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Splenic artery aneurysm (SAA) is the most common aneurysm of visceral vessels. Usually the rupture occurs into the free peritoneal cavity and causes massive bleeding, much less frequently the rupture happens into the lumen of the gastrointestinal tract. We describe the case of a 39-year-old male patient with a spontaneous rupture of a splenic artery aneurysm and an acute massive peritoneal bleeding. The case described confirms the rupture of SAA is always a dramatic event and an emergency laparotomy is a life-saving procedure.

WDLPS are very rare retroperioneal tumors that can reach huge size before becoming symptomatic. The aim of this article is show the diagnostic management and the surgical approach to giant WDLPS. A standard treatment has yet to be established because the pre-operative diagnosis is very difficult. We present a case of a 69-year-old male patient with progressive increase of abdominal girth, weight loss and light abdominal pain and with an abdominal mass of over 15 kg that displaced the right kidney. A complete tumor resection and right nephrectomy were performed. Histology revealed a well-differentieated liposarcoma. CT scan is the most common imaging technique and laparotomic open radical resection represent the most common surgical approach.

We performed a subtotal cystectomy on the second and third hepatic segments, with the aid of a radiofrequency dissector device (Ligasure), together with removal of daughter cysts from the peritoneal cavity and irrigation of the peri- toneum with iodine solution. The postoperative course was uneventful and complication-free. A three-year follow-up was carried out without any recurrence. Our review of the recent literature showed that an adequate surgical procedure, proper cleaning of the peritoneal cavity and postoperative medical treatment with albendazole are the most important factors for reducing the incidence of recurrence.

We report what to the best of our knowledge is the first case of primary angiosarcoma of the adrenal gland. A 49-year-old woman, with blunt abdominal trauma, was admitted to our department. Computed tomography revealed a suspected rupture of a liver neoplasm and surgical treatment was performed. At laparotomy there was no evidence of liver tumour but a large mass was found in the right adrenal gland. The mass was removed along with the entire periadrenal fat tissue and locoregional lymph nodes. Microscopically, we found diffuse neoangiogenesis with large, hyperchromatic cells. This cellular proliferation, together with the widespread necrosis, distorted the normal appearance of the adrenal gland. No adjuvant therapy was administered. Six months and 1 year later thoracic- abdominal computed tomography and positron emission tomography were performed, and no signs of local recurrence or metastases were observed.

Polyarteritis nodosa is a form of vasculitis that affects several organs. Gastrointestinal involvement is frequent, but cases in which the gastrointestinal tract is the only site of disease are rare. In this paper we report a case of a 70-year-old patient with polyarteritis nodosa restricted to the large intestine, who underwent a total colectomy. The patient had no other signs of chronic vasculitis and for this reason surgical treatment resolved the clinical symptoms.

Aim of the Study: Report as contribution to the controversy between supporters of total thyroidectomy versus "less than total" thyroidectomy., Materials and Methods: 42 patient operated on over six years; 35 treated with total thyroidectomy, 7 with lobohystmectomy., Results: In the patients who underwent total thyroidectomy we observed recurrent nerve lesions in 5.7%, hypoparathyroidism in 14.3% and 1 lymph nodal relapse (it was a cancer stay III); in patients who underwent lobohystmectomy, we observed 1 temporary recurrent nerve palsy (14.2%) and 1 lymph nodal relapse (14.2%)., Discussion: The choice between total thyroidectomy and lobohystermectomy depends upon different goals: reduction in risk of relapse in total thyroidectomy, to minimize complications in lobohystmectomy. In our series the risk of lymph nodal relapse seems to depend more on biological characters of the tumour than surgical tech of lymphadenectomy; however, this occurrence does not change prognosis., Conclusions: In our experience, potential multifocality of the disease, low risk of hyatrogenic lesions and easy postoperatory management make total thyroidectomy the our preferred technique. Informed consensus is mandatory in order to involve the patients to the best choice.

Aim of the Study: Evaluation of total thyroidectomy, subtotal thyroidectomy and lobectomy in the management of multinodular non-toxic goitre., Materials and Methods: 225 patients: 101 total thyroidectomies, 64 sub-total thyroidectomies, 29 lobo-hystmectomies. Hemorrages, recurrent nerve palsies, post-operatory hypocalcemias, clinical and ultrasonographic relapses, undesired effects of ormonal therapy and hypothyroidism after partial resection (considered risk factor for recurrence) have been pointed out., Results: All three procedures showed a low incidence of recurrent nerve palsy; lobectomy didn't show post-operatory hypocalcemia, that appeared respectively in 26.6% and 23% after sub-total and total thyroidectomy. Recurrence's percentage in patients followed-up, was 18.2% after lobectomy and 12.2% after sub-total thyroidectomy, but in that group we observed 46.9% of hypothyroidism (vs. 9.1% after lobectomy) and 8.6% of undesired effects of therapy. Reoperations showed inferior laringeal palsy and post-operatory hypocalcemia significantly more elevated., Discussion: Compared to lobectomy, total thyroidectomy showed higher risk of hypoparathyroidism; compared to subtotal thyroidectomy, it showed on all occasions less incidence of complications. Endocrinological follow-up is easier after total thyroidectomy., Conclusions: According to our results, we deem the indications for lobectomy have to be limited to the patients having solitary nodule, undoubtedly benign, without familiarity or other environmental risk factor of goitre.

We report a case of a spleen infarction caused by the vascular pedicle torsion. A 25 year-old-man, heterozygous for HbS, presented with severe abdominal pain especially in the left upper quadrant in front and in the back, fever other symptoms related to acute abdomen. First we excluded most common disease (occlusive one and hematologic one) through conform investigation, then we suspected a spleen problem. So we did further investigation with ultrasonography which showed splenomegaly and the spleen looked twisted with its hilum in contact with previous abdominal wall, moreover (here were are as of decreased signal intensity characteristic of splenic infarction under the capsule and some blood in the Douglas pouch. The patient underwent splenectomy urgently. During the intervention we saw a splenomegaly like the ultrasonography showed, moreover there were a long twisted vascular pedicle and many areas of infarctions, some of which had ruptured causing emoperitoneum. The surgical intervention was successful and the clinical spectrum was solved. The splenic infarction might be clinically silent or to represent a surgical emergency. In front a case of acute abdomen, after exclusion of most common etiology, we underline the importance to suspect a spleen suffering, especially vascular one, when (here was no history of trauma. Considering this fact, a simple not invasive examination like ultrasonography is able to confirm this kind of hypothesis and to give soon information to make the surgical choose.

Cancer of the small bowel observed at the 1st Surgical Clinic of Palermo University between 1964 and 1985 have been examined. In the light of reported data, the various factors that might explain the low frequency are analysed, stress being laid on the fact that non-pathognomonic clinical features present considerable diagnostic problems for an early diagnosis. The primary role of surgery in the treatment of such cancers is emphasised.