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Gaetano La Greca

Publications and source records attributed to Gaetano La Greca.

9 recordsLinked to original sources
PubMed2006

Acute biliary pancreatitis and cholecystolithiasis in a child: one time treatment with laparoendoscopic "rendez-vous" procedure.

Acute biliary pancreatitis (ABP) is rare in childhood and endoscopic sphincterotomy should be avoided in the child due to the risk of both early and late complications but, when necessary, the optimal timing between endoscopic procedure and cholecystectomy is still uncertain. A nine years old child with acute biliary pancreatitis underwent successful laparo-endoscopic "Rendez-Vous" procedure in which endoscopic drainage of the common bile duct and laparoscopic cholecystectomy were performed simultaneously. This is the first case reported of laparo-endoscopic Rendez-Vous in a child. The excellent outcome of this patient and the review of the literature concerning other available options for the treatment of such cases suggest that this procedure offers great advantages, especially in children, of reducing the required number of treatments, the risk of ineffectiveness, the number of anaesthesia, the length of hospital stay and the risk of iatrogenic morbidity.

Acute Disease↗
PubMed2006

Isolated injury of the superior mesenteric artery caused by a lap belt in a child.

Isolated vascular injuries are rare in cases of blunt abdominal trauma, and superior mesenteric artery injury is extremely rare but potentially lethal. The incidence of this kind of life-threatening injury has increased in recent years. The diagnosis of these isolated injuries is difficult, and its delay is associated with a higher morbidity and mortality. The authors report on the case of a child with an isolated injury of the superior mesenteric artery caused by a lap belt, during a motor-vehicle crash which was successfully managed. Correct use of all types of restraints is to be recommended. The diagnosis of this rare intraabdominal vascular injury is possible especially when the major signs are evident, but an awareness of this rare possibility is essential for the outcome.

Abdomen↗
PubMed2004

Arterialization of the portal stump by right renal artery after portocaval shunt in the rat.

Portosystemic shunts cause severe secondary effects, so that arterializations of the portal stump are planned to increase the blood supply to the liver. The aim of this study was to verify the technical feasibility of arterialization of the portal stump with the right renal artery in order to obtain a valid experimental model to study the pathophysiology of arterial revascularization of the liver. Twenty rats underwent end-to-side portocaval shunt + end-to-end anastomosis between the right renal artery and portal stump; another 20 rats were subjected to the same surgical procedure, but the portal stump underwent a reduction in size. In our study, both techniques gave good results, but the use of an operating microscope and good microsurgical training were essential in achieving a good patency rate (78.3%).

Anastomosis, Surgical↗
PubMed2002

Isolated agenesis of the gallbladder: report of a case.

We report the rare case of an isolated gallbladder with cystic duct agenesis that was misdiagnosed as acute alithiasic cholecystitis. We underline the inaccuracy of currently used diagnostic tests and the importance of making a correct preoperative diagnosis to avoid a needless surgical procedure. Based on the rare and incidental nature of this congenital anomaly, we discourage an extensive routine diagnostic workup, but rather, suggest a careful clinical and diagnostic evaluation of the patient who has symptoms suggestive of biliary tract disease. We conclude that in patients with gallbladder and cystic duct agenesis surgery might be useless and risky when performed by the laparoscopic approach. On the other hand, the awareness of the laparoscopic surgeon of the problems posed by this anomaly and a careful review of currently available diagnostic tests can prevent unnecessary laparotomy and minimize the risk of complications.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Biliary squamous cell carcinoma.

Squamous cell carcinoma of the liver, bile ducts and gallbladder is extremely rare. We report a case of squamous cell carcinoma of the common bile duct manifesting atypically without jaundice, despite its large size and proximal bile duct dilation. A review of the literature concerning all other squamous carcinoma of the biliary tract is presented including 3 other bile duct cancers, 17 intrahepatic and 30 gallbladder cancers. Compared to the more common adenocarcinoma these rare biliary cancers seem to present particular clinical features and prognostic differences which may be important for planning treatment.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Hepatocarcinoma, gallstone disease and gallbladder carcinoma: a case report of a rare incidental association.

We report a rare case of a patient operated on with a diagnosis of hepatic tumour and gallstone disease, which postoperatively was found to be a hepatocellular carcinoma associated with a gallbladder carcinoma. Spiral CT at admission showed only a hepatic mass in the 4th segment, compatible with hepatocellular carcinoma and gallbladder lithiasis. Cholecystectomy was performed followed by a wedge resection of the 4th segment of the liver. The histopathological examination revealed a well-differentiated hepatocellular carcinoma and, surprisingly, an adenocarcinoma of the gallbladder confined to the mucosa. The association of a hepatocellular carcinoma and gallbladder adenocarcinoma is extremely rare. This association, together with an analysis of the literature showing the increased incidence of gallstones in cirrhotic patients and the consequent greater surgical risk when undergoing subsequent cholecystectomy after liver resection, would suggest that cholecystectomy should be performed routinely during liver resection for hepatocellular carcinoma or cirrhosis, even for minor resections and when there are no evident signs of gallbladder disease.

Adenocarcinoma↗
PubMedDate not supplied

[Blunt liver trauma: efficacy of non-operative management].

All haemodynamically stable patients with blunt abdominal trauma can be managed conservatively by non-operative management which is the treatment of choice in 80% of liver trauma. Non-operative management, when feasible, yields very good results in terms of survival, need for blood transfusions, morbidity and reduction of hospital stay. The Authors retrospectively analyse their recent experience with liver trauma. Of 53 patients with blunt liver trauma, 36 underwent surgical treatment whereas 17 haemodynamically stable patients received non-operative management. After CT scans, all patients on non-operative management underwent haemodynamic monitoring, US and blood examinations. A percentage of 47.1 % had a > or = grade III trauma. The mortality and morbidity rates were 0% and no blood transfusions were needed. The efficacy of non-operative management was 100% and none of the patients needed subsequent surgical treatment. Our clinical experience demonstrates that non-operative management is feasible and effective even for higher grade traumas, but always requires strict clinical, haemodynamic and US monitoring and careful patient selection. Current progress in the field and recent evidence reported in the literature indicate the likelihood of further developments and more widespread utilisation of non-operative management in liver trauma.

Adolescent↗
PubMedDate not supplied

[Pancreatic trauma: a case report].

Pancreatic trauma is a rare event, accounting for approximately 3% of all blunt abdominal traumas. The related mortality is quite high, around 5-30%, mostly due to the associated haemorrhagic lesions and to the delay in establishing the diagnosis, while pancreatic damage is directly responsible for death in only 5-10% of cases. We report here on a case of severe pancreatic trauma, underestimated initially and treated surgically at a later stage. The literature shows that the main difficulty in cases of pancreatic trauma is still related to failure recognizing the injury or to the frequent delay in diagnosing the condition, above all in haemodynamically unstable patients. In these cases, as in the one treated in this report, the clinical evidence and the priority accorded to the treatment of the shock are factors that tend to limit thorough examination. In haemodynamically stable patients, on the other hand, the multislice CT-scan and MR pancreatography-wirsungography are useful for the diagnosis. The treatment can be either conservative or surgical, depending on the extent of the damage, especially to the Wirsung duct. Surgical treatment with preservation of the entire pancreatic parenchyma, as performed in our case, even if technically demanding, makes it possible to maintain the function of the pancreas, thus reducing the risk of metabolic complications.

Adult↗