Publications by authors named "Giuseppe Evola"

25 Publications

  • Page 1 of 1

Subhepatic perforated acute appendicitis in a patient with midgut malrotation: A case report and review of the literature.

Int J Surg Case Rep 2022 Jun 28;95:107249. Epub 2022 May 28.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95124 Catania, Italy.

Introduction And Importance: Subhepatic acute appendicitis (SHAA) is a very rare cause of acute abdomen, developing in association with two types of congenital anomalies like as midgut malrotation (MM) and maldescent of the caecum. Preoperative diagnosis of SHAA is a challenge because of its rarity and atypical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents the standard treatment of SHAA.

Case Presentation: A 25-year-old Caucasian male presented to the Emergency Department with a one-day history of right lower quadrant (RLQ) abdominal pain, nausea and vomiting. Physical examination revealed RLQ abdominal rebound tenderness with guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography showed a SHAA with intraluminal appendicolith, fat infiltration and pelvic fluid collection in a patient with MM. The patient underwent laparoscopic appendectomy: a retrocaecal subhepatic phlegmonous and perforated appendicitis was sectioned and removed with drainage of pelvic abscess. The postoperative course of the patient was uneventful.

Clinical Discussion: SHAA is characterized by anatomical variation of appendix and atypical presentation. Preoperative clinical diagnosis of SHAA is very difficult and imaging may be helpful for determining the correct diagnosis, as well as confirming MM or maldescent of the caecum. Laparoscopic appendectomy represents the correct treatment of SHAA.

Conclusion: SHAA is a rare surgical emergency that should be considered in the differential diagnosis of patients with RLQ abdominal pain. Preoperative diagnosis needs a high index of suspicion and is facilitated by imaging. Surgery represents the appropriate treatment of SHAA.
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http://dx.doi.org/10.1016/j.ijscr.2022.107249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160733PMC
June 2022

Left Paraduodenal Hernia in a Young Patient with Recurrent Abdominal Pain: A Case Report and Short Literature Review.

Am J Case Rep 2022 Jun 4;23:e935413. Epub 2022 Jun 4.

Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.

BACKGROUND Internal hernias are a rare cause of small bowel obstruction in patients, which usually have a long history of mild abdominal symptoms, sometimes leading to emergency surgery due to acute abdominal pain. Occasionally, it takes a long time to make the correct diagnosis because of symptoms vagueness and transience of typical imaging findings; at times, a definitive diagnosis is possible only through surgery, especially in cases of acute presentations in a low-resource setting where high-performance diagnostic equipment may be unavailable. CASE REPORT We report the case of a young male patient with a long history of mild abdominal symptoms and some episodes of acute abdominal pain. Following one of these episodes, several diagnostic examinations were performed and he was diagnosed with left paraduodenal hernia after typical signs were found on imaging exams, both CT and MRI; the patient underwent laparotomy with reduction of intestinal loops in the peritoneal cavity and suturing of the sac and was eventually discharged with no further symptoms whatsoever. CONCLUSIONS Among internal hernias, left paraduodenal hernias account for the major part and are characterized by the protrusion of bowel loops through the fossa of Landzert; herniated loops produce a sac-like appearance (typical imaging sign on both CT and MRI) and may cause partial displacement of other organs and blood vessels. Internal hernias should always be considered as a rare differential diagnosis in the workup of a patient with abdominal pain or intestinal obstruction: knowledge of both typical imaging features and specific surgical techniques are mandatory so that these patients may be properly cared for.
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http://dx.doi.org/10.12659/AJCR.935413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9175513PMC
June 2022

Giant retroperitoneal well-differentiated liposarcoma presenting in emergency with intestinal occlusion: Case report and review of the literature.

Int J Surg Case Rep 2022 Jun 3;95:107152. Epub 2022 May 3.

General Surgery Department, San Salvatore Hospital, Paternò (Catania), Italy.

Introduction And Importance: Liposarcoma (LPS) represents the most common type of retroperitoneal sarcoma (RPS) and can be classified into four subtypes. Preoperative diagnosis of retroperitoneal liposarcoma (RLPS) is a challenge because of its late and nonspecific clinical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents a potentially curative treatment of RLPS.

Case Presentation: A 55-year-old Caucasian female presented to the Emergency Department with a two-day history of abdominal pain, abdominal distension, inability to pass gas or stool, nausea, vomiting and lipothymia. Abdominal examination revealed abdominal distention, abdominal pain without obvious muscle guarding and a giant non-tender mass. Laboratory tests reported neutrophilic leukocytosis and anemia. Abdominal contrast-enhanced computed tomography (CECT) showed a heterogeneous and hypodense giant retroperitoneal mass compressing and displacing the surrounding organs and vessels. The patient underwent excision of a giant retroperitoneal mass. The postoperative course of the patient was uneventful.

Clinical Discussion: RLPS is a malignant neoplasm that can slowly grow to enormous size with possible involvement of adjacent organs and vessels; it may recur locally and has a minimal capacity to metastasize. Preoperative diagnosis and staging of RLPS are important to establish appropriate management and prognosis. Surgery represents the gold standard for non-metastatic RLPS treatment.

Conclusion: RLPS is a rare malignant neoplasm generally difficult to detect early due to its late and nonspecific clinical presentation. CECT represents the most commonly used modality for diagnosis, staging and preoperative evaluation. Surgery represents the appropriate treatment of non-metastatic RLPS.
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http://dx.doi.org/10.1016/j.ijscr.2022.107152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9117537PMC
June 2022

An unusual cause of abdominal pain: Case report of a Superior Mesenteric Artery syndrome.

Int J Surg Case Rep 2022 May 6;94:107034. Epub 2022 Apr 6.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.

Introduction And Importance: Superior Mesenteric Artery (SMA) syndrome is an occlusive vascular disease, mainly caused by a severe weight loss that leads to a reduction of the fatty cushion around the SMA. Postprandial abdominal pain, early satiety, vomits, weight loss and malnutrition are the main symptoms of SMA syndrome. Therapy consists of nutritional support, while mini-invasive surgery is indicated when conservative measures are unsuccessful.

Case Presentation: A 39-years old caucasian woman reported the following symptoms: epigastric pain irradiated up to the right hypochondrium, late post-prandial vomiting and severe weight loss. During previous hospitalizations a gastroscopy, a colonoscopy, and radiographic study of food transit were performed, these exams showed a slow gastric emptying. We performed an abdomen CT scan discovering SMA syndrome typical features. A duodenojejunostomy was performed in videolaparoscopy; the procedure was completed easily without complications.

Clinical Discussion: Debilitating conditions with severe weight loss or anatomic abnormalities are the main causes of SMA syndrome. Symptoms are usually unclear and non-specific. The commonest SMA syndrome features are highlighted with contrast CT. This syndrome is often misunderstood and not considered in differential diagnosis of abdominal pain, determining a delay in diagnosis and further weight loss. An early diagnosis is useful to choose the best treatment of the case. For severe cases, surgery represents the best treatment, especially duodenojejunostomy that is usually linked to rapid symptoms' resumptions without post-operative consequences.

Conclusion: SMA syndrome should be included in differential diagnosis of abdominal pain. Severe cases can be treated with mini-invasive surgery.
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http://dx.doi.org/10.1016/j.ijscr.2022.107034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9027382PMC
May 2022

Misdiagnosed desmoid fibromatosis of the chest wall presenting in emergency like as recurrence of post-traumatic hematoma: A case report and review of the literature.

Int J Surg Case Rep 2022 May 4;94:107019. Epub 2022 Apr 4.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95124 Catania, Italy.

Introduction And Importance: Desmoid Fibromatosis (DF) represents a rare neoplasm developing from fascial and musculoaponeurotic structures. Preoperative diagnosis of DF is a challenge because of its rarity and nonspecific presentation. Imaging may be helpful for determining the correct diagnosis. Currently there are different clinical treatments of DF including surgical treatment, drug treatment and radiotherapy.

Case Presentation: A 43-year-old Caucasian male presented to the Emergency Department with a 6-month history of recurrence of post-traumatic chest wall hematoma. Physical examination revealed a partially solid, painless mass on the right anterior chest wall. Laboratory tests reported and neutrophilic leukocytosis. Thoracic contrast-enhanced computed tomography showed a smooth contour, heterogeneous and hypodense subcutaneous soft tissue mass anterior to the right pectoral muscles and to the right 4th-7th rib. The patient underwent surgery: a solid suprafascial neoplasm was completely excised. The postoperative course of the patient was uneventful.

Clinical Discussion: DF is a soft tissue neoplasm with a tendency for local invasion and recurrence. The course of DF cannot be predicted, being fatal if DF infiltrates vital structures. Diagnosis of DF is difficult and imaging may be helpful for determining the correct diagnosis. Currently the treatment for DF has shifted from surgery (post-operative recurrence rates of 20%-70%) to conservative therapy including watchful waiting.

Conclusion: DF is a myofibroblastic proliferative soft tissue tumor and classified as an intermediate malignancy. Preoperative diagnosis of DF needs a high index of suspicion and is facilitated by imaging. Surgery, among different treatments, represents a potentially curative treatment of DF.
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http://dx.doi.org/10.1016/j.ijscr.2022.107019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9026611PMC
May 2022

Jejunal volvulus within an inguinal hernia sac like as an extremely rare cause of acute mechanical gastrointestinal obstruction in adults: First literature report.

Int J Surg Case Rep 2022 Feb 28;91:106757. Epub 2022 Jan 28.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.

Introduction And Importance: Small bowel volvulus (SBV) represents a rare and life-threatening cause of gastrointestinal obstruction among adults. SBV can be classified as primary and secondary subtypes. Preoperative diagnosis of SBV is a challenge because of the absence of pathognomonic clinical, radiographic and laboratory findings. Surgery represents the correct treatment of SBV.

Case Presentation: A 69-year-old Caucasian male presented to the Emergency Department with a two-day history of abdominal pain, inability to pass gas or stool, nausea, vomiting. Physical examination revealed abdominal distension, generalized abdominal pain without guarding or rebound tenderness, a partially reducible and painless right inguinal hernia. Laboratory tests reported neutrophilic leukocytosis. Abdominal computed tomography revealed massive gastroduodenal dilatation with pneumoperitoneum and small bowel loops in the right inguinal sac. The patient underwent exploratory laparotomy: a jejunal volvulus (JV) located within the right inguinal hernia sac, causing gastrointestinal obstruction, was devolvulated and a right prosthetic inguinal hernia repair was also performed. The patient was discharged on the 10th postoperative day.

Clinical Discussion: Secondary SBV is due to any congenital or acquired lesions and rarely occurs among adults in Western countries. This is the first literature report of a JV located within an inguinal hernia sac causing gastrointestinal obstruction.

Conclusion: Secondary JV represents an extremely rare abdominal emergency necessitating early diagnosis to prevent the development of intestinal ischemia, bowel necrosis and peritonitis. Diagnosis of JV needs a high index of suspicion and may be facilitated by imaging, often it is made intraoperatively. Surgery represents the appropriate treatment of JV.
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http://dx.doi.org/10.1016/j.ijscr.2022.106757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858751PMC
February 2022

Left-sided acute appendicitis in a patient with situs viscerum inversus totalis: A case report.

Int J Surg Case Rep 2022 Jan 4;90:106658. Epub 2021 Dec 4.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.

Introduction And Importance: Left-sided acute appendicitis (LSAA) is a very rare cause of acute abdomen, developing in association with two types of congenital anomalies like as situs viscerum inversus (SVI) and midgut malrotation (MM). Preoperative diagnosis of LSAA is a challenge because of its rarity and atypical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents the standard treatment of LSAA.

Case Presentation: A 67-year-old Caucasian male with presented to the Emergency Department with a two-day history of left lower quadrant (LLQ) abdominal pain, nausea, vomiting, diarrhea and fever. Physical examination revealed LLQ abdominal rebound tenderness with guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography showed a LSAA with intraluminal appendicoliths, fat infiltration and pericecal fluid collection in a patient with SVI. The patient underwent laparoscopic appendectomy: a gangrenous and perforated appendicitis was sectioned and removed with drainage of pericecal abscess. The postoperative course of the patient was uneventful.

Clinical Discussion: LSAA is characterized by anatomical variation of appendix and atypical presentation. Preoperative clinical diagnosis of LSAA is very difficult and imaging may be helpful for determining the correct diagnosis, as well as confirming SVIT or MM. Laparoscopic appendectomy represents the correct treatment of LSAA.

Conclusion: LSAA is a rare surgical emergency that should be considered in the differential diagnosis of patients with LLQ abdominal pain. Preoperative diagnosis of LSAA needs a high index of suspicion and is facilitated by imaging. Surgery represents the appropriate treatment of LSAA.
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http://dx.doi.org/10.1016/j.ijscr.2021.106658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683727PMC
January 2022

Primary jejunogastric intussusception: A case report and review of the literature.

Int J Surg Case Rep 2021 Dec 7;89:106666. Epub 2021 Dec 7.

General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy.

Introduction: Jejunogastric intussusception following gastric surgery is a rare complication that, if not diagnosed early, can have catastrophic outcomes.

Presentation Of Case: We have reported a case, never described previously, of an acute spontaneous retrograde JGI, presenting with obstruction and hematemesis, in a 70-year-old woman who has never, previously, undergone abdominal surgery.

Discussion: As in all cases of intestinal intussusception, early diagnosis is important for acute JGI as mortality rates increase from 10% when the intervention occurs within 48 h. to 50% if treatment is delayed for 96 h. The diagnosis of JGI can be determined with many imaging studies, such as endoscopy, ultrasonography (US), barium stadium and CT scan. Although JGI, up to now, has been described as a rare complication after any type of gastric surgery, this disease must, however, be suspected also in patients who have never undergone abdominal surgery, if they present with non-sedable abdominal pain associated with signs of high intestinal obstruction and hematemesis.

Conclusion: Our hope is to add to the available literature to aid physicians in their diagnostic work-up and in developing management plans for similar cases occurring in the future.
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http://dx.doi.org/10.1016/j.ijscr.2021.106666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8668994PMC
December 2021

Management of acute length-unstable Monteggia fractures in children: A case report.

World J Orthop 2021 Nov 18;12(11):954-960. Epub 2021 Nov 18.

Maternity-Childhood Department, Division of Paediatrics, "Cannizzaro" Hospital, Catania 95124, Italy.

Background: Monteggia fractures are uncommon injuries in paediatric age. Treatment algorithms assert that length-unstable fractures are treated with plate fixation. In this case report, intramedullary fixation of an acute length-unstable Monteggia fracture allowed a stable reduction to be achieved, along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture. The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture.

Case Summary: A four-year-old girl presented at the Emergency Department following an accidental fall off a chair onto the right forearm. The X-ray highlighted a length-unstable acute Bado type 1 Monteggia fracture of the right forearm. On the same day, the patient underwent surgical treatment of the Monteggia fracture. The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation. The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and, subsequently, humeroradial joint reduction through manual manipulation. The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion, extension, pronation and supination of the forearm. Healing of the fracture occurred within six weeks after surgery, as indicated by the presence of calluses on at least three cortices on standard radiographs. Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination.

Conclusion: Intramedullary fixation of unstable Monteggia fractures results in excellent outcomes, provides reliable reduction and causes fewer complications.
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http://dx.doi.org/10.5312/wjo.v12.i11.954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613677PMC
November 2021

Granular cell tumor of the cecum: Case report of mini invasive surgical resection and review of the literature.

Int J Surg Case Rep 2021 Oct 13;87:106397. Epub 2021 Sep 13.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.

Introduction And Importance: Granular Cell Tumor (GCT) is a rare lesion with unclear histogenesis, predominantly described as a skin lesion. Visceral localization of GCT is even more rare with few cases reported in the literature. Nowadays GCT guidelines are not available.

Case Presentation: A 45-year-old Caucasian woman was visited in our surgical department for significant weight loss (about 30 kg) during the previous 6 months. Colonoscopy showed a caecal polypoid lesion that was resected with a diatermic loop and classified as GCT. Microscopically, the neoplasm partially involved the mucosa and diffusely the submucosa, extending to the endoscopic resection margins. Because of the high risk of perforation during endoscopic radicalisation attempt, the patient underwent ileocecal resection. The postoperative course was uneventful.

Clinical Discussion: GCT is a rare soft tissue neoplasm probably deriving from Schwann cells. The main treatment for GCT is an endoscopic mucosal/submucosal resection. Nevertheless, a radicalization of the lesion through a surgical attempt should be preferred when the endoscopic procedure is linked to a high risk of perforation. It is important to distinguish GCT from other polypoid lesions of the colon, due to its malignant potential (about 2%) and its relapsing capacity when margins are involved.

Conclusion: GTC is a rare neoplasm and as its diagnosis is made only histologically, it should be included in differential diagnosis of colonic polypoid lesions. Surgery can be considered the best choice when an endoscopic attempt of GCT lesions is linked to a high risk of colon perforation.
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http://dx.doi.org/10.1016/j.ijscr.2021.106397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450234PMC
October 2021

Complicated Littre's umbilical hernia with normal Meckel's diverticulum: A case report and review of the literature.

Int J Surg Case Rep 2021 Jul 18;84:106126. Epub 2021 Jun 18.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.

Introduction And Importance: A Littre's hernia (LH) is defined by the presence of Meckel's diverticulum (MD) in any kind of hernia sac. Preoperative diagnosis of LH is a challenge because of its rarity and the absence of specific radiological findings and clinical presentation. Surgery is the appropriate treatment of complicated LH that is an extremely rare condition with approximately 50 cases reported in the literature over the past 300 years.

Case Presentation: A 46-year-old Caucasian female was admitted to the Emergency Department with a two-day history of abdominal pain. Physical examination revealed an irreducible and painfull mass in umbilical region. Abdominal computed tomography scan showed the protrusion of greater omentum and small bowel loop through the umbilical ring. Laboratory tests were unremarkable. After diagnosis of strangulated umbilical hernia, the patient underwent exploratory laparotomy: the irreducible umbilical hernial sac was opened with presence of incarcerated and strangulated omentum and uncomplicated MD. Resection of incarcerated and ischemic greater omentum alone was performed. The postoperative course of patient was uneventful.

Clinical Discussion: Meckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Preoperative diagnosis of LH is very difficult and surgery represents the correct treatment of complicated LH.

Conclusion: LH represents an extremely rare complication of MD difficult to diagnose and suspect because of the lack of specific radiological findings and clinical presentation. Surgery represents the appropriate treatment of abdominal wall hernias and complicated MD.
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http://dx.doi.org/10.1016/j.ijscr.2021.106126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250448PMC
July 2021

Intestinal obstruction and ischemia by necrotic annular Meckel's diverticulum: Case report and review of the literature.

Int J Surg Case Rep 2021 May 20;82:105897. Epub 2021 Apr 20.

General Surgery Department, San Salvatore Hospital, Paternò, Catania, Italy.

Introduction And Importance: Meckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Diagnosis of MD is a challenge because of its rarity and frequent asymptomaticity. Radiological exams generally aren't useful for its diagnosis. Intestinal obstruction represents the most common complication of MD in adults. Surgery is the appropriate treatment of complicated MD.

Case Presentation: A 70-year-old Caucasian male was admitted to the Emergency Department with a two-day history of abdominal pain associated with inability to pass gas or stool, nausea and vomiting. Physical examination revealed abdominal distention and abdominal pain without Blumberg's sign. Abdominal contrast-enhanced computed tomography (CECT) showed small bowel obstruction caused by suspected MD. Laboratory tests reported high serum levels of glycemia, LDH, C-reactive protein and leukocytosis. After diagnosis of intestinal obstruction, the patient underwent exploratory laparotomy: a segmental resection of ischemic distal ileum bearing a necrotic MD was performed. The postoperative course of patient was uneventful.

Clinical Discussion: MD is found in 2%-4% of the population in large autopsy and surgical series. MD is mostly asymptomatic and incidentally discovered if not complicated; a debate exist about management of asymptomatic MD. Surgery represents the definitive treatment of complicated MD.

Conclusion: MD is a true diverticulum rarely discovered in adults. Diagnosis of MD is difficult even with the help of radiological exams. Although surgical resection represents the correct treatment of symptomatic MD, nowadays there is no consensus on the optimal treatment of asymptomatic and incidentally discovered MD.
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http://dx.doi.org/10.1016/j.ijscr.2021.105897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099489PMC
May 2021

Idiopathic giant pancreatic pseudocyst presenting in emergency with abdominal compartment syndrome and intestinal occlusion: Case report and review of the literature.

Int J Surg Case Rep 2021 Apr 26;81:105812. Epub 2021 Mar 26.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy.

Introduction And Importance: This is the first case of idiopathic giant pancreatic pseudocyst (IGPP) causing intestinal occlusion, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) reported in the literature. Diagnosis of IGPP in emergency is a challenge because of its rarity and the absence of a history of pancreatitis or pancreatic trauma and specific clinical presentation. Abdominal contrast-enhanced computed tomography (CECT) represents the gold standard in diagnosing of pancreatic cyst (PP). Different types of treatment of PP are reported in the literature.

Case Presentation: A 52-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain, inability to pass gas or stool, nausea and vomiting, oliguria and a seven-day history of abdominal swelling and swollen legs. Physical examination revealed abdominal distention, abdominal pain, swelling in the legs. CECT showed a voluminous cystic pancreatic mass suspected of neoplasm. Laboratory tests reported high serum levels of BUN, creatinine and C-reactive protein and neutrophilic leukocytosis. After preoperative diagnosis of ACS, the patient was taken to the operating room for pancreatic resection. The postoperative course was uneventful. Diagnosis of IGPP was made by histopathological examination.

Clinical Discussion: IGPP is difficult to diagnose in emergency. Although different types of drainage of IGPP are described in the literature, pancreatic resection represents the treatment of choice when a cystic pancreatic neoplasm cannot be excluded.

Conclusion: IGPP is a rare disease that may cause intestinal occlusion, IAH and ACS. Pancreatic resection if necessary is safe and therapeutic with acceptable morbidity and mortality.
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http://dx.doi.org/10.1016/j.ijscr.2021.105812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049989PMC
April 2021

Two Cases of Spontaneous Isolated Dissection of Superior Mesenteric Artery in One Night: Report of a (Noninvasive) Double Challenge.

Am J Case Rep 2021 Apr 13;22:e929538. Epub 2021 Apr 13.

Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-San Marco", Catania, Italy.

BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare but potentially fatal condition. Although many cases of SID-SMA have been reported in the literature in recent years because of the increased use of contrast-enhanced computed tomography (CT) scanning, optimal management has not yet been firmly established. CASE REPORT We report 2 cases of SID-SMA that were managed with stenting and angioplasty via transfemoral access. In case 1 a 54-year-old man presented with diffuse abdominal pain without Blumberg sign. Laboratory data were unremarkable. Abdominal CT scanning revealed SID-SMA and initial bowel ischemia. The angiogram revealed a dissected true lumen of SMA with a narrowing of the ileo-colic artery managed, respectively, with self-expandable stent placement and angioplasty. In case 2, a 45-year-old man presented with severe abdominal cramping and pain of 3 days' duration. Physical examination revealed abdominal tenderness with positive Blumberg sign. Laboratory tests showed leukocytosis and increased lactate dehydrogenase. Abdominal CT scan revealed SID-SMA and initial bowel ischemia. After an SMA angiogram, 2 self-expandable stents were placed and an angioplasty was performed. Although a postprocedural angiogram showed good patency of the SMA in both patients, the first patient had a recurrence of abdominal pain after 5 days with a new narrowing tract of the SMA and more inferiorly a dissection with aneurysm of a false lumen, detected on CT scan, treated respectively with stenting and coils. CT follow-up showed successful morphological results in both patients. CONCLUSIONS In our experience, endovascular treatment of SID-SMA is safe and effective, including in cases of recurrence and postprocedural evolution.
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http://dx.doi.org/10.12659/AJCR.929538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053640PMC
April 2021

Gangrenous appendicitis in Amyand's hernia: Surgical approach under local anesthesia. Case report and review of the literature.

Int J Surg Case Rep 2021 Feb 16;79:215-218. Epub 2021 Jan 16.

General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy.

Introduction And Importance: Amyand hernia is a rare disease seen in approximatively 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the preoperative period: it is usually an incidental finding.

Case Presentation: We report an unusual case of perforated gangrenous appendicitis with peri-appendicular abscess occurring in an irreducible Amyand's hernia. An 80-year-old male, with chronic obstructive disease and pulmonary emphysema, atrial fibrillation, acute myocardial infarction, underwent urgent surgery, under local anesthesia, for right incarcerated inguinoscrotal hernia. He was found to have a perforated gangrenous appendicitis with peri-appendicular abscess within a right indirect inguinal hernia sac. Appendicectomy and Bassini's hernia repair were performed under local anesthesia without any complications.

Clinical Discussion: The treatment of Amyand's hernia is not standardized. The current generally accepted algorithm for Amyand's hernia is essentially contingent on the appendix's condition within the hernia sac.

Conclusion: Appendectomy and primary herniorrhaphy, under local anesthesia, for type 3 of Amyand's hernia, is a safe procedure and easy to perform and, if confirmed by further study, could be part of every surgeon's knowledge.
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http://dx.doi.org/10.1016/j.ijscr.2021.01.048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820297PMC
February 2021

Non-traumatic rupture of voluminous non-typhoid Salmonella splenic abscess presenting with peritonitis: Case report and review of the literature.

Int J Surg Case Rep 2021 Feb 15;79:160-163. Epub 2021 Jan 15.

General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy.

Introduction And Importance: Splenic abscess (SA) is an uncommon, life-threatening disease with about 600 reported cases in the literature. It is caused by various infective pathogens and generally occurs in immunocompromised patients. SA is a rare complication of non-typhoid Salmonella (NTS) infection. Diagnosis of ruptured SA is a challenge because the absence of specific symptoms and signs. Abdominal computed tomography (CT) scan represents the gold standard in diagnosing of SA. Splenectomy is the treatment of choice of ruptured SA with peritonitis.

Case Presentation: A 26-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain and fever. Physical examination revealed severe and generalized abdominal pain on superficial and deep palpation with obvious muscle guarding and rebound tenderness. Abdominal CT scan showed ruptured SA. Laboratory tests reported anemia (hemoglobin 10.4 g/dl). The patient was taken emergently to the operating room for splenectomy. The postoperative course was uneventful, the patient was discharged on the 7th post-operative day. Diagnosis of NTS SA was made by pus cultures.

Clinical Discussion: SA is a rare complication of NTS infection associated with high morbidity and mortality rates. Although different types of treatment of SA are reported in the literature, splenectomy represents the treatment of choice of ruptured SA.

Conclusion: NTS SA is difficult to diagnose because of its rarity and non-specific clinical presentation, often fatal if left untreated. Although there is no gold standard for treating SA, splenectomy with peritoneal lavage is mandatory in case of ruptured SA with peritonitis.
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http://dx.doi.org/10.1016/j.ijscr.2020.12.081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815976PMC
February 2021

Use of short stems in revision of standard femoral stem: A case report.

World J Orthop 2020 Nov 18;11(11):528-533. Epub 2020 Nov 18.

University of Catania, Department of Surgery, Clinic Orthopaedic, Catania 95124, Italy.

Background: Short stems are usually uncemented prosthetics and are recommended in the treatment of traumatic or degenerative diseases of hip. In revision procedures for elderly patients with serious comorbidity, applying a short stem could reduce peri- and post-operative secondary surgical risks to femoral osteotomy, which are necessary for the removal of parts of the implant or acrylic cement from the medullary canal. There are no cases in the literature that apply a short stem for prosthetic revision by acrylic cement anchorage.

Case Summary: A male patient had a left hip replacement in 1995 due to coxarthrosis. At the age of eighty the patient reported an accidental trauma and walked with pain in the left thigh. The X-ray highlighted the stem breakage in the distal section without fracturing the femoral cortex. The patient had various comorbidities (diabetes, anaemia, heart deficiency, and arrhythmia) presenting a high operation risk (ASA 4). During the revision procedure, the distal apex of the stem could not be removed from the femoral cortex. Because of the poor general health of the patient, the surgeon decided not to perform a Wagner femoral osteotomy to remove the distal section of the stem and decided to implant a short stem to avoid removing the stem section of the previous implant. The patient had his left femur X-rayed 15 d post-trauma.

Conclusion: A field of application of short stem may be the development of a cemented short stem to reduce the complexity of the revision procedure.
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http://dx.doi.org/10.5312/wjo.v11.i11.528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672800PMC
November 2020

Hemorrhagic shock from post-traumatic rupture of microcystic splenic lymphangioma: A case report and review of the literature.

Int J Surg Case Rep 2020 10;75:376-379. Epub 2020 Sep 10.

Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.

Introduction: Lymphangioma is an abnormal proliferation of lymphatic vessels. Isolated splenic lymphangioma (SL) is rare; in the last 30 years only 22 cases were reported in the literature. Diagnosis is difficult by the absence of typical symptoms and signs. SL is often asymptomatic and occasionally detected through radiological exams or, after the onset of a life-threatening complication, at surgery or pathological examination. Surgery represents the treatment of choice.

Presentation Of Case: A 22-year-old Caucasian male was admitted to the Emergency Department after a car accident, complaining of sudden onset, severe, left upper quadrant abdominal pain. Abdominal examination revealed mild abdominal distention and a severe abdominal pain on superficial and deep palpation of left upper abdominal quadrant with obvious muscle guarding and rebound tenderness. Abdominal computed tomography scan showed splenic rupture with hemoperitoneum. Laboratory tests reported severe anemia. The patient received blood transfusions and was taken emergently to the operating room for exploratory laparotomy, evacuation of hemoperitoneum and splenectomy. The postoperative course was uneventful, the patient was discharged on the 7th post-operative day. Diagnosis of microcystic SL was made at pathological examination.

Discussion: Post-traumatic splenic rupture may be favored by the presence of a unknown and asymptomatic isolated SL. Although different types of treatment of SL are reported in the literature, splenectomy represents the treatment of choice to avoid complications.

Conclusion: Isolated SL is difficult to diagnose and suspect because of lack of pathognomonic symptoms and specific diagnostic signs. It can be diagnosed after the onset of a life-threatening complication. Splenectomy is the preferable definitive treatment.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522038PMC
September 2020

Giant parathyroid adenoma: a rare cause of primary hyperparathyroidism mimicking a carcinoma.

Endokrynol Pol 2020 29;71(4):359-360. Epub 2020 Jun 29.

Surgical Oncology, Garibaldi-Nesima Hospital, Catania, Italy.

Not required for Clinical Vignette.
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http://dx.doi.org/10.5603/EP.a2020.0035DOI Listing
May 2021

Acute intrathoracic gastric volvulus with retrograde gastric intussusception: A case report of a rare surgical emergency with review of the literature.

Int J Surg Case Rep 2020 12;72:381-385. Epub 2020 Jun 12.

General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy.

Introduction: The gastric volvulus is a rare condition in which the stomach, or part of it, rotates on its axis, for over 180°, constituting a surgical emergency. Even more rare is gastro-gastric intussusception. A delay in their diagnosis and treatment can have fatal consequences PRESENTATION OF CASE: An 82-year-old woman was admitted to the Surgery Unit with a two-day history of abdominal pain associated at first with coffee vomiting and, subsequently, with unproductive retching and oligoanuria. Physical examination showed severe dehydration, fever, at the abdominal level, palpation caused a marked tenderness of all quadrants, with signs of peritonism. Laboratory test showed showed neutrophilic hyperleukocytosis and high C reactive protein level. Abdominal computed tomography revealed an acute intrathoracic gastric volvulus and a gastrogastric intussuception. The patient was submitted to exploratory laparotomy, subtotal gastrectomy with Roux en Y anastomosis and simple plastic of the esophageal hiatus. At the end of the surgery, however, the patient died of your septic shock.

Discussion: The traditional treatment for a patient with acute gastric volvulus is an immediate surgical intervention to derotate the stomach and prevent vascular insufficiency. In the presence of necrosis or gastric perforation, resection should be performed. The few cases of gastrogastric intussusception described in the literature have been treated with sub-total gastrectomy and gastro-jejunal anastomosis. Any delay in diagnosis and treatment can prove fatal.

Conclusion: Intrathoracic Gastric Volvulus and, even more, retrograde gastrointestinal intussusception are very rare pathologies, difficult to diagnose.
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http://dx.doi.org/10.1016/j.ijscr.2020.06.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306532PMC
June 2020

Bouveret's syndrome as a rare complication of cholelithiasis: Disputes in current management and report of two cases.

Int J Surg Case Rep 2020 25;71:315-318. Epub 2020 May 25.

General Surgery Department, San Salvatore Hospital, Paternò, Catania, Italy.

Introduction: Bouveret's syndrome is a rare complication of cholelithiasis that determines an unusual type of gallstone ileus, secondary to an acquired fistula between the gallbladder and either the duodenum or stomach with impaction of a large gallbladder stone. Preoperative diagnosis is difficult because of its rarity and the absence of typical symptoms. Adequate treatment consists of endoscopic or surgical removal of obstructive stone.

Presentation Of Cases: Two old females patients were admitted to the Emergency Department with a history of abdominal pain associated with bilious vomiting. Physical examination revealed abdominal distension with tympanic percussion of the upper quadrants, abdominal pain on deep palpation of all quadrants and in the first patient positive Murphy's sign. Preoperative diagnosis of gallstone impacted in the duodenum was obtained by abdominal computed tomography (CT) scan in the first patient and by esophagogastroduodenoscopy in the second one. Both patients underwent surgery with extraction of the gallstone from the stomach. Postoperative course of two patients was uneventful and they were discharged home.

Discussion: Bouveret's syndrome usually presents with signs and symptoms of gastric outlet obstruction. Preoperative radiological investigations not always are useful for its diagnosis. Appropriate treatment, endoscopic or surgical, is debated and must be tailored to each patient considering medical condition, age and comorbidities.

Conclusion: Bouveret's syndrome is a very rare complication of cholelithiasis, difficult to diagnose and suspect, because of lack of pathognomonic symptoms. Nowaday there are no guidelines for the correct management of this pathology. Endoscopic or surgical removal of obstructive stone represents the correct treatment.
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http://dx.doi.org/10.1016/j.ijscr.2020.05.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264957PMC
May 2020

Tubulo-villous adenoma of the appendix: A case report and review of the literature.

Int J Surg Case Rep 2019 16;61:60-63. Epub 2019 Jul 16.

General Surgery Department, San Salvatore Hospital, Paternò, Catania, Italy.

Introduction: Tubulo-villous adenoma is a rare benign appendiceal neoplasm often asymptomatic with the most clinical manifestation that resembles acute appendicitis. Pre-operative diagnosis is difficult by its rarity and the absence of typical symptoms. Adequate treatment is surgical resection.

Presentation Of Case: A 69-year-old male was admitted to the Emergency Department with a two-day history of abdominal pain associated with constipation. Abdominal examination revealed abdominal pain localized, at deep palpation, in the right iliac fossa and in hypogastrium without obvious muscle guarding or rebound tenderness. Laboratory tests showed a normal white blood cell count with 82.3% neutrophils and high C-reactive protein level. After a negative abdominal ecography, the patient was evaluated by abdominal computed tomography, which revealed acute appendicitis. The patient was submitted to surgery and open appendectomy was performed. The post-operative course was uneventful and the patient was discharged on the 5 post-operative day.

Discussion: Acute appendicitis may be a clinical manifestation of a benign appendiceal neoplasm. Pre-operative radiological investigations not always are useful for an early diagnosis that is mandatory because of the potential risk of malignant degeneration. Appropriate treatment of acute appendicitis is debated: some surgeons suggest operative treatment, but others advocate for non-operative management. In our case the patient was submitted to surgery avoiding the risk of diagnostic delay of neoplasm.

Conclusion: Appendiceal tubulo-villous adenoma is a rare neoplasm difficult to diagnose and suspect because of lack of pathognomonic symptoms and specific diagnostic signs. Acute appendicitis is the most common clinical presentation. Appendectomy is the appropriate treatment.
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http://dx.doi.org/10.1016/j.ijscr.2019.06.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658925PMC
July 2019

Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin.

Int J Mol Sci 2019 Mar 5;20(5). Epub 2019 Mar 5.

Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via Plebiscito 628, 95124 Catania, Italy.

Wound healing implicates several biological and molecular events, such as coagulation, inflammation, migration-proliferation, and remodeling. Here, we provide an overview of the effects of malnutrition and specific nutrients on this process, focusing on the beneficial effects of curcumin. We have summarized that protein loss may negatively affect the whole immune process, while adequate intake of carbohydrates is necessary for fibroblast migration during the proliferative phase. Beyond micronutrients, arginine and glutamine, vitamin A, B, C, and D, zinc, and iron are essential for inflammatory process and synthesis of collagen. Notably, anti-inflammatory and antioxidant properties of curcumin might reduce the expression of () and () and restore the imbalance between reactive oxygen species (ROS) production and antioxidant activity. Since curcumin induces apoptosis of inflammatory cells during the early phase of wound healing, it could also accelerate the healing process by shortening the inflammatory phase. Moreover, curcumin might facilitate collagen synthesis, fibroblasts migration, and differentiation. Although curcumin could be considered as a wound healing agent, especially if topically administered, further research in wound patients is recommended to achieve appropriate nutritional approaches for wound management.
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http://dx.doi.org/10.3390/ijms20051119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429075PMC
March 2019

Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up.

World J Orthop 2017 Jul 18;8(7):553-560. Epub 2017 Jul 18.

Francesco Roberto Evola, Luciano Costarella, Giuseppe Evola, Giuseppe Sessa, Department of Surgery, Orthopaedic Clinic, University of Catania, 95100 Catania, Italy.

Aim: To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.

Methods: Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An database was created and statistical analyses were performed with SPSS software (IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's test for independent and paired samples. A value of < 0.05 was considered statistically significant and cumulative survival was calculated by the Kaplan-Meier method.

Results: The mean follow-up was 87.6 ± 25.6 mo (range 3-120 mo). 25 cases (43.1%) were classified as minor defects, and 33 cases (56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1 (range: 29-53) before revision, to a mean of 85.8 ± 6.1 (range: 70-94) at the end of the follow-up (Student's test for paired samples: < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect (Student's test for independent samples: > 0.05). Radiolucent lines were found in 4 implants (6.9%). Postoperative acetabular gaps were observed in 5 hips (8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95% (for all reasons) and 100% for aseptic loosening of the acetabular component.

Conclusion: The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.
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http://dx.doi.org/10.5312/wjo.v8.i7.553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534404PMC
July 2017

Transumbilical single-access laparoscopic perforated gastric ulcer repair.

Surg Innov 2012 Jun 23;19(2):130-3. Epub 2011 Oct 23.

Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.

Introduction: In patients presenting with peritonitis, laparoscopy offers the possibility of diagnosis as well as treatment, with less abdominal trauma, reduced postoperative pain, and shorter hospital stay.

Case Report: A 30-year-old woman, presenting with diffuse abdominal pain and free pneumoperitoneum, was submitted to transumbilical single-access laparoscopy. The procedure was performed using a standard 11-mm reusable trocar in the umbilicus and curved reusable instruments inserted transumbilically without trocars. The cavity exploration showed a perforated gastric ulcer at the anterior surface of the prepyloric area. A gastric suture repair, omentoplasty, and lavage of the cavity were performed.

Results: The umbilical incision was 15 mm and laparoscopy lasted 86 minutes. Use of painkillers was minimal, and the patient was discharged on the fifth postoperative day. After 6 months, the umbilical scar was no visible.

Conclusions: Transumbilical single-access laparoscopy can be proposed in selected patients presenting perforated gastric ulcer, with the main advantage of improved cosmetic results.
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http://dx.doi.org/10.1177/1553350611423931DOI Listing
June 2012
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