Cic edizioni internazionali
Il Giornale di Chirurgia

Thrombotic complications in inflammatory bowel diseases

Mini-review, 14 - 19
Tag this article
Abstract
Full text PDF
Inflammatory bowel disease (IBD), Crohn’s Disease (CD) and Ulcerative Colitis (UC) are associated with an increased risk of arterial and venous thromboembolism. A 2 to 3 time fold increased risk of developing thromboembolic complications was reported for IBD
patients compared to general population. A systematic literature search was conducted using PubMed, Medline, Scopus, Cochrane database. The key words were: “Inflammatory Bowell Disease”, “Crohn’s Disease and Thrombosis”, “Ulcerative Colitis and Thrombosis”, “Thrombosis” and “Inflammatory Bowel Diseases and Thrombosis”. Full articles and abstracts were included. Studies such as case reports, letters and commentaries were excluded from the analysis if appropriate data could not be extracted. Although no randomized controlled trials (RCTs) have been established to evaluate the efficacy of thromboprophylaxis in patients with IBD due to the incidence of VTE and PE in such patients, it is highly recommended the adoption of thromboprophylactic measures. Available prophylaxis and treatment options include pharmacological anticoagulant therapy (LMWH-Low Molecular Weight Heparin, Fondaparinux and UH-Unfractionated Heparin) and mechanical prophylaxis. In case of acute VTE patient must be treated with fibrinolytic agents and in selected non-responsive cases vascular surgery. IBD patients have an increased risk of VTE complications. Prophylaxis for VTE should be recommended in all patients who do not show contraindications to treatment.

Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage (iC

Original Article, 20 - 25
Tag this article
Abstract
Full text PDF
Background. Anastomotic leakage (AL) is a dreaded major complication after colorectal surgery. There is no uniform definition of anastomotic dehiscence and leak. Over the years many risk factors have been identified (distance of anastomosis from anal verge, gender, BMI, ASA score) but none of these allows an early diagnosis of AL. The DUtch LeaKage (DULK) score, C reactive protein (CRP) and procalcitonin (PCT) have been identified as early predictors for anastomotic leakage starting from postoperative day (POD) 2-3. The study was designed to prospectively evaluate AL rates after colorectal resections, in order to give a definite answer to the need for clear risk factors, and testing the diagnostic yeld of DULK score and of laboratory markers.
Methods and analysis. A prospective enrollment for all patients undergoing elective colorectal surgery with anastomosis carried out from September 2017 to September 2018 in 19 Italian surgical centers. Outcome measures: preoperative risk factors of anastomotic leakage; operative parameters; leukocyte count, serum CRP, serum PCT and DULK score assessment on POD 2 and 3. Primary endpoint is AL; secondary endpoints are minor and major complications according to Clavien-Dindo classification; morbidity and mortality rates; readmission and reoperation rates, length of postoperative hospital stay (Retrospectively registered at ClinicalTrials.gov Identifier: NCT03560180, on June 18, 2018). Ethics. The ethics committee of the “Comitato Etico Regionale delle Marche - C.E.R.M.” reviewed and approved this study protocol on September 7, 2017 (protocol no. 2017-0244-AS). All the participating centers submitted the protocol and obtained authorization from the local Institutional Review Board.

Open inguinal hernia repair with self-gripping Parietex ProGrip mesh: a retrospective study of 204 cases

Original Article, 26 - 31
Tag this article
Abstract
Full text PDF
Chronic pain and recurrence rates are the main challenge in modern inguinal hernia surgery. Several trials have investigated the role of self-adhesive mesh repair for inguinal hernia, with special attention to the incidence of chronic postoperative inguinal pain and recurrence.
The purpose of our study was to retrospectively evaluate the early and long-term results using a self-gripping mesh (Parietex Progrip® , Covidien) in our institution. A total of 204 patients, mean age 50.3 standard deviation (SD) 15.3, was included in the study. The repair was performed under local anaesthesia in 159 (78%) cases and locoregional anaesthesia in remaining 45 (22%). Mean operative time was 39 ± 20 minutes. The time for self-gripping mesh placement ranged from 5 to 9 minutes (mean 7 ± 2 minutes). There were no intraoperative complications.
Clinical follow-up was performed at 1 month, 1 year and 2 years and consisted in the evaluation of complications, discomfort/pain and recurrence. One case of cutaneous infection and three cases of seroma were observed at one-month follow-up and were all treated conservatively. 8 patients were lost at one year follow-up, and another 4 were lost at 2 years. 3 patients died for other causes during follow-up. At 1 year and 2 years follow-up no cases of seroma, testicular complications or mesh infection were observed. Two cases of recurrence were recorded at 2 years follow up. No patient reported VAS score > 2 at one month, 1 year and 2 years follow-up. There were no readmissions, systemic complications or death during 2 years follow-up. Lichtenstein open repair using Parietex Progrip® mesh is a simple, rapid, effective and safe method for inguinal hernia repair. The main advantage of self-fixing mesh is the reduced operative time. A suturless fixation seems to prevent the development of postoperative chronic pain, without increasing recurrence rate in the majority of the trials.

Use of the KSVM-based system for the definition, validation and identification of the incisional hernia recurrence risk factors

Original Articles, 32 - 38
Tag this article
Abstract
Full text PDF
Background. Incisional hernia is one of the most common complications after abdominal surgery with an incidence rate of 11 to 20% post laparotomy. Many different factors can be considered as risk factors of incisional hernia recurrence. The aim of this study is to confirm and to validate the incisional hernia recurrence risk factors and to identify and to validate new ones.
Methods. In the period from July 2007 to July 2017, 154 patients were selected and subjected to incisional hernia repair. The surgical operations were conducted under general anaesthesia. Patients received antibiotic prophylaxis when indicated, according to the hospital prophylaxis scheme. Inclusion criteria of the study were single operator case studies and open laparotomy for incisional hernia repair. The statistical analysis proposed to identify and to verify the risk factors for recurrence of incisional hernia is the Support Vector Machine (SVM). The analysis was conducted verifying 34 risk factors.
Results. The data analysis confirmed the known correlations showed in the international literature with a greater incidence of comorbidities such as diabetes 37%, dyslipidaemia and hypercholesterolemia with a cumulative incidence of 16%; tobacco smoke - by combining categories smokers and ex-smokers - reach 46%, COPD 16% and hypertension 51%.
Conclusions. The analysis of the data therefore confirmed the correlations showed in the international literature. A KSVM-based system to classify incisional hernia recurrence has been presented. The type of prosthesis and the site of its implant also play a significant role in the development of the recurrence. Sensitivity (86,25%), Specificity (87,14%), Negative Predictive Value (84,72%), Precision (88,46%), Accuracy (86,67%), and Error (13,33%) scores obtained using the proposed technique highlight the validity for the relapse’s classification methodology.

Colocutaneous fistula through ulcerative colitis and cancer to the pyoderma gangrenosum: a never-ending story for a single patient.
Case report

Clinical practice, 39 - 43
Tag this article
Abstract
Full text PDF
Background. Inflammatory bowel diseases may be associated with many extraintestinal complications, that in some cases can represent the first onset of these disorders. In particular during the course of the disease, Ulcerative Colitis develops extraintestinal manifestations very frequently. One of the rarest is pyoderma gangrenosum, a noninfectious neuthrophilic dermatosis, that can involve most commonly legs but also other parts of the skin or mucosas. It can be idiopathic or associated with gammopathies, vasculitis, chronic arthritis or, like in our case, with inflammatory bowel disease and malignancies.
Case presentation. A 38-year-old man was referred to our Department with a colo-cutaneous fistula in the left quadrant of abdominal wall. In the anamnesis he reported a trauma during a soccer match three weeks before. Through a CT scan and endoscopy with biopsy an inflammatory bowel disease with a segmental colitis and stenosis was diagnosed. After medical therapy, an initial radiological drainage and a period of parenteral nutrition, he underwent a left hemicolectomy.
Despite the previous endoscopic biopsy the histopathological examination put in evidence not only inflammatory disease (in particular Ulcerative Colitis) but also a colorectal tumor pT4pN0. After the full recovery before chemotherapy he has developed on the chest and on the abdomen some painful nodules, with central necrosis, one of those in contact with one of the ribs. Through TC and RM it was impossible to understand the precise nature of these skin lesions. With biopsy a pyoderma gangrenosum was diagnosed and treated until complete resolution.
Discussion and conclusion. Management of inflammatory bowel diseases can be a true challenge, not only for the intestinal manifestations, but also for all the other features not related to gut. In some cases the same patient can develop many complications, such as malignancies or rare cutaneous diseases. Despite the initial surprise for such a weird evolution in a same patient, from fistula to inflammatory disease to cancer and finally to pyoderma gangrenosum, to face every single complication following consolidated diagnostic and pathological paths has been the correct strategy for controlling the disease.

Amyand’s hernia: role of CT for a correct diagnosis

Clinical practice, 44 - 48
Tag this article
Abstract
Full text PDF
Amyand’s hernia consists in the protrusion of the vermiform appendix into an inguinal hernia sac and represents an uncommon condition with a difficult preoperative diagnosis to be recognized with clinical examination and imaging diagnostic tools in order to choose a correct therapeutic approach for the patient. Four types of Amyand’s hernias exist. The case of a recurrent type 1 Amyand’s hernia is presented.
Multi detector computed tomography allowed a correct diagnosis and the subsequent surgical treatment had no complication for the patient. Radiologists and surgeons need to be aware of this pathology and its classification, as well as of the importance of recognizing both the inflamed and normal appendix within the inguinal canal and the abdominal complications. With the availability of multi detector CT scanning, a greater number of type 1 and 2 hernias are able to be preoperatively diagnosed, and type 3 and 4 better characterized in emergency situation, allowing to perform the best surgical treatment and reducing the chances of pathological recurrence.

Modular megaprosthesis as definite treatment of femur osteomyelitis

Clinical practice, 49 - 53
Tag this article
Abstract
Full text PDF
Chronic osteomyelitis represents a challenging to treat clinical entity.
A case of a whole femur chronic osteomyelitis, definitely treated with total femur resection and a positioning of a modular megaprosthesis in 2 stages is presented. An 81-year-old female, with hip hemiarthroplasty and internal fixation plate of the distal femur presented with signs and symptoms of femur osteomyelitis. Based on the clinical, radiologic and laboratory findings, the diagnosis of chronic femur osteomyelitis was established. Multiple bone cultures from different femur sites revealed the same methicillin resistant S. aureus. The patient was subjected to a two stage femur reconstruction operation. At the first stage, radical debridement, total femur resection and the application of a custom made vancomycin loaded spacer was performed. After a total of 6 weeks i.v. and 3 months oral proper causative antimicrobial treatment a modular megaprosthesis was applied. The patient was definitely treated from total femur chronic osteomyelitis and has returned to her daily activities. Chronic osteomyelitis demands a multidisciplinary approach, including the right causative long-term antimicrobial treatment, as well as the proper surgical treatment, aiming for eradication of infection and best possible postoperative limb function.

Testicular torsion in a newborn: a case report

Clinical practice, 54 - 57
Tag this article
Abstract
Full text PDF
Discovery of an apparent scrotal mass is a non common entity in neonates. Testicular torsion is rare in newborn infants and is an urologic emergency that requires emergency surgical management. We present a rare case of testicular torsion in a neonate.

Surveillance of pregnant women with potential exposure to Zika virus following travel

Clinical practice, 58 - 65
Tag this article
Abstract
Full text PDF
Aim. To describe the experience of a single fetal medicine unit in evaluating pregnant women with potential exposure to Zika virus (ZIKV) following travel.
Method. Between February 2016 and June 2017, a multidisciplinary team evaluated pregnant women by developing a local pathway based on Public Health England guidance. All pregnant women were offered serial fetal ultrasound scans (USS). If they presented
with a history of clinical symptoms consistent with ZIKV infection during or within two weeks of travel or fetal USS was suggestive of microcephaly, reverse transcriptase polymerase chain reaction (RT PCR) and/or serology was used. Results. 69 women were referred. Eight patients reported symptoms consistent with ZIKV infection (11.6%) and six (8.7%) patients reported mosquito bites. Maternal exposure was mainly during the preconception period and the first trimester in 35 (50.8%) and 19 (27.5%) women, respectively. Prenatally, there was no evidence of microcephaly in any of the 69 referrals. Sixty-two live births and seven miscarriages were reported. One patient had serology confirming ZIKV infection during pregnancy. At birth, 57 babies had normal head circumference (HC) measurements, including the baby born to the Zika positive mother. Two babies had small HC measurements but were not infected and were small for gestational age.
Conclusions. One case of maternal ZIKV infection was detected but without any fetal congenital abnormalities postnatally. The number of potentially infected patients referred to our unit is a demonstration of the concern regarding perinatal ZIKV infection in the pregnant population.

Mesenteric cyst and recurrent abdominal pain in a patient with Gorlin-Goltz syndrome: a case report

Clinical practice, 66 - 69
Tag this article
Abstract
Full text PDF
Gorlin-Goltz syndrome (GGS) is an infrequent autosomal do-minant multisystemic disease with complete penetrance and variable expressivity. It is estimated to have an incidence of 1:50,000 - 1:150,000 cases with a M/F = 1:1. This report describes a case of recurrent abdominal pain due to a large mesenteric cyst in a 38-year-old female patient affected by a rare disease: Gorlin-Goltz syndrome.

Squamous carcinoma in pilonidalis sinus: case report and review of literature

Clinical practice, 70 - 74
Tag this article
Abstract
Full text PDF
Aim. We report a case of squamous carcinoma arising from a pilonidal sinus.
Case report. Patient of 83 years old, that after 30 years had a recurrence of pilonidal sinus revealed by a sacral abscess studied with pelvic CT scan and MRI. After clinical investigation, traditional open surgical technique was performed and pathologic studies revealed a squamous carcinoma. The patient performed a new CT scan with persistence of disease, and a second surgical look with mass excision until the presacral fascia and V-Y flap was performed. Histological exami-nation was found to be positive for squamous carcinoma on the margin and the patient underwent adjuvant radiotherapy cycles with a close follow-up with evidence of free disease survival. He died after 5 years for old age.
Discussion. The incidence of carcinoma arising from a pilonidalis sinus is about 0.1% and the most important risk factor is represented by a chronic abscess from 20-30 years. In literature there are about 100 cases. Gold standard treatment is surgery with complete excision of the presacral fascia, while radiotherapy decrease the risk of recurrence.
Conclusion. All cases reported in literature are submitted as case report. Sacro-coccyxal fistula should be treated early because chronic inflammation can determine neoplastic degeneration. Histological examination should be performed routinely. Gold standard is surgery with wide excision. There is no evidence about the gold standard for the reconstructive time.

Vol. XL (No. 1) 2019 January - February

  1. Raffaele Bastianelli: Magister sine cathedra
    Di Matteo G.
  2. Thrombotic complications in inflammatory bowel diseases
    Fornaro R., Caristo G., Stratta E., Caratto M., Caratto E., Giovinazzo D., Di Maira L., Casaccia M., Frascio M.
  3. Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage (iC
    Benedetti M., Ciano P., Pergolini I., Ciotti S., Guercioni G., Ruffo G., Borghi F., Patriti A., Del Rio P., Scatizzi M., Mancini S., Garulli G., Carrara A., Pirozzi F., Scabini S., Liverani A., Baiocchi G., Campagnacci R., Muratore A., Longo G., Caricato M., Macarone Palmieri R., Vettoretto N., Caccaroni M., Guadagni S., Bertocchi E., Cianflocca D., Lambertini M., Pace U., Baraghini M., Pandolfini L., Angeloni R., Lucchi A., Martorelli G., Tirone G., Motter M., Sciuto A., Martino A., Luzzi A.P., Di Cesare T., Molfino S., Maurizi A., Marsanic P., Tomassini F., Santoni S., Capolupo G.T., Amodio P., Arici E., Clementi M., Ruggeri B., Catarci M.
  4. Open inguinal hernia repair with self-gripping Parietex ProGrip mesh: a retrospective study of 204 cases
    Del Papa M., D'Amata G., Manzi F., Carnì P., Florio G., Crovaro M., Musmeci L., Buonocore C.
  5. Use of the KSVM-based system for the definition, validation and identification of the incisional hernia recurrence risk factors
    Licari L., Salamone G., Campanella S., Carfì F., Fontana T., Falco N., Tutino R., De Marco P., Comelli A., Cerniglia D., Petrucci G., Vitabile S., Gulotta G.
  6. Colocutaneous fistula through ulcerative colitis and cancer to the pyoderma gangrenosum: a never-ending story for a single patient. Case report
    Eberspacher C., Mascagni D., Fralleone L., Maturo A., Di Matteo F.M., De Cristofaro F., Merletti D., Santoro A., Mascagni P., Pontone S., Pironi D.
  7. Amyand’s hernia: role of CT for a correct diagnosis
    Drago A., Carbone M., Lorusso V., Moschetta M., Scardapane A., Lucarelli N., Angelelli G., Stabile Ianora A.A.
  8. Modular megaprosthesis as definite treatment of femur osteomyelitis
    Koutserimpas C., Raptis K., Mari A., Kotsirakis A.
  9. Testicular torsion in a newborn: a case report
    Blevrakis E., Xenaki S., Chrysos E.
  10. Surveillance of pregnant women with potential exposure to Zika virus following travel
    Spiliopoulos D., Panchal M., Economides D.L.
  11. Mesenteric cyst and recurrent abdominal pain in a patient with Gorlin-Goltz syndrome: a case report
    Monaco L., Guida F., D'Onofrio G., Di Martino N.
  12. Squamous carcinoma in pilonidalis sinus: case report and review of literature
    Delvecchio A., Laforgia R., Sederino M.G., Minafra M., Carbotta G., Balducci G., Fabiano G., Fedele S., Palasciano N.
  13. congresses, academies, societies
    Di Matteo G.
Last Viewed articles: la lista degli ultimi x visitati.
  1. congresses, academies, societies
    Di Matteo G.
  2. Squamous carcinoma in pilonidalis sinus: case report and review of literature
    Delvecchio A., Laforgia R., Sederino M.G., Minafra M., Carbotta G., Balducci G., Fabiano G., Fedele S., Palasciano N.
  3. Mesenteric cyst and recurrent abdominal pain in a patient with Gorlin-Goltz syndrome: a case report
    Monaco L., Guida F., D'Onofrio G., Di Martino N.
  4. Surveillance of pregnant women with potential exposure to Zika virus following travel
    Spiliopoulos D., Panchal M., Economides D.L.
  5. Testicular torsion in a newborn: a case report
    Blevrakis E., Xenaki S., Chrysos E.
  6. Modular megaprosthesis as definite treatment of femur osteomyelitis
    Koutserimpas C., Raptis K., Mari A., Kotsirakis A.
credits