Abstract:
:Blunt colorectal traumas are rare clinical entities with a challenging diagnostic and operative management. We describe the case of a 40-year-old man, victim of an accidental fall from a height of four meters who was subsequently diagnosed to have a blunt rectal trauma. A first CT scan showed fracture of the skull and an extensive subcutaneous haematoma of the lower back associated with a fracture of the left transverse processes of lumbar vertebrae. No other visceral abdominal lesions were recognized and patient was admitted to our department for observational studies. After 48 hours from admission the patient presented a subcutaneous emphysema suspicious for hollow viscus injuries. A digital rectal examination detected a laceration both of the posterior rectal wall and the superior anal margin. The patient was successfully managed with spur colostomy, transanal evacuation of the retroperitoneal haematoma and primary repair of both the sphincteric muscle and the rectal wall. As soon as the patient achieved full recovery we performed a reversal colostomy. Diagnosis and management of rectal blunt trauma is still a matter of debate and no definitive recommendation treatments are available. The surgical treatment should be tailored on patient medical conditions and clinicians should maintain a high index of suspicious because a delay in diagnosis can result in higher morbidity and mortality rate. KEY WORDS:Colorectal blunt injury, Colostomy, Laparoscopy, Trauma. :Riportiamo il caso clinico di un paziente maschio di 40 anni vittima di una trauma da precipitazione condizionante una lesione contusiva del retto. Il paziente è stato sottoposto ad una riparazione primaria dello sfintere e della parete rettale posteriore, associata a confezionamento di una colostomia temporanea per via laparoscopica. Il paziente è stato in seguito sottoposto ad intervento sequenziale di ricanalizzazione dopo che gli accertamenti preoperatori non hanno evidenziato la presenza di sequele funzionali. In ambiente civile l’incidenza globale delle lesioni contusive del colon-retto oscilla tra lo 0,1-0,5%. Nonostante la rarità di questa condizione, le lesioni contusive del retto sono associate ad elevata morbilità e mortalità e la corretta gestione clinica e chirurgica è ancora dibattuta. Le lesioni contusive traumatiche di un viscere cavo possono essere difficili da diagnosticare, soprattutto nei pazienti acuti. Nonostante attualmente non siano disponibili dati solidi sul trauma rettale, in letteratura medica, molti autori concordano sul fatto che la gestione delle lesioni traumatiche del retto dipenda dalla localizzazione anatomica (intraperitoneale vs extraperitoneale), dalla complessità del danno (distruttivo vs non distruttivo) e dalle condizioni del paziente. Nel nostro caso, abbiamo deciso di eseguire una colostomia terminale per diversione fecale, tramite approccio laparoscopico, ed un’evacuazione transanale dell'ematoma retroperitoneale associate a una riparazione primaria del muscolo sfintere e della parete rettale. Il trauma rettale contusivo è un'entità clinica rara con un’impegnativa gestione diagnostica e operativa. I medici dovrebbero mantenere un alto indice di sospetto, perché un ritardo nella diagnosi può portare a maggiore morbilità e mortalità.
journal_name
Ann Ital Chirjournal_title
Annali italiani di chirurgiaauthors
Marini M,Fratus G,D'Amore P,Tagliabue F,Mariani P,Spinelli L,Novellino Lsubject
Has Abstractpub_date
2016-12-20 00:00:00eissn
0003-469Xissn
2239-253Xpii
S2239253X16025445journal_volume
5pub_type
杂志文章,评审abstract:BACKGROUND:CD10 is a metalloprotein that is potentially associated with greater tumour growth. MATERIALS AND METHOD:We have correlated CD10 positive in carcinomatous polyps with tumour size, grade, patient age and sex, postoperative TNM staging and Asler-Coller classification. We have matched these cases with a contro...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2010-03-01 00:00:00
abstract::Gastric hyperplastic polyps are often asymptomatic and are found incidentally at upper endoscopy performed for unrelated reasons. Although they are considered a benign lesion, all symptomatic polyps should be removed for a more reliable histological diagnosis, resolution of symptoms and to prevent potential malignant ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2011-07-01 00:00:00
abstract::A case of isolated mammary metastasis from surgically untreated urothelial vesical carcinoma is discussed. An integrated chemo-radiotherapeutical treatment had been planned, due to bad general condition; after this, an optimal subjective benefit and good objective response (reduction in lesion diameter < 50%, MR) were...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1993-09-01 00:00:00
abstract:OBJECTIVES:Acute hypercalcemia is a serious condition and represents a physician-surgical emergency: the difficulty in setting a precise diagnosis is due to several possibilities that can cause the condition. It is our purpose to critically evaluate the most actual schemes of treatment and the conditions that could fav...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Thyroid cancer has the highest prevalence of all endocrine malignancies. Malignancy can be of thyroid or non-thyroid origin. Sarcomas and primary thyroid lymphomas (PTL) are rare and surgery is treatment of choice in the former but not in latter. OBJECTIVE:To describe thyroid lymphomas histological types of...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2013-09-01 00:00:00
abstract::Carotid restenosis is defined as a new > 50% diameter-reducing lesion present in sites of previous surgery. The clinical aspects of this complication are strongly connected with their anatomopathologic evolution: fibromuscular hyperplasia in early recurrent disease, atherosclerotic degeneration in the later lesions. R...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVE:The authors report their experience about the surgical treatment of a epiphrenic diverticulum (ED) associated with motor disfunctions and gastroesophageal reflux. DESIGN:Report of 1 case; evaluation of effectiveness of the treatment. SETTING:Operative Unit of General and Thoracic Surgery, Department of Surg...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:Primary hyperparathyroidism (pHPT) is often accompanied by underlying thyroid pathology and 1 to 36% of these thyroid pathologies are malignant. How the identification of these lesions affects patient management is unclear. We present a single-center experience with the prevalence of concomitant thyroid cance...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2017-01-01 00:00:00
abstract::Combined modality treatments are indicated for most patients with breast cancer. The definition of a proper treatment schedule and of the timing of each modality is a relevant issue that affects the feasibility and the clinical outcome of the treatment. A review of the literature was done on the timing of radiation th...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVE:Cervical radiation for head and neck cancer has been associated with an increased incidence of carotid arterial stenosis. Modern radiation therapy delivers higher doses with increasing long-term survival. In our study 50 patients with head and neck malignancies treated with radiotherapy are analized with colo...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2014-11-01 00:00:00
abstract:INTRODUCTION:Penetrating injury of the skull and brain is relatively uncommon, representing about 0.4% of head injuries. In this paper the Authors describe a case of patient victim of transorbital stab with brain injury with good recovery and review the literature about cranial stab wound. CASE REPORT:A 23-year-old ma...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2009-11-01 00:00:00
abstract::Carcinoid tumors of the ampulla are an uncommon finding. The authors report an asymptomatic case of ampullary carcinoid in which the diagnosis was obtained only with definitive histology after radical surgery. The differential diagnosis of these tumors is quite difficult, mostly because they are often asymptomatic. Su...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::The authors present their experience on surgical treatment of intestinal fistulas based on personal cases treated from 1981 to 1990. The cases are divided into two groups: the first: the first group of patients was treated only surgically (1981-1984); the second group was treated with surgery and artificial nutrition ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1992-09-01 00:00:00
abstract:INTRODUCTION:Acute gastrointestinal bleeding is rare in Crohn's disease. METHODS:We characterized the clinical features and course of such hemorrhage in patients seen at our institution from 1992 to 2000. RESULTS:Five patients had gastrointestinal bleeding during Crohn's disease. All patients had a known Crohn's dise...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2003-03-01 00:00:00
abstract::Four cases of Palma's operation (veno-venous cross-over bypass) performed from 1986 through 1992 for occlusive venous disease are reported together with an extensive follow-up. After a synthetic review of the literature, the authors conclude that this operation should no more be considered an experimental procedure, e...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1996-07-01 00:00:00
abstract::The authors refer to three cases of congenital dilatation of the biliary system in an adult, an extremely rare pathology in the West, with no specific symptomatology, and therefore often discovered accidentally and unexpectedly The first patient had suffered from unexplained periods of fever since childhood, the secon...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2011-11-01 00:00:00
abstract:AIMS:We aim to test and compare the effects of Flavonoids (Fs) and Centella asiatica (Ca), and the traditional treatment to find out which best deals with healing time, bleeding and pain in the treatment of chronic Anal Fissure (AF). Materials of Study: 98 outpatients were divided randomly into treated (either Fs or Ca...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:To show the possible role of abdominal scintigraphy in the diagnosis of intra-abdominal pathology and its accuracy in detecting ectopic gastric mucosa in pts with intestinal bleeding and/or abdominal pain. METHOD:99m-Tc-pertechnetate scintigraphy was performed on 54 pts with a history of intestinal bleeding ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2000-03-01 00:00:00
abstract::The diagnosis of incidental thyroid carcinoma in patients submitted to thyroidectomy for a benign disease is quite frequent. A retrospective analysis was performed on 240 patients submitted to surgical intervention in order to establish the incidence of the carcinoma. One hundred sixty five patients (68.75%) were affe...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2010-05-01 00:00:00
abstract:AIM:We propose our experience in soft tissue reconstruction in Hemifacial microsomia using a free fascioadiposal flap. MATERIAL OF STUDY:Hemifacial microsomia (HFM) is a congenital disorder characterized by craniofacial malformation of one or both sides of the lower face. A 18-year-old female presented with hemifacial...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2017-01-01 00:00:00
abstract:INTRODUCTION:Coverage of soft tissue defects in the lower leg is often made by use of free flap, also because of the improving of anaesthesiology techniques in the last decades. However, there are disadvantages in the use of free flaps like the need for a remote donor site, increased operative time, use of a major vess...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:The aim of this study is to demonstrate the functional capacity of thyroid autografts after total thyroidectomy in a rat model. MATERIALS AND METHODS:60 rats were divided into 6 groups of 10 rats each. Thyroid gland was cut into 0.5 mm pieces and was inserted intramuscularly into the left rectus abdominis m...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2008-09-01 00:00:00
abstract::Solitary extramedullary plasmacitomas (SEMP) of the liver are very rare. We report the case of an elderly woman with a huge symptomatic SEMP of the liver mimicking hepatocellular carcinoma (HCC). The patient was a 89-year-old woman who presented with severe abdominal pain and a huge solid mass in the right hypochondri...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2016-01-01 00:00:00
abstract:AIM:Many methods have been described for the reconstruction of the lower lip, but each has its own advantages and its disadvantages. The purpose of this study is to evaluate the results obtained with the use of different methods in order to choose the most appropriate method, according to the characteristics of the los...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2012-07-01 00:00:00
abstract::The gastrointestinal autonomic nerve tumors (GAN tumor) are uncommon stromal tumors of the intestinal tract and retroperitoneum. The distinction of GAN tumors from other gastrointestinal stromal tumors is based on electron microscopic findings. However further study of additional cases is needed to fully characterize ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2000-11-01 00:00:00
abstract:AIM:The liver is the most common site of metastases in colorectal cancer but metastases seem to be less common in patients with a chronically liver damage. The aim of our study was to assess the development of metachronous liver metastases in patients affected by HBV or HCV related liver diseases. MATERIAL OF STUDY:We...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2013-05-01 00:00:00
abstract::The acute acalculous cholecystitis (A.A.C.) is a disease with high rates of morbidity and mortality and risk and promoting factors are very important. Pathogenesis has not completely explained, diagnosis is difficult, and there is no agreement on the more effective therapy. The authors present two cases of A.A.C. and ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1997-05-01 00:00:00
abstract::The authors report on a case of a hemophilic male patient, aged 43, HIV positive, HCV positive, who had an episode of intracerebral hemorrhage after a car accident. Intracranial hemorrhage is the most feared complication of hemophilia, especially among HIV positive, who now are considered to be a group at high risk fo...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:The treatment of acute diverticulitis is a matter of debate and has undergone significant changes. Currently the main focus of surgical treatment is a more conservative and less invasive management. AIMS AND METHODS:To focus the role of surgery in the treatment of acute diverticulitis, the Authors have cond...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2019-01-01 00:00:00
abstract::A case of non-functioning parathyroid cyst is reported, in which the preoperative diagnosis was missed. A careful review of the pertinent literature allows to outline the correct approach to this rare pathology as for the diagnosis and the treatment; as well, to enlight the current controversies about the physiopathol...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:1999-07-01 00:00:00