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[Short bowel syndrome].

In the last year at the Department of Surgery of the University of Siena two patients presenting a clinical feature of intestinal infarct have been operated. In these patients a wide intestinal resection has been performed. After this surgical operation, a patient had a residual tract of 40 cm of bowel and the other 50 cm. It was not possible during operation to preserve the Bauin valve in a case; in the other, this valve has been sacrificed during a previous operation for cecal neoplasm. In the postoperative period, patients were transferred temporarily in the intensive care unit, and after some days they returned to the department where total parenteral nutrition with progressive decreasing mixture in calories over time was administered. Enteral nutrition was also started and the quantity of water, calories and azote was slavly increased. In a second time an oral diet was started up to completely weaning from parenteral and then enteral nutrition. At present, these patients are enlisted in quarterly follow-up and are completely stabilized. They are independent from artificial nutrition and they have a good quality of life.

Aged↗

Inguinal canal as an anatomic sanctuary site of relapse in peritoneal carcinomatosis previously treated with intraperitoneal chemotherapy.

Early postoperative intraperitoneal chemotherapy (EPIC) and intraoperative peritoneal hypertermic chemotherapy (IPHC) are used in addition with cytoreductive surgery to treat with curative intent peritoneal carcinomatosis arising from colorectal adenocarcinomas. Three patients with such a disease were treated with perioperative intraperitoneal chemotherapy in addition to cytoreductive surgery and presented isolated local recurrence located in the inguinal canal (round ligament in two and spermatic cord in one). All these patients were treated by local surgical excision. No patient showed evidence of intra-abdominal recurrence at the last follow-up, but one developed pulmonary metastasis. When communicating with the peritoneal cavity, the inguinal canal may act as a sanctuary site for peritoneal carcinomatosis, since it is not totally soaked by the intraperitoneal chemotherapy solution. A local recurrence is thus possible. New clinical presentations such as this one have first to be described in order to improve patient follow-up.

Adenocarcinoma, Mucinous↗