Giorgio Vasquez | Università degli Studi di Ferrara (original) (raw)
Papers by Giorgio Vasquez
World Journal of Surgery, 2016
Background In recent years, the emergency management of acute left colonic diverticulitis (ALCD) ... more Background In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. Methods IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. Results Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. Conclusions The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.
Chirurgia, 2018
Foreign body (FB) ingestion, which can be accidental or intentional, is quite common, especially ... more Foreign body (FB) ingestion, which can be accidental or intentional, is quite common, especially in children, elderly and some categories of profession. On the other hand, perforation and abscess formation as complications of FB ingestion are rare. Their presentation is not clinically different from other causes of peritonitis and differential diagnosis is sometimes difficult. The most common cause of FB perforation is due to fish bone ingestion. We present two consecutive cases of complications associated to fish bone ingestion. In the first case, patient had diffused abdominal pain, without laboratory considerable signs of inflammation. Computer tomography (CT) scan evidenced ileal perforation due to a probable FB; in the second case patient presented abdominal pain, leukocytosis and elevated CRP. The CT scan revealed presence of abscess and omental inflammation near ileum. Both patients submitted surgery. In the first case, an enterotomy was done, in the second case omentectomy and abdominal cleaning were performed. Surprisingly, In the second case, the patient claimed for damages in the high suspicion for a medical error occurred in a previous operation. Fortunately, the specimen exam revealed the truth. Complications due to FBs ingestion must be adequately recognized and rapidly treated. Radiological tools, especially ultrasonography and CT scan, can be useful to make diagnosis but sometimes this is reached only at the time of intervention
Background: Acute appendicitis is one of the most common abdominal urgent/emergent conditions wor... more Background: Acute appendicitis is one of the most common abdominal urgent/emergent conditions worldwide and can occur at every age. It can be simple, in many cases treated conservatively, or complicated which require a surgical intervention. Sometimes is present peritonitis or abscesses which can deal to the creation of laparostomy (in order to oversee bowel inflammation). Diagnosis can be difficult because of a great variety of clinical presentations but many Scores (such as Alvarado Score) can help Surgeons to adopt a correct approach. Objectives: This work aims to describe a possible treatment of complicated perforated appendicitis with diffuse peritonitis and multiple abscesses with the use of the Open Abdomen technique. Case Report: We present a case of perforated gangrenous appendicitis occurred in a young man associated to diffuse peritonitis and septic shock. We also discuss contemporary methods in diagnosis and management of the condition. Conclusions: Appendicitis must nev...
Il Giornale di chirurgia
Angiomyolipoma (AML) is a rare mesenchymal tumor composed by blood vessels, adipose tissue and sm... more Angiomyolipoma (AML) is a rare mesenchymal tumor composed by blood vessels, adipose tissue and smooth muscle cells in variable proportions. Although it is most often diagnosed in the kidney, this tumor may originate from any part of the liver. It is often misdiagnosed as hepatocellular carcinoma (HCC) or other benign liver tumor. We describe a case of spontaneous rupture of hepatic angiomyolipoma in a young woman, with evidence of internal hemorrhage and hemoperitoneum. Liver tumor rupture is a rare but real surgical emergency. In our case it has been managed according to the trauma principles of the damage control surgery. At the time of the observation, the patient presented an instable condition, so the decision-making was oriented toward a less invasive first step of liver packing instead of a more aggressive intervention such as one shot hepatic resection. Damage control surgery with deep parenchymal sutures of the liver and pro-coagulant tissue adhesives packing abbreviates su...
Minerva chirurgica
Among the anomalies of internal carotid artery, agenesi and aplasia recur with a low rate: only a... more Among the anomalies of internal carotid artery, agenesi and aplasia recur with a low rate: only about sixty cases are reported in literature. We observed a case of aplasia of the left internal carotid in a 49 year old male suffering from hypertension and showing cerebro-vascular symptoms due to TSA pathology: it was studied with arterial angiography and duplex scanner. The angiografic examination raised a suspicion of left internal carotid thrombosis; on the contrary the duplex scanner revealed a correct diagnosis of carotid aplasia
Hepato-gastroenterology, 1995
Transcatheter arterial chemoembolization (TAE) is often considered a mean of palliation for inope... more Transcatheter arterial chemoembolization (TAE) is often considered a mean of palliation for inoperable liver carcinomas. A few centers use a sequential treatment (TAE followed by surgery). However the role of TAE in bringing to surgery patients with hepatocarcinomas (HCC) considered inoperable at first diagnosis is debated. We report on the case of a 57 y.o. male diagnosed as having HCC, inoperable because of bilateral location and size. The patient was treated with repeated TAEs and the results were monitored with CT scans. After three TAEs, the main tumor mass volume was reduced 2.2 fold and the patient could undergo surgery; the postoperative period was uneventful, with no clinical signs of liver failure. Our experience leads us to suggest that TAE, further to being an option for palliation, can be a valuable tool to lead to surgery otherwise inoperable HCC patients.
Hernia, 2015
Incisional hernia is one of the most common complications after surgery. In the past two decades,... more Incisional hernia is one of the most common complications after surgery. In the past two decades, laparoscopic mesh repair has been proposed as an alternative approach to standard open mesh repair. The aims of this study were: 1) to compare laparoscopic and open incisional hernia repairs with regard to complications, operative time, and hospital length of stay (LOS) and 2) to identify predictive factors of postoperative complications and prolonged hospital LOS. This is a retrospective observational cohort study on 270 consecutive patients operated on between May 2004 and July 2014 at the Departments of Surgery of the S. Anna University Hospital in Ferrara, Italy. Patients were divided in two groups according to the surgical approach, laparoscopic surgery (laparoscopic group) or open surgery (open group). Patients’ characteristics, wall defect (European Hernia Society – EHS classification), adhesions (Zuhlke classification), type of mesh, conversions to open, peri-operative complications (Clavien-Dindo classification), hospital LOS, and follow up data were all collected in a database. The analysis of the data was by intention to treat. The laparoscopic group (N=94) and the open group (N=176) were well balanced regarding baseline characteristics. Both small and single wall defects were prevalent in the open group (W1-W2=72% and N1=86%, respectively), while big and multiple defects were mainly represented in the laparoscopic group (W3-W4=66% and N≥2=52%, respectively) (p<0.001). Median operative time and hospital LOS were both increased in the open vs. laparoscopic group (148 vs. 138 min, p=0.001 and 5 vs. 3 days, p<0.001, respectively) (Tab 1). No difference was found within the two groups in postoperative complications and recurrence (Tab 1). Full-adjusted logistic regression analysis showed that open approach and increasing width of wall defect were not significantly associated to major complications (Clavien Dindo ≥III) (Tab 2). Full adjusted Cox regression analysis showed that increasing age [HR 0.97( 95%CI 0.95-0.99), p=0.02], increasing width of wall defect [HR 0.79 (95%CI 0.61-1.00), p=0.05], and the open surgical approach [HR 0.55 (95%CI 0.34-0.89), p=0.02) were independent factors predictive of prolonged hospital LOS (Tab 3). These data suggest that, in high-volume centers, laparoscopic incisional hernia repair is feasible and safe; compared to the open procedure, it has similar postoperative outcomes, offering the advantage of reduced operating time and hospital LOS . The type of surgical approach and size of wall defect were not associated to a higher risk of major complications. Increasing patients’ age and size of wall defect, and open approach independently predicted prolonged hospital LOS. Further analysis focused on the correlation between the hospital LOS, complications, feasibility, and costs for the Health Care System are warranted in the perspective of a balance between technical innovation and economic sustainability of optimal health care
Pervenuto in Redazione: Aprile 2015. Accettato per la pubblicazione Giugno 2015 Correspondence to... more Pervenuto in Redazione: Aprile 2015. Accettato per la pubblicazione Giugno 2015 Correspondence to: Lucia Morganti, MD, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna di Ferrara, Via Aldo Moro 8, Room 2 34 38 (1C2), 44124 Ferrara (Cona), Italy (e-mail: mrglcu@unife.it) Savino Occhionorelli*, Lucia Morganti*, Dario Andreotti*, Lorenzo Cappellari**, Rocco Stano**, Mattia Portinari*, Giorgio Vasquez**
Annali italiani di chirurgia, Nov 28, 2016
The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal traum... more The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left comm...
Annali italiani di chirurgia, 2015
To identify patients with splenic injuries, who should benefit from a conservative treatment, and... more To identify patients with splenic injuries, who should benefit from a conservative treatment, and to compare inhospital follow-up and hospital length of stay (LOS), in patients treated by non-operative management (NOM) versus immediate-splenectomy (IS). A retrospective cohort study on consecutive patients, with all grade of splenic injuries, admitted between November 2010 and December 2014 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara. Patients were offered NOM or IS. Fifty-four patients were enrolled; 29 (53.7%) underwent IS and 25 (46.3%) were offered NOM. Splenic artery angioembolization was performed in 9 patients (36%) among this latter group. High-grade splenic injuries (IVV) were more represented in IS group (65.5% vs 8%), while low grade (I-II) were more represented in NOM group (64% vs 10.3%). Failure of NOM occurred in 4 patients (16%). Hospital LOS was longer in IS group (p=0.044), while in-hospital and 30-day mortality were not statistic...
Annali italiani di chirurgia, 2016
AIM To describe an acute portomesenteric venous thrombosis, with massive small bowel infarction, ... more AIM To describe an acute portomesenteric venous thrombosis, with massive small bowel infarction, which is managed with small bowel resection, primary anastomosis, and open abdomen management (OAM). CASE REPORT A 76-year-old male patient was admitted to the surgical ward, complaining spread abdominal pain. Contrast Enhanced Computed Tomography (CECT) diagnosed massive bowel ischemia, caused by portomesenteric thrombosis. He had negative coagulation tests for thrombophilia, while he presented concomitant risk factors (cancer, previous venous thrombosis, obesity). Surgery was performed, including open abdomen management, and the patient was discharged one month after surgery. No recurrences of portal thrombosis were found in one-year follow-up. DISCUSSION Mesenteric venous thrombosis (MVT) diagnosis could be difficult to establish and it often presented itself late with peritonitis. Currently, CECT scanning is considered the gold standard for MVT, because it identifies not only filling...
Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful ... more Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful in clinical practice to assess the progression of chronic venous insufficiency. We carried out a study to assess the clinical feasibility of routine, non-invasive determination of saphenous vein wall compliance, and the reliability of such measure in discriminating between early and advanced stages of varicose vein disease.
Chirurgia italiana
The aim of this study is to report the experience of a case of benign multicystic mesothelioma of... more The aim of this study is to report the experience of a case of benign multicystic mesothelioma of the peritoneum presented with acute appendicitis symptomatology. A 28 years old man with right lower and upper abdominal pain was admitted into hospital. Because of the clinical picture, the symptomatology and the leukocytosis a diagnosis of acute appendicitis was made and the patient underwent appendicectomy according to Mc Burney. At laparotomy some cc of purulent fluid were sucked and a cystic mass that contained clear fluid was revealed. In consequence of the incidental diagnosis a following middle laparotomy was made with a careful surgical excision of the mass and of the appendix. Macroscopically the lesion was identified like a neoplastic mass 25 centimeters in diameter, with a multicystic and fibrous-adipose aspect, with cysts 5 centimeters in diameter. The cystic spaces were lined by a layer of eptelial cells which presented positive reaction for cytokeratin and EMA, whereas en...
Annali italiani di chirurgia, 2016
The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal traum... more The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left comm...
Annali italiani di chirurgia, 2015
AIM To identify patients with splenic injuries, who should benefit from a conservative treatment,... more AIM To identify patients with splenic injuries, who should benefit from a conservative treatment, and to compare inhospital follow-up and hospital length of stay (LOS), in patients treated by non-operative management (NOM) versus immediate-splenectomy (IS). MATERIAL OF STUDY A retrospective cohort study on consecutive patients, with all grade of splenic injuries, admitted between November 2010 and December 2014 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara. Patients were offered NOM or IS. RESULTS Fifty-four patients were enrolled; 29 (53.7%) underwent IS and 25 (46.3%) were offered NOM. Splenic artery angioembolization was performed in 9 patients (36%) among this latter group. High-grade splenic injuries (IVV) were more represented in IS group (65.5% vs 8%), while low grade (I-II) were more represented in NOM group (64% vs 10.3%). Failure of NOM occurred in 4 patients (16%). Hospital LOS was longer in IS group (p=0.044), while in-hospital and 30-da...
World Journal of Surgery, 2016
Background In recent years, the emergency management of acute left colonic diverticulitis (ALCD) ... more Background In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. Methods IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. Results Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. Conclusions The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.
Chirurgia, 2018
Foreign body (FB) ingestion, which can be accidental or intentional, is quite common, especially ... more Foreign body (FB) ingestion, which can be accidental or intentional, is quite common, especially in children, elderly and some categories of profession. On the other hand, perforation and abscess formation as complications of FB ingestion are rare. Their presentation is not clinically different from other causes of peritonitis and differential diagnosis is sometimes difficult. The most common cause of FB perforation is due to fish bone ingestion. We present two consecutive cases of complications associated to fish bone ingestion. In the first case, patient had diffused abdominal pain, without laboratory considerable signs of inflammation. Computer tomography (CT) scan evidenced ileal perforation due to a probable FB; in the second case patient presented abdominal pain, leukocytosis and elevated CRP. The CT scan revealed presence of abscess and omental inflammation near ileum. Both patients submitted surgery. In the first case, an enterotomy was done, in the second case omentectomy and abdominal cleaning were performed. Surprisingly, In the second case, the patient claimed for damages in the high suspicion for a medical error occurred in a previous operation. Fortunately, the specimen exam revealed the truth. Complications due to FBs ingestion must be adequately recognized and rapidly treated. Radiological tools, especially ultrasonography and CT scan, can be useful to make diagnosis but sometimes this is reached only at the time of intervention
Background: Acute appendicitis is one of the most common abdominal urgent/emergent conditions wor... more Background: Acute appendicitis is one of the most common abdominal urgent/emergent conditions worldwide and can occur at every age. It can be simple, in many cases treated conservatively, or complicated which require a surgical intervention. Sometimes is present peritonitis or abscesses which can deal to the creation of laparostomy (in order to oversee bowel inflammation). Diagnosis can be difficult because of a great variety of clinical presentations but many Scores (such as Alvarado Score) can help Surgeons to adopt a correct approach. Objectives: This work aims to describe a possible treatment of complicated perforated appendicitis with diffuse peritonitis and multiple abscesses with the use of the Open Abdomen technique. Case Report: We present a case of perforated gangrenous appendicitis occurred in a young man associated to diffuse peritonitis and septic shock. We also discuss contemporary methods in diagnosis and management of the condition. Conclusions: Appendicitis must nev...
Il Giornale di chirurgia
Angiomyolipoma (AML) is a rare mesenchymal tumor composed by blood vessels, adipose tissue and sm... more Angiomyolipoma (AML) is a rare mesenchymal tumor composed by blood vessels, adipose tissue and smooth muscle cells in variable proportions. Although it is most often diagnosed in the kidney, this tumor may originate from any part of the liver. It is often misdiagnosed as hepatocellular carcinoma (HCC) or other benign liver tumor. We describe a case of spontaneous rupture of hepatic angiomyolipoma in a young woman, with evidence of internal hemorrhage and hemoperitoneum. Liver tumor rupture is a rare but real surgical emergency. In our case it has been managed according to the trauma principles of the damage control surgery. At the time of the observation, the patient presented an instable condition, so the decision-making was oriented toward a less invasive first step of liver packing instead of a more aggressive intervention such as one shot hepatic resection. Damage control surgery with deep parenchymal sutures of the liver and pro-coagulant tissue adhesives packing abbreviates su...
Minerva chirurgica
Among the anomalies of internal carotid artery, agenesi and aplasia recur with a low rate: only a... more Among the anomalies of internal carotid artery, agenesi and aplasia recur with a low rate: only about sixty cases are reported in literature. We observed a case of aplasia of the left internal carotid in a 49 year old male suffering from hypertension and showing cerebro-vascular symptoms due to TSA pathology: it was studied with arterial angiography and duplex scanner. The angiografic examination raised a suspicion of left internal carotid thrombosis; on the contrary the duplex scanner revealed a correct diagnosis of carotid aplasia
Hepato-gastroenterology, 1995
Transcatheter arterial chemoembolization (TAE) is often considered a mean of palliation for inope... more Transcatheter arterial chemoembolization (TAE) is often considered a mean of palliation for inoperable liver carcinomas. A few centers use a sequential treatment (TAE followed by surgery). However the role of TAE in bringing to surgery patients with hepatocarcinomas (HCC) considered inoperable at first diagnosis is debated. We report on the case of a 57 y.o. male diagnosed as having HCC, inoperable because of bilateral location and size. The patient was treated with repeated TAEs and the results were monitored with CT scans. After three TAEs, the main tumor mass volume was reduced 2.2 fold and the patient could undergo surgery; the postoperative period was uneventful, with no clinical signs of liver failure. Our experience leads us to suggest that TAE, further to being an option for palliation, can be a valuable tool to lead to surgery otherwise inoperable HCC patients.
Hernia, 2015
Incisional hernia is one of the most common complications after surgery. In the past two decades,... more Incisional hernia is one of the most common complications after surgery. In the past two decades, laparoscopic mesh repair has been proposed as an alternative approach to standard open mesh repair. The aims of this study were: 1) to compare laparoscopic and open incisional hernia repairs with regard to complications, operative time, and hospital length of stay (LOS) and 2) to identify predictive factors of postoperative complications and prolonged hospital LOS. This is a retrospective observational cohort study on 270 consecutive patients operated on between May 2004 and July 2014 at the Departments of Surgery of the S. Anna University Hospital in Ferrara, Italy. Patients were divided in two groups according to the surgical approach, laparoscopic surgery (laparoscopic group) or open surgery (open group). Patients’ characteristics, wall defect (European Hernia Society – EHS classification), adhesions (Zuhlke classification), type of mesh, conversions to open, peri-operative complications (Clavien-Dindo classification), hospital LOS, and follow up data were all collected in a database. The analysis of the data was by intention to treat. The laparoscopic group (N=94) and the open group (N=176) were well balanced regarding baseline characteristics. Both small and single wall defects were prevalent in the open group (W1-W2=72% and N1=86%, respectively), while big and multiple defects were mainly represented in the laparoscopic group (W3-W4=66% and N≥2=52%, respectively) (p<0.001). Median operative time and hospital LOS were both increased in the open vs. laparoscopic group (148 vs. 138 min, p=0.001 and 5 vs. 3 days, p<0.001, respectively) (Tab 1). No difference was found within the two groups in postoperative complications and recurrence (Tab 1). Full-adjusted logistic regression analysis showed that open approach and increasing width of wall defect were not significantly associated to major complications (Clavien Dindo ≥III) (Tab 2). Full adjusted Cox regression analysis showed that increasing age [HR 0.97( 95%CI 0.95-0.99), p=0.02], increasing width of wall defect [HR 0.79 (95%CI 0.61-1.00), p=0.05], and the open surgical approach [HR 0.55 (95%CI 0.34-0.89), p=0.02) were independent factors predictive of prolonged hospital LOS (Tab 3). These data suggest that, in high-volume centers, laparoscopic incisional hernia repair is feasible and safe; compared to the open procedure, it has similar postoperative outcomes, offering the advantage of reduced operating time and hospital LOS . The type of surgical approach and size of wall defect were not associated to a higher risk of major complications. Increasing patients’ age and size of wall defect, and open approach independently predicted prolonged hospital LOS. Further analysis focused on the correlation between the hospital LOS, complications, feasibility, and costs for the Health Care System are warranted in the perspective of a balance between technical innovation and economic sustainability of optimal health care
Pervenuto in Redazione: Aprile 2015. Accettato per la pubblicazione Giugno 2015 Correspondence to... more Pervenuto in Redazione: Aprile 2015. Accettato per la pubblicazione Giugno 2015 Correspondence to: Lucia Morganti, MD, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna di Ferrara, Via Aldo Moro 8, Room 2 34 38 (1C2), 44124 Ferrara (Cona), Italy (e-mail: mrglcu@unife.it) Savino Occhionorelli*, Lucia Morganti*, Dario Andreotti*, Lorenzo Cappellari**, Rocco Stano**, Mattia Portinari*, Giorgio Vasquez**
Annali italiani di chirurgia, Nov 28, 2016
The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal traum... more The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left comm...
Annali italiani di chirurgia, 2015
To identify patients with splenic injuries, who should benefit from a conservative treatment, and... more To identify patients with splenic injuries, who should benefit from a conservative treatment, and to compare inhospital follow-up and hospital length of stay (LOS), in patients treated by non-operative management (NOM) versus immediate-splenectomy (IS). A retrospective cohort study on consecutive patients, with all grade of splenic injuries, admitted between November 2010 and December 2014 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara. Patients were offered NOM or IS. Fifty-four patients were enrolled; 29 (53.7%) underwent IS and 25 (46.3%) were offered NOM. Splenic artery angioembolization was performed in 9 patients (36%) among this latter group. High-grade splenic injuries (IVV) were more represented in IS group (65.5% vs 8%), while low grade (I-II) were more represented in NOM group (64% vs 10.3%). Failure of NOM occurred in 4 patients (16%). Hospital LOS was longer in IS group (p=0.044), while in-hospital and 30-day mortality were not statistic...
Annali italiani di chirurgia, 2016
AIM To describe an acute portomesenteric venous thrombosis, with massive small bowel infarction, ... more AIM To describe an acute portomesenteric venous thrombosis, with massive small bowel infarction, which is managed with small bowel resection, primary anastomosis, and open abdomen management (OAM). CASE REPORT A 76-year-old male patient was admitted to the surgical ward, complaining spread abdominal pain. Contrast Enhanced Computed Tomography (CECT) diagnosed massive bowel ischemia, caused by portomesenteric thrombosis. He had negative coagulation tests for thrombophilia, while he presented concomitant risk factors (cancer, previous venous thrombosis, obesity). Surgery was performed, including open abdomen management, and the patient was discharged one month after surgery. No recurrences of portal thrombosis were found in one-year follow-up. DISCUSSION Mesenteric venous thrombosis (MVT) diagnosis could be difficult to establish and it often presented itself late with peritonitis. Currently, CECT scanning is considered the gold standard for MVT, because it identifies not only filling...
Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful ... more Venous compliance is a physical index of mechanical wall properties (1–5), which could be useful in clinical practice to assess the progression of chronic venous insufficiency. We carried out a study to assess the clinical feasibility of routine, non-invasive determination of saphenous vein wall compliance, and the reliability of such measure in discriminating between early and advanced stages of varicose vein disease.
Chirurgia italiana
The aim of this study is to report the experience of a case of benign multicystic mesothelioma of... more The aim of this study is to report the experience of a case of benign multicystic mesothelioma of the peritoneum presented with acute appendicitis symptomatology. A 28 years old man with right lower and upper abdominal pain was admitted into hospital. Because of the clinical picture, the symptomatology and the leukocytosis a diagnosis of acute appendicitis was made and the patient underwent appendicectomy according to Mc Burney. At laparotomy some cc of purulent fluid were sucked and a cystic mass that contained clear fluid was revealed. In consequence of the incidental diagnosis a following middle laparotomy was made with a careful surgical excision of the mass and of the appendix. Macroscopically the lesion was identified like a neoplastic mass 25 centimeters in diameter, with a multicystic and fibrous-adipose aspect, with cysts 5 centimeters in diameter. The cystic spaces were lined by a layer of eptelial cells which presented positive reaction for cytokeratin and EMA, whereas en...
Annali italiani di chirurgia, 2016
The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal traum... more The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left comm...
Annali italiani di chirurgia, 2015
AIM To identify patients with splenic injuries, who should benefit from a conservative treatment,... more AIM To identify patients with splenic injuries, who should benefit from a conservative treatment, and to compare inhospital follow-up and hospital length of stay (LOS), in patients treated by non-operative management (NOM) versus immediate-splenectomy (IS). MATERIAL OF STUDY A retrospective cohort study on consecutive patients, with all grade of splenic injuries, admitted between November 2010 and December 2014 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara. Patients were offered NOM or IS. RESULTS Fifty-four patients were enrolled; 29 (53.7%) underwent IS and 25 (46.3%) were offered NOM. Splenic artery angioembolization was performed in 9 patients (36%) among this latter group. High-grade splenic injuries (IVV) were more represented in IS group (65.5% vs 8%), while low grade (I-II) were more represented in NOM group (64% vs 10.3%). Failure of NOM occurred in 4 patients (16%). Hospital LOS was longer in IS group (p=0.044), while in-hospital and 30-da...