Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use.

Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes.

Acute Chyloperitoneum with Small Bowel Volvulus: Case Series and Systematic Review of the Literature.

Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus.

Intestinal Perforation in a patient with peritoneal carcinomatosis from colon cancer treated with Regorafenib. Description of a case and review of the literature.

Regorafenib is a multikinase inhibitor approved for treatment of patients with metastatic Colo-Rectal Cancer (mCRC) and Gastro-Intestinal Stromal Tumor (GIST) progression after the administration of other tyrosine-kinase inhibitors such as imatinib and sunitinib. Only a handful of severe side effects such as intestinal perforations and fistulas have been described in the literature in patients undergoing multikinase inhibitor treatment. We report a case of a patient with peritoneal mCRC who experienced an intestinal perforation during the administration of Regorafenib and review the literature.

Health economics aspects of kidney transplantation in Sicily: a benchmark analysis on activity and estimated savings.

Background: International and national registries consistently report substantial differences in kidney transplant (KT) activity despite demonstrable clinical and financial benefits. The study aims to estimate the financial resources gained by KT and produce a benchmark analysis that would inform adequate strategies for the growth of the service.

Methods: We analyzed the KT activity in our region between 2017 and 2019.

Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines.

Dealing with acute cholecystitis in high-risk, critically ill, and unfit-for-surgery patients is frequent during daily practice and requires complex management. Several procedures exist to postpone and/or prevent surgical intervention in those patients who temporarily or definitively cannot undergo surgery. After a systematic review of the literature, an expert panel from the Italian Society of Emergency Surgery and Trauma (SICUT) discussed the different issues and statements in subsequent rounds.

Management of Cholelithiasis in Cirrhotic Patients.

Gallstone disease (GD) is a common disease worldwide and has a higher incidence in cirrhotic patients than in the general population. The main indications for cholecystectomy surgery in cirrhotic patients remain symptomatic cholelithiasis and its complications. Over the past two decades, numerous published reports have attested to the feasibility and safety of laparoscopic cholecystectomy in cirrhotic patients.

Percutaneous trans-stomal jejunostomy: a new technique.

Aim: We propose a new technique for feeding a malnourished patient with a "high" double-barrel jejunostomy (at about 60 cm from the Treitz Ligament). The procedure aims to restore an adequate nutritional state maintaining a correct diet for 24 h a day, without complications and without interfering with the normal activity of the nurses caring for the stoma.

Method: Using local anesthesia, we introduced a Reverdin needle through the efferent loop of jejunostomy and externalized it through the skin, medially from jejunostomy of about 10 cm.

A critical view of safety in left colectomy surgery: A case of renal artery injury.

Introduction: The standardization of the laparoscopic approach in left hemicolectomy was facilitated by the vascular anatomy of the left colon, which has few anatomical variants. The current technique for left hemicolectomy consists in approaching the inferior mesenteric artery (IMA), after identification of the inferior mesenteric vein (IMV), from above (craniocaudal) or from below (caudocranial). The type of approach is decided on the basis of the vascular window between the IMV and IMA.

Laparoscopic assisted ERCP in patient with Roux-en-Y gastric bypass. A case report.

Introduction: Choledocholithiasis in Roux-en-Y patients is a therapeutic challenge for both surgeons and endoscopists. In fact, typical procedures, such as ERCP, can't be performed due to the altered anatomy of the patient. Nowadays, procedures on this kind of patient are performed not only in specialized bariatric centers, but, due to the increasing number of patients undergoing bariatric surgery, are starting to become more common even in smaller and non-specialized centers that don't possess the same expertise and technology.

Technique of neuromonitoring during pelvic peritonectomy.

Objectives: Pelvic peritonectomy can induce anorectal and urogenital dysfunctions. To reduce this type of complications during the procedure, we propose to use intraoperative neuromonitoring (IONM).

Content: Stimulation with a bipolar probe allows the identification of the obturator and ilioinguinal and pudendal nerves.

Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with trans-peritoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy.

The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016.

An unusual case of gastric volvulus through Bochdalek hernia A case report and review of the recent literature.

Introduction: Bochdalek Hernias are one of the most common types of diaphragmatic hernia, a congenital pathology diagnosed during the neonatal period. In adulthood, diagnosis of a Bochdalek hernia is rare and its complications may be fatal.

Case Report: We report an unusual case of a 60-year-old woman who presented with upper gastrointestinal bleeding due to a Bochdalek hernia with herniation of stomach and spleen into the chest with a gastric volvulus.

Therapeutic strategies for perforated jejunal diverticulitis. A case report.

Aim: The jejuno-ileal diverticulosis is an unusual disease which affects elderly people and its complications can be fatal due to delayed diagnosis. The most frequent complication of jejunal diverticulitis is the perforation.

Case Report: In this report we describe a case of elderly patient presenting with acute abdominal pain and fever.

Metastatic melanoma of the small bowel. Report of a case and review of literature.

Aim: Malignant melanoma incidence is rapidly growing worldwide. The small bowel is well known to be a preferred site for melanoma metastases. In 60% of patients who died of disseminated melanoma, the gastrointestinal (GI) tract was affected, but only 1% to 4% of GI metastases were clinically diagnosed ante mortem.

Cystic lymphangioma of the pancreas: a hard diagnostic challenge between pancreatic cystic lesions-review of recent literature.

Lymphangiomas are rare congenital benign tumors arising from the lymphatic system. The incidence of this disease in the pancreas is extremely rare, accounting for less than 1% of these tumors. Before introducing the review we reported a case of a 67-year-old woman with cystic lymphangioma of the pancreas.

Gastric inflammatory fibroid polyp tumor with acute intestinal obstruction-Vanek's tumor can mimick a giant gastrointestinal stromal tumor or a gastric lymphoma.

An inflammatory fibroid polyp (IFP) is a solitary rare benign neoplasm of the gastrointestinal tract, frequently located in the gastric antrum. IFPs account for about 0.1% of all gastric polyps.

Evaluation of cisplatin plasma levels in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Introduction Peritoneal surface malignancies have long been regarded as incurable, however, they can be treated with cytoreductive surgery in addition to hyperthermic intraperitoneal chemotherapy. This approach is associated with an increase in morbidity and mortality, unless hyperhydration is provided in a timely manner. Methods Cisplatin (CDDP) is the most widely used chemotherapeutic agent.

Wernicke encephalopathy as rare complication of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Background: Peritoneal carcinomatosis of gastric origin is a frequent event with poor survival. A new promising approach is the association of the Cytoreductive Surgery (CRS) with the Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which yet is characterized by high morbidity and mortality. We report, to our knowledge, the first case of Wernicke Encephalopathy (WE) complicating CRS plus HIPEC.

Giant retroperitoneal liposarcoma: Case report and review of the literature.

Aim: Retroperitoneal soft-tissue sarcomas are relatively uncommon diseases, the most frequent histotype, ranging from 20% to 45% of all cases, is represented by liposarcoma, which is a hard-to treat condition for its local aggressiveness and clinical aspecificity.

Presentation Of Case: We report a case of a 64-years-old woman who underwent surgical resection for a giant pleomorphic retroperitoneal liposarcoma.

Discussion: Currently chemotherapy for retroperitoneal soft-tissue sarcomas is no effective, and radiotherapy has limited efficacy due to the toxicity affecting adjacent intra-abdominal structures, showed validity only in case of high-grade malignancy by reducing local recurrence, but with no advantage in overall survival.

Vulvar endometriosis and Nuck canal.

Aim: Endometriosis is not a well-known disease and sometimes its rare onset is a pathogenetic, diagnostic and therapeutic problem. The Canal of Nuck is an embryonal rest of the parietal peritoneum that accompanies the round ligament through the inguinal canal. The perviousness of the canal of Nuck could explain the pathogenesis of vulvar endometriosis.

Metastasis of the gallbladder from the breast cancer.

Aim: Metastatic lesions of the gallbladder are an infrequent clinical condition. The metastatic lesions of gallbladder from primary breast tumors are rarely described in literature.

Material Of Study: We report a case of an 83-year-old woman who underwent cholecystectomy for cholelithiasis by video laparoscopy (VL), and in whom a metastatic lesion was detected at the histological examination of surgical specimen.

Gastric paraganglioma: a case report and a review of the literature.

Aim: Paragangliomas are neural crest-derived neuroendocrine tumors, originating from paraganglia, which are dispersed neuroendocrine organs characterized by catecholamine and peptide-producing cells. With an annual incidence estimated at 1/100,000, paragangliomas represent 10% of catecholamine secreting tumors.

Material Of Study: We report a case of a 76-year-old man who was submitted to a subtotal gastrectomy with omentectomy and gastrojejunal anastomosis.

Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: preliminary analysis of a multicentre study.

Aim: To assess the incidence of morbidity and mortality of Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy.

Patients And Methods: A retrospective multicentric study was performed. Six hundred and eighty-three patients were recorded.

The role of prophylactic hyperthermic intraperitoneal chemotherapy in the management of serosal involved gastric cancer.

Background: Peritoneal carcinomatosis of gastric origin is associated with poor survival. The use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) did not significantly improve the survival of patients with this disease. A promising approach can be based on the use of HIPEC as prophylaxis of peritoneal dissemination.