Annali italiani di chirurgia
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Esophageal anastomotic leaks are associated with significant morbidity and mortality. The purpose of this study was to retrospectively assess the role of the anastomotic positioning (thoracic or cervical) on the incindence of the anastomotic leak and its severity. ⋯ On the basis of our findings we suggest the adopt the cervical anastomosis due to lower mortality rate related when leaks occur.
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Retroperitoneal hematomas (RPH) mostly occur after blunt and penetrating traumas. However, these hematomas may develop spontaneously in the elderly and the patients who use anticoagulants. Between January 2006 and December 2011, 31 patients with RPH were evaluated retropectively. The patients were allocated into three groups according to the underlying etiological factor: Group I; spontaneous RPH, group II; RPH caused by penetrating trauma, group III; RPH caused by blunt trauma. ⋯ Additional organ injury, massive blood transfusion, the route of injury and the need for surgery are defined as the most significant factors associated with increased mortality.
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The authors analyse clinical cases of penetrating thoracic, abdominal, perineal and anorectal injury and describe the traumatic event and type of lesion, the principles of surgical treatment, the complication rate and follow up. ⋯ Based on the our clinical experience and the literature, in penetrating abdominal trauma laparotomy may be required if patients are hemodynamically unstable (or in hemorrhagic shock), in patients with evisceration and peritonitis, or for exploration of penetrating thoracoabdominal and epigastric lesions. In anterior injuries of the abdominal wall from gunshot or stab wounds, laparotomy is indicated when there is peritoneal violation and significant intraperitoneal damage. In patients with actively bleeding wounds of the abdominal wall muscles minimal laparotomy is often necessary for control of hemorrhage and abdominal wall reconstruction to avoid herniation. If patients are asymptomatic, in cases of anterior lesions the indications for diagnostic laparoscopy are uncertain. Selective conservative treatment is reserved for asymptomatic patients who are hemodynamically stable. Further controlled studies are needed. Early surgery for perineal and anorectal trauma, and also for complex injuries, is the gold standard for treatment.
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Review Case Reports
Tracheal necrosis, oesophageal fistula: unusual complications of thyroidectomy. Report of two case and literature review.
Thyroidectomy is considered a low-risk operation. The authors report a case of tracheal necrosis after total thyroidectomy for multinodular goiter with bilateral adenomas, and a case of oesophageal fistula after total thyroidectomy for papillary cancer. ⋯ Thyroidectomy is a safe surgical procedure, but in some patients major complications may arise. In cases of iatrogenic tracheal or oesophageal perforation, conservative non-surgical or conservative surgical treatment, in specialized centers, results in a favourable outcome. The authors discuss the risk factors and management of these two rare complications.