Piero Lippolis

The role of ultrasonography in blunt abdominal trauma: results in 250 consecutive cases.

The accuracy of ultrasonography (US) in detecting abdominal lesions and free fluid collections in patients with blunt abdominal trauma was evaluated in 250 patients. Particular attention was paid to the role of associated US-guided paracentesis in doubtful cases and in those referred for nonsurgical therapy. The overall sensitivity of US in detecting free fluid collection was 98% (51 of 52 cases) with a specificity of 99% and a positive predictive value of 100%. The overall sensitivity was 93% in spleen injuries, 80% in liver injuries, and 100% in kidney lesions with a positive predictive value of 93%, 100%, and 100%, and a specificity of 99%, 100%, and 100%, respectively. Three stable patients underwent celiotomy on the basis of the results of US-guided paracentesis. The versatility, sensitivity and, repeatability of US, along with its feasibility at bedside and the possibility of performing a guided paracentesis represent the main characteristics that make US the first diagnostic approach to patients with blunt abdominal trauma.

Five‐year follow‐up of percutaneous ethanol injection for the treatment of hyperfunctioning thyroid nodules: a study of 117 patients

Percutaneous ethanol injection (PEI) has been suggested as an alternative to radioiodine and surgery for the treatment of autonomous thyroid nodules (ATN).

Laparoscopic radiofrequency thermal ablation of hepatocarcinoma: preliminary experience.

The objective was to evaluate the feasibility, safety, and effectiveness of radiofrequency thermal ablation (RFT), performed during laparoscopy with a cooled-tip electrode needle, in the treatment of neoplastic hepatic focal lesions. Seven patients with hepatocarcinoma (10 hepatic lesions) were treated during laparoscopy with RFT using a 100-watt RF generator and 17-gauge, dual-lumen, cooled-tip electrode needles with a 3-cm exposed tip. The mean exposure time was 12 minutes for each needle insertion. Spiral computed tomography scanning detected complete tumor necrosis in nine lesions; in one lesion, peripheral neoplastic tissue was detected, and percutaneous RFT was performed. Two patients during follow-up developed two new neoplastic lesions, treated with percutaneous ethanol injection. No recurrences of the treated lesions were seen after 6 months of follow up. Intraoperative RFT with a cooled-tip electrode needle is a safe and effective local treatment of hepatic focal lesions during laparoscopic surgery. Possible indications are large hepatocarcinoma (>5 cm), superficial lesions, multiple lesions, or tumor located near vascular or biliary structures.

Intrasplenic posttraumatic pseudoaneurysm: echo color doppler diagnosis.

Nonsurgical conservative treatment of blunt splenic trauma has gained widespread consensus in the last few years. It has been demonstrated that 60% of patients with blunt abdominal trauma with spleen lesion achieve the best therapy by using conservative therapy. Despite the accuracy of ultrasonography (US) and computed tomography in detecting and grading the spleen lesions, the evolution of the lesion is often unexpected. In 15 to 30% of patients, a two-stage splenic rupture may be expected within 2 weeks. Delayed complications, such as splenic abscesses and pseudoaneurysms of the splenic artery and its branches, have been observed. To prevent complications, a short follow-up has been scheduled for these patients by using US and US color Doppler. The authors propose routine echo Doppler evaluation for all patients affected by intraparenchymal hematoma after blunt abdominal trauma.

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.

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.

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

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..

Emoperitoneo da lacerazione epatica attivamente sanguinante

1. Emoperitoneo (frecce bianche) e lacerazione epatica traumatica nel VI-VII segmento (freccia nera) caratterizzata da rifornimento arterioso (Figg. 3, 4). 2. In caso di riscontro alla MDCT (Multidetector Computed Tomography) di uno stravaso di mdc e.v. in fase arteriosa o di lesioni di grado maggiore (IV-V) con coinvolgimento dei vasi venosi epatici principali, essendo le lesioni di queste strutture segno indiretto di altre lesioni arteriose. 3. Il trattamento conservativo. 4. Si, poiche il principale fattore predittivo della necessita di ricorrere ad un intervento chirurgico e l’instabilita emodinamica e non il grado della lesione riportata. Il riscontro alla TC di un rifornimento arterioso non cambia la strategia conservativa delle lesioni traumatiche epatiche. In tali circostanze si deve ricorrere all’embolizzazione del vaso, prima che il paziente diventi emodinamicamente instabile, senza dover intraprendere un intervento chirurgico in urgenza.

Ematoma retroperitoneale da rottura di arteria lombare associato ad emoperitoneo ed emotorace

1 Ematoma retroperitoneale destro, rifornito in fase arteriosa per rottura di arteria lombare (Figg. 2, 4); emoperitoneo in sede periepatica associato ad emotorace a destra (Figg. 1, 3). 2. Terapia anticoagulante. 3. L’esame ecografico e la MDCT senza mdc e.v. non sono sufficienti per la diagnosi, in quanto non consentono di stabilire se e come sia rifornito l’ematoma. La MDCT con mdc e.v. consente di rilevare la natura arteriosa della raccolta emorragica (Fig. 4). 4. Embolizzazione in caso di rifornimento arterioso.