Il Giornale di chirurgia (Il Giorn Chir)

Publications in this journal

• Article: Whipple's disease infection surgical treatment: presentation of a rare case and literature review.

  M Amendolara, C Barbarino, D Bucca, G Stevanato, M Zucchelli, F Romano, L Baiano, M Bernardi, A Broggiato, S Ramuscello, M Rizzo
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  ABSTRACT: The Whipple' Disease (W.D.) is a very rare disease with an incidence of 1 per 1.000.000 inhabitants; it is a systemic infection that may mimic a wide spectrum of clinical disorders, which may have a fatal outcome and affects mainly male 40-50 years old. The infective agent is an actinomycete, Tropheryma Whipplei (T.W.) that was isolated 100 years after first description by Wipple, and identified in macrophages of mucosa of the small intestine by biopsy which is characterized by periodic acid-Schiff-positive, products of the inner membrane of his polysaccharide bacterial cell wall. The multisystemic clinical manifestations evolve rapidly towards an organic decay characterized by weight loss, malabsorption, diarrhea, polyathralgia, opthalmoplegia, neuro-psychiatric disorders and sometimes associated to endocarditis. Early antibiotic treatment with trimethoprim and sulfometathaxazole reduces the fatal evolution of the disease. The authors present a rare experience about a female subject in which the clinical gastrointestinal signs were preceded by neuro-psychiatric disorders, and evolved into obstruction and intestinal perforation which required an emergency surgery with temporary ileostomy, recanalized only after adequate medical treatment with a full dose of antibiotic and resolution of clinical disease for the high risks of fistulae for the edema and lymphadenopathy of mucosa. The diagnosis was histologically examined by intestinal biopsy performed during surgery, which showed PAS-positive histiocytes, while PRC polymerase RNA was negative, which confirms the high sensibility of PAS positive and low specificity of RNA polymerase for T.W.
  Il Giornale di chirurgia 04/2013; 34(4):117-21.
• Article: Successful management of evisceration occurred after exploratory laparotomy for bilateral ovarian micropapillary serous borderline tumors.

  C Grigoriadis, A Vezakis, N Salakos, O Triantafyllidou, N F Vlahos
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  ABSTRACT: Micropapillary serous borderline tumor of the ovary is characterized by a more frequent association with extraovarian, especially invasive, implants. The aim of this study was to report the clinicopathological findings of a rare case of micropapillary serous borderline tumor of the ovary since there are less than 100 similar cases in the published literature. Additionally, the successful management of evisceration that complicated the postoperative stay of the patient is analyzed. The incidence of this severe complication is estimated between 0.29-2.3%. There are four main causes: suture tearing through the fascia, knot failure, suture failure, and extrusion of abdominal contents between sutures placed too far apart. At least 50% of the cases are due to technical error with a potentially lethal result.
  Il Giornale di chirurgia 04/2013; 34(4):128-31.
• Article: Twenty years experience in oncologic surgery for primary cardiac tumors.

  A Dell'amore, A Albertini, M Lamarra
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  ABSTRACT: Introduction. Primary cardiac tumors are uncommon in cardiac surgery. To investigate the clinical presentation, surgical results and long-term follow-up we retrospectively analyzed our experience in the treatment of primary cardiac tumors. Patients and methods. Ninety-one patients with primary cardiac tumors underwent surgery in our department in the last 20 years. Fifthy-one patients were female, the mean age was 62,2 years. Sixty-three had myxomas, 22 had papillary fibroelastoma, 4 had malignant neoformations and 2 had other benign tumors. Results. All myxomas, fibroelastomas and angiomyolipoma were radically removed. Only a palliative treatment was possible in malignant disease. In-hospital mortality was 1.2%. The mean follow-up time was 78.5 months. Three patients had recurrence of myxoma, all patients with malignant disease dead during the follow-up. Discussion. Primary benign cardiac tumors can be treated with low morbidity and mortality. The follow-up demonstrates that radical surgery is curative in case of benign tumors. The prognosis of malignant tumors is still poor. Palliative procedures have small impact on survival in these patients.
  Il Giornale di chirurgia 04/2013; 34(4):106-11.
• Article: Delayed presentation of blunt duodenal injuries in children. Case report and review of literature.

  M Torba, A Gjata, S Buci, A Troci, K Subashi
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  ABSTRACT: Background. Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion. Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.
  Il Giornale di chirurgia 04/2013; 34(4):122-4.
• Article: Secretory breast cancer. Case report.

  A Lombardi, S Maggi, L Bersigotti, G Lazzarin, E Nuccetelli, C Amanti
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  ABSTRACT: Secretory carcinoma of the breast is a rare tumor initially described in children but occurring equally in adult population. This unusual breast cancer subtype has a generally favorable prognosis, although several cases have been described in adults with increased aggressiveness and a risk of metastases. However, surgery is still considered the most appropriate treatment for this pathology. We describe the case of a 50 -year-old woman who has undergone a breast conservative surgery for a little tumor, preoperatively diagnosticated by a fine needle aspiration biopsy (FNAB) as a well differentiated infiltrating carcinoma.
  Il Giornale di chirurgia 04/2013; 34(4):125-7.
• Article: One-stage laparoscopic procedure for a patient with bilateral colorectal tumours and renal carcinoma.

  M Fazzin, L Dellachiesa, G Resta, M Bandi, S Marino, G Anania
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  ABSTRACT: We describe a case of a patient with synchronous bilateral colorectal tumours and renal carcinoma who underwent one-stage laparoscopic surgery procedure with right transperitoneal nefrectomy, right hemicolectomy and sigmoidectomy. One-stage laparoscopic procedure can be used safely and successfully for a patient with multiple primary tumours.
  Il Giornale di chirurgia 04/2013; 34(4):132-4.
• Article: Sternal wound dehiscence from intense coughing in a cardiac surgery patient: could it be prevented?

  G Santarpino, S Pfeiffer, G Concistré, T Fischlein
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  ABSTRACT: This case report is on a obese patient who underwent a coronary artery bypass. The immediate postoperative phase, on the 8th day, was characterized by sternal dehiscence with diastasis, from intense coughing. At present, for obese patients there are not any guidelines aimed to prevent the sternal diastasis. The use of a sternum support vest after median sternotomy could be a valuable tool in the postoperative care of our patients, in order to avoid chest wall hyperexpansion and to prevent sternal wound dehiscence and diastasis.
  Il Giornale di chirurgia 04/2013; 34(4):112-11.
• Article: Unilateral synchronous breast tumors. Rare association of myofibroblastoma and osteosarcoma.

  M A Barbuscia, D Paparo, A Querci, G Lemma, F Fedele, M Scollica, A Caizzone, M Lentini
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  ABSTRACT: The authors describe the case of a patient with two particularly rare contiguous tumors, myofibroblastoma and osteosarcoma, in the same breast. Rare does not mean untreatable, and the chance of recovery is no less than with more common tumors. However, rare tumors do present a significant problem for pathologists due to diagnostic difficulties, and so an exact prognosis is not always possible.
  Il Giornale di chirurgia 04/2013; 34(4):101-5.
• Article: Indications for and limits of conservative surgery in breast cancer.

  M A Barbuscia, E A Cingari, U Torchia, A Querci, G Lemma, A Ilacqua, A Caizzone, A Sanò, V Fabiano
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  ABSTRACT: Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself.
  Il Giornale di chirurgia 03/2013; 34(3):90-4.
• Article: Surgical results and survival of older patients with unsuspected N2 (stage IIIA) non-small cell lung cancer.

  A Dell'amore, M Monteverde, G Caroli, S Sanna, F Stella, A Bini
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  ABSTRACT: Purposes. The optimal treatment of N2 non-small cell lung cancer (NSCLC) in older patients is still debate and represent an important treatment and ethical problem. Patients and methods. Between January 2000 to December 2010, 273 older patients underwent lung resection for (NSCLC). Results. The overall-operative mortality was 9.5%. Risk factors for in-hospital mortality were pneumonectomy and poli-vasculopathy. One, 3 and 5-year survival were 73%, 23% and 16% respectively. Conclusions. In potentially operable older patients with NSCLC we need to make every effort to exclude N2 involvement because very poor long-term survival. Pneumonectomy in older patients gains prohibitive in-hospital mortality.
  Il Giornale di chirurgia 03/2013; 34(3):53-8.
• Article: Simultaneous Meckel's diverticulitis and appendicitis: a rare complication in puerperium.

  D Spiliopoulos, A O Awala, P Peitsidis, A Foutouloglou
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  ABSTRACT: We report a case of a 24-year-old woman who was delivered via cesarean section at 39 weeks and presented in the puerperium with symptoms of worsening abdominal pain and septicaemia. Preoperative ultrasonography suggested the presence of a pelvic collection. Explorative laparotomy revealed the simultaneous presence of Meckel's diverticulitis and appendicitis without bowel perforation. The patient made an uneventful recovery following small bowel resection with end to end reanastomosis and appendicectomy.
  Il Giornale di chirurgia 03/2013; 34(3):64-9.
• Article: Primary neuroendocrine lung tumor presenting with acute ileal obstruction. Case report.

  G Li Destri, M J Ferraro, G Vecchio, A Musumeci, M Calabrini, A Giarrizzo
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  ABSTRACT: The authors describe a clinical case of a patient with neuroendocrine carcinoma of the lung diagnosed after the onset of an intestinal obstruction from an ileal metastasis. A review of literature reveals that the incidence of symptomatic gastro-intestinal metastases from lung cancer has been estimated to be about 2-3% and is exceedingly rare that the intestinal symptoms may be the initial presentation of cancer of the lung. The authors emphasize the difficulty of preoperative diagnosis of gastro-intestinal metastases which is made, almost always, too late because of the lack of specific symptoms. In our case, on account of the computed tomography, we leaned towards the diagnosis of lymphoma because of the double mediastinal and abdominal localization. Furthermore, this diagnosis was supported by the fact that the pulmonary lesion did not have clear radiological features of a lung cancer. The prognosis is poor because once intestinal metastases occur, other metastatic sites, which would make surgery only a palliative measure, are already present. The review of the literature shows that the average survival rate of these patients is 136 days. In our case the patient survived 277 days.
  Il Giornale di chirurgia 03/2013; 34(3):78-81.
• Article: Biliary duct injuries in the laparoscopic era: our experience.

  C De Werra, R Del Giudice, R Di Micco, S Aloia, L Bracciano, M Cervotti, G Galloro, L Bucci
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  ABSTRACT: Aim. The main aim of our study is to evaluate the incidence, the type, the causes and the therapy of biliary duct injuries which occurred after the video laparoscopic cholecystectomies performed in our Department during the period from 1990 to 2012. Patients and methods. A retrospective analysis of 1186 VLC has been made in our Department from March 1990 to June 2012. Before the cholecystectomy all patient were evaluated with trans abdominal echography. Beyond the incidence of BDI was evaluated damaging mechanism, etiology, therapy and time of diagnosis. Results. From 1990 to 2012 a total of 9 BDIs occurred, with an incidence of 0,75%. Out of 9 patients 4 had major lesions and 5 had minor lesions; the most common BDI was Strasberg A (45%), the most common etiology was the presence of anatomical variations. In four cases the diagnosis has been intraoperative, in five cases has been postoperative. Conclusions. Our clinical experience shows that the main cause of BDI are the surgeon experience and the bile ducts anatomical variation.
  Il Giornale di chirurgia 03/2013; 34(3):59-63.
• Article: Small bowel obstruction caused by mesh migration. Case report.

  S Olmi, M Uccelli, G O Cesana, F Ciccarese, D Carrieri, G Castello, G Legnani
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  ABSTRACT: Introduction. Endoscopic hernia repair methods have become increasingly popular over the past 15 years. Nonetheless, there is no consensus regarding an optimal fixation method. Transabdominal sutures and titanium tacks or staples are the most traditional ones. Case report. We present a case of mechanic small bowel obstruction due to mesh migration occurring one year and a half after incisional hernia repair with polytetrafluoroethylene mesh fixed by spiral tacks. Discussion. Titanium spiral tacks are dangerous because of their sharp components, which can damage organs such as the small intestine, by causing microperforations. The type of prosthesis used has also contributed to the intraluminal migration, since polytetrafluoroethylene mesh is very flexible and poorly integrates in the abdominal wall. Conclusion. A prosthesis of a different material combined with a different fixation system such as absorbable tacks, biological glue, or mechanical tacks without sharp components, would have obviated mesh migration.
  Il Giornale di chirurgia 03/2013; 34(3):70-3.
• Article: Duodenal tumors: four case reports.

  V Pasta, M Biffoni, G Martino, M S Malavenda, D Sottile, L Marinaccio, R Merola, M Vergine, M G Bernieri, M Monti, A Redler
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  ABSTRACT: We report 4 cases of neuroendocrine tumors of the duodenum. Signs and symptoms were non-specific. The choice of surgery depended on the site and stage of the tumor and any concomitant diseases.
  Il Giornale di chirurgia 03/2013; 34(3):74-7.
• Article: A case of extraovarian primary peritoneal carcinoma in an oophorectomized-hysterectomized patient: a diagnostic dilemma.

  F Moccia, M Cimmino, G Ciancia, G Rossetti, B Pascotto, I Morra, M D'Armiento, L Fei
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  ABSTRACT: Extra Ovarian Primary Peritoneal Carcinoma (EOPPC) is a rare type of adenocarcinoma of the pelvic and abdominal peritoneum. The objective examination and the histological aspect of the neoplasia virtually overlaps with that of ovarian carcinoma. The reported case is that of a 72 year-old patient who had undergone a total hysterectomy with bilateral annessiectomy surgery 20 years earlier subsequently to a diagnosis for uterine leiomyomatosis. The patient came to our attention presenting recurring abdominal pain, constipation, weight loss, severe asthenia and fever. Her blood test results showed hypochromic microcytic anemia and a remarkable increase CA125 marker levels. Instrumental diagnostics with Ultrasound (US) and CT scans indicated the presence of a single peritoneal mass (10-12 cm diameter) close to the great epiploon. The patient was operated through a midline abdominal incision and the mass was removed with the great omentum. No primary tumor was found anywhere else in the abdomen and in the pelvis. The operation lasted approximately 50 minutes. The post-operative course was normal and the patient was discharged four days later. The histological exam of the neoplasia, supported by immunohistochemical analysis, showed a significant positivity for CA 125, vimentin and cytocheratin, presence of psammoma bodies, and cytoarchitectural pattern resembling that of a serous ovarian carcinoma even in absence of primitiveness, leading to a final diagnosis of EOPPC. The patient later underwent six cycles of chemotherapy with paclitaxel (135 mg/m2/24 hr) in association with cisplatin (75mg/m2). At the fourth year follow-up no sign of relapse was observed.
  Il Giornale di chirurgia 03/2013; 34(3):82-5.
• Article: De Garengeot hernia with acute appendicitis.

  E Erdas, L Sias, S Licheri, L Secci, S Aresu, M Barbarossa, M Pomata
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  ABSTRACT: Aim. The presence of the appendix within a femoral hernia sac is a rare condition known as De Garengeot hernia. We report a case of De Garengeot hernia with concomitant appendicitis and a brief review of the literature on the pathogenesis, diagnosis and treatment of this uncommon condition. Case report. A 33 year-old woman was admitted to our Surgical Unit with acute-onset pain and swelling in the right groin region. Clinical signs and ultrasound imaging suggested the presence of a strangulated femoral hernia and the patient was operated on in emergency setting. An inflamed appendix was discovered within the hernia sac. Appendectomy via McBurney incision and prosthetic repair of the femoral ring were performed. The postoperative course was uneventful and at the 2 week and 1 year follow-up no signs of wound infection and no hernia recurrence were found. Conclusion. Since clinical signs are non-specific and radiological findings may often be misinterpreted, appendicitis within a femoral hernia sac is often an incidental finding during an emergency operation for strangulated femoral hernia. Appendectomy-associated hernia repair may be performed with or without prosthesis depending on the extent of surgical field contamination.
  Il Giornale di chirurgia 03/2013; 34(3):86-9.
• Article: Pre-operative ultrasound for breast tumour measurements: is there potential for mismanagement?

  S Doddi, T Singhal, S Maghsoudi, P Sinha, A J Desai
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  ABSTRACT: The pre-operative size of breast tumour is the most important factor in determining feasibility of breast conserving surgery in operable breast cancer. Currently there is no consensus on the most accurate modality to measure tumour size. A prospective study of consecutive and unselected symptomatic patients with invasive breast cancer who had primary surgery between January 2006 and December 2007 was conducted. Patients with multi-focal and multi-centric tumours were excluded. The aim of this study was to find the correlation between histological size of invasive breast cancer and pre-operative tumour size as measured by ultrasound. Over this two year period, data for 192 patients was analysed for this study. The mean tumour diameter on ultrasound and histology was 19.5mm and 29mm respectively. The difference between the means in the two modalities was found to be statistically significant (P<0.001).Ultrasound underestimates the true size of breast tumours as determined histologically. Inaccurate tumour size measurements may result in re-operations to achieve adequate margins.
  Il Giornale di chirurgia 01/2013; 34(1-2):6-10.
• Article: Extracranial association of arteriovenous and venous malformations. Case report.

  C Alfano, S Chiummariello, M Iera, N Scuderi
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  ABSTRACT: Association of multiple vascular malformations of the face is a rare condition. An arteriovenous malformation (AVM) with a venous malformation as the draining vein is also a rarity. We report a case of extracranial mixed vascular malformations that deformed the normal architecture of the lower face. Removal of the AVM was followed by stability of the jaw and tongue malformation, indicating the AVM used the venous malformation as its draining vein. This approach spared the patient severe cosmetic and functional sequelae.
  Il Giornale di chirurgia 01/2013; 34(1-2):32-4.