermis was divided from the subcutaneous tissue. This way, a mucocutaneous cylinder including the whole lesion was obtained. A median radial incision was carried out to open the cylinder at its front. A progressive circumferential section on healthy mucosa (≈1 cm above the margin of the lesion) by means of a radiofrequency dissector allowed for the complete removal of the mass. The healthy mucosa of the anal canal was pulled out by Allis forceps and was sutured to the external margin of the internal sphincter with single layer of Vicryl (polyglactin 910) 2-0 sutures. RESULTS: Two months after surgery, no findings of anal stenosis or mucosal ectropion were reported. At the 1-year follow-up there was no recurrence of condylomatosis in any of the 3 cases. CONCLUSIONS: Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.

Impact of Pre-Storage and Bedside Filtered Leukocyte-Depleted Blood Transfusions on Infective Morbidity after Colorectal Resection: A Single-Center Analysis of 437 Patients

BACKGROUND Leukocyte-depleted blood transfusions were introduced to reduce transfusion-associated immunomodulation, but the clinical effects of different types of leukocyte depletion have been analyzed rarely. The aim of this survey was to analyze the clinical impact of pre-storage leukocyte-depleted blood transfusions (considered as pre-storage or bedside-filtered) on post-operative complications in patients undergoing elective or urgent colorectal resection. METHODS Data were collected retrospectively from the medical records of 437 consecutive patients who underwent colorectal resection from 2005 to 2010. All patients requiring transfusion received pre-storage or bedside-filtered leukocyte-depleted red blood cell concentrates according to availability at the blood bank. The outcomes were measured by the analysis of post-operative morbidity in patients receiving the different types of transfusions or having other potentially predictive risk factors. RESULTS The overall morbidity rate, infective morbidity rate, and non-infective morbidity rate were, respectively, 35.6%, 28.1%, and 21.0%. Two hundred five patients (46.9%) received peri-operative transfusions. On multivariable analysis, leukocyte-depleted transfusion (odds ratio [OR] 3.33; 95% confidence interval [CI] 2.14-5.20; p<0.001) and both pre-storage (OR 2.82; 95% CI 1.73-4.59; p<0.001) and bedside-filtered (OR 4.69; 95% CI 2.54-8.67; p<0.001) transfusions were independent factors for post-operative morbidity. Prolonged operation (p=0.035), American Society of Anesthesiologists score≥3 points (p=0.023), diagnosis of cancer rather than benign disease (p=0.022), and urgent operation (p=0.020) were other independent predictors of post-operative complications. Patients transfused with bedside-filtered blood showed significantly higher rates of infective complications (51.4% vs. 31.8%; p=0.006), but not non-infectious complications (35.7% vs. 32.6; p=0.654) than patients who received pre-storage transfusions. CONCLUSIONS Leukocyte-depleted blood transfusions and, in particular, bedside-filtered blood have a significant negative effect on infectious complications after colorectal resection.

Surgical Management of Full-Thickness Rectal Prolapse in the Elderly Patient

The incidence of full-thickness rectal prolapse is 1% in patients over 65 years of age. Risk factors are multiparity, previous pelvic surgery, and neurological or psychiatric disorders. IBS, constipation, and chronic straining are comorbidity factors. Symptoms and risk of complications are indications for surgical treatment. Among abdominal operations, ventral rectopexy recently seems to offer the best long-term results. Recurrence rate less than 3–4%, a net improvement of continence, is in up to 80–90% of cases; compared with traditional rectopexies, a greater improvement in constipation and a reduced risk of postoperative constipation are observed. Perineal procedures (Altemeier’s proctosigmoidectomy) are less demanding on the patients and are still the favorite technical choice in the elderly, mostly in high-risk patients. Morbidity and mortality are low and postoperative recovery is faster. If the technique is correctly performed, there seems to be no statistically significant difference in recurrence rate between abdominal and perineal procedures. However, in the last few years, there is a new emerging trend for a wider use of laparoscopic ventral rectopexy also in geriatric low-risk patients.

What is this very big skin lesion

This clinical image shows the importance of the early diagnosis and treatment of any suspicious skin lesion.

Big anal skin tags? What is this?

A hard and bleeding anal and perianal mass stenotized the anus and required left‐sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass.

Intestinal Obstruction by a Pancreatic Bezoar: A Case Report

CONTEXT Pancreatic pseudocysts are relatively common complications of pancreatitis. A pseudocyst can result from an episode of acute pancreatitis, exacerbation of chronic pancreatitis, or trauma. Treatment is indicated for persistent, symptomatic pseudocysts and in the case of related complications. CASE REPORT We describe the case of a 66-year-old man who referred to our department for bowel obstruction caused by a necrotic pancreatic bezoar occurring 16 days after the patient underwent a jejunal-pseudocyst anastomosis performed to treat a post-pancreatitis voluminous pseudocyst obstructing the gastric outlet. CONCLUSION In case of intestinal obstruction after a jejunal-pseudocyst anastomosis, pancreatic bezoar should be considered in the armamentarium of the differential diagnosis.

The implications for patients undergoing splenectomy: postsurgery risk management

Splenectomy has been performed for a heterogeneous group of hematologic diseases with a therapeutic or diagnostic purpose or as part of the staging process in Hodgkins disease. Most patients undergoing therapeutic splenectomy are chronically ill with significant splenomegaly. This scenario can be associated with a high risk of postoperative morbidity and mortality due to the prolonged course of disease for patients with myelofibrosis; their susceptibility to infection, thrombosis, and hemorrhage; and the severe enlargement of their spleens. We have reviewed the main papers published about postoperative complications after splenectomy, analyzing the risk factors, prevention measures, and respective treatments. Great care must be taken in the management of patients presenting malignant diseases, splenomegaly, and hemostasis disorder. Moreover, despite the faster discharge that new surgical techniques now allow, close attention should be paid to symptoms reported by patients, in order to avoid potentially life-threatening complications such as portal vein thrombosis, pancreas injuries, and overwhelming postsplenectomy infection.