Pietro Fransvea

Emergency presentation of cystic lymphangioma of the colon: A case report and literature review.

Highlights • Lymphangiomas of the colon are benigne tumors.• They may lead to life-threatening conditions.• Infection, volvulus, obstruction and bleeding into the lumen of a cyst are usually very difficult to manage.

Changes in the Surgical Approach to Colonic Emergencies during a 15-Year Period

Purpose: The present study aims to determine the morbidity and mortality of emergency colonic surgery and the factors associated with adverse outcome, and to evaluate any change in incidence of the different types of pathological conditions and in the surgical approach over the last 15 years. Materials and Methods: A total of 319 patients who underwent emergency colonic surgery between January 1997 and December 2011 were retrospectively analyzed. Patients were divided into two groups according to the date of surgery, namely group 1, between 1997 and 2006, and group 2, between 2006 and 2011. The differences in terms of postoperative outcomes between the groups were analyzed. Results: Overall postoperative morbidity and mortality rates were 25.3 and 17.2%, respectively; no differences were found between the groups. Group 2 showed a significantly increased rate of primary resection and anastomosis (p < 0.001), as well as an increase in laparoscopic approach compared with group 1 (p < 0.001). Conclusions: Emergency colon surgery is today primarily performed for benign diseases, of these the most common is diverticular disease followed by ischemic colitis. Age, comorbidities, and ischemic colon disease are predictors of adverse outcomes, while the surgical procedure per se is not.

Bowel perforation secondary to metastatic lung cancer: Report of two cases with literature review

Highlights • Intestinal metastasis of a pulmonary tumor is a rare occurrence but must be suspected in acute abdominal syndrome in a patient with a diagnosed pulmonary neoplasia.• Emergency surgical treatment of abdominal metastases of a lung cancer is mandatory but prognosis is extremely unfavorable.

Challenging case of horseshoe kidney double fracture

Highlights • The incidence of horseshoe kidney in the general Population is 0.25%.• It is twice as common in men as in women.• Early diagnosis and management can lead to a successful outcome preserving renal fuction.

Colorectal cancer in pregnancy: one disease, two patients

Recently, we performed a low anterior resection in a 32-year-old woman, gravida 2, para 2, for an obstructing rectosigmoid adenocarcinoma associated with multiple bilobar liver metastases. She had developed diarrhoea and rectal bleeding during the fifth month of pregnancy and had refused colonoscopy at 34 weeks gestation. After delivery, she had persisting symptoms and agreed to be investigated; the diagnosis of rectal cancer was obtained 2 months following vaginal delivery of a healthy baby girl. She was treated with diverting colostomy, modified FOLFIRI and pharmacological suppression of lactation. As of this writing, she is under adjuvant chemotherapy. Colorectal cancer (CRC) in pregnancy is a rare disease with a reported incidence rate of 0.002%. The first report was set forth by Cruveilhier in 1837; since then, barely 450 cases have been described. Profound psychoemotional, ethical, religious and medicolegal questions surround this condition. Once cancer has been diagnosed, the aim of treatment should be to assist both mother and fetus; however, this appears laborious and perilous as oftentimes the fetomaternal unit shows conflicting interests. Treating the mother for cancer as soon as possible, ensuring the fetal well-being, an uneventful delivery, as well as female fertility through curative or palliative surgery, minimally invasive procedures, neoadjuvant (over pregnancy) or adjuvant chemoradiotherapy comprise the extremely arduous challenges that CRC in pregnancy poses by itself to surgeon, oncologist, radiotherapist, obstetrician, neonatologist, gastroenterologist and radiologist. Furthermore, all the information about pharmacological and radiological adverse effects on fetus emanate from case reports or small series, as cancer and drug trials exclude pregnant patients: thus, no high-grade evidence exists. The occurrence of protracted rectal bleeding during pregnancy should not be overlooked and should be endoscopically investigated if associated with inexplicable changes in bowel habits.