Annali italiani di chirurgia
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Review Case Reports
[Spontaneous rectus sheath hematoma: a rare condition with uneasy diagnosis and multidisciplinary treatment. Report of 5 cases and review of literature].
Spontaneous rectus sheath hematoma is a rare condition. It encompasses a wide spectrum of severity (self-limiting to fatal) depending of its size, etiology, and the development of complications. It enters into the differential diagnosis of abdominal pain but it's frequently difficult to diagnose and often radiologic imaging is required. ⋯ The difficulties in the correct diagnosis frequently lead to delay in treatment or unneeded surgery. CT-scan is the gold-standard investigation. Treatment options are variable and include conservative treatment, intravascular embolization and surgery Frequently an interdisciplinary team approach is needed.
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Review Multicenter Study
Post-operative peritonitis due to anastomotic dehiscence after colonic resection. Multicentric experience, retrospective analysis of risk factors and review of the literature.
Intraperitoneal sepsis due to anastomotic leakage significantly affects the outcomes of intestinal surgery. The aim of this retrospective review is to examine retrospectively general and local factors involved in anastomotic leakage and their prognostic value. ⋯ In our experience, the site of colonic anastomosis represents the risk factor most strictly related to the anastomotic leak rate, while other technical factors seem weakly associated with leakage. A significantly high percentage of patients (65.6%) with anastomotic fistulas have medical comorbidities.
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Review Case Reports
Uncommon cause of acute abdomen: volvulus of gallbladder with necrosis. Case report and review of literature.
Gallbladder volvulus is a rare condition which can mimic an acute cholecystitis. This condition is characterized from a rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. ⋯ This is an acute surgical emergency that must be treated with immediate detorsion and cholecystectomy. We report a case of acute gallbladder torsion in an elderly man and review the clinical aspects of the disease in the context of the available literature.
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Review Case Reports
Thrombosis of the superior mesenteric vein in association with hormonal contraceptive use. A case report and review of the literature.
There are a number of reports in the literature which describe the association of venous thrombosis with oral contraceptives. Venous thrombosis is a rare form of mesenteric ischemia which may be lethal if not diagnosed and treated quickly. Although the non specificity of clinical signs do not always permit an early diagnosis. ⋯ Before the prescription of contraceptive therapy the examination of risk factors is necessary, compiled preferably by hematochemical screening to exclude haematological and/or coagulative pathologies, and not deriding the use of non-pharmalogical methods of contraception when possible. Considering the technological advancement of instrumentation (CAT scan, angiogram), even a diagnosis aimed at a suspected clinical history; starting from less invasive screening by ultrasonographic Doppler, might induce to a rapid intervention and thereby avoid sacrificing too much intestinal tissue if it is the case.
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The technique of ultrasound-guided subclavian cannulation was evaluated in our experience assessing the real effectiveness of such procedure. ⋯ Our experience demonstrate that, both in no difficult cases and in no teaching procedures, central venous catheterization using landmark technique seems to be acceptable on both clinical and medico-legal grounds. However the ultrasound guided technique is necessarily required to achieve the reduction of complications in difficult venous access.