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We report a case of a 57-year-old woman admitted for abdominal pain and a not reducible mass in left inguino-abdominal region. With a diagnosis of strangulated inguinal hernia, the patient underwent urgent surgery. The surgical exploration showed a gangrenous intestinal loop with a Meckel's necrotic diverticulum. A small bowel resection (20 cm) was performed. The post-operative course was uneventful. This seems the first case reported in the literature of woman with a Meckel's diverticulum involved in a strangulated left inguinal hernia.

The purpose of this study was to compare magnetic resonance angiography with duplex ultrasound for defining anatomical features relevant to performing lower limb revascularisation. From June 2003 to June 2004, 30 consecutive patients with chronic lower limb ischaemia underwent magnetic resonance angiography and duplex ultrasound investigations before undergoing lower limb revascularisation procedures. The mean age was 72 years (range: 45-93). Indications for the procedure included resting pain (6 cases), ischaemic ulcer (8 cases), and gangrene (16 cases). We compared magnetic resonance angiography and duplex ultrasonography findings and the differences in the aorto-iliac, femoro-popliteal and infrapoliteal segments were noted. Magnetic resonance angiography and duplex ultrasound findings agreed in 13/15 cases (86%) in the aorto-iliac segment, in 14/17 (82%) in the femoro-popliteal segment, and in 8/11 (74%) in the infrapopliteal segment. In all, duplex ultrasound agreed with intraoperative findings in 97% of cases while magnetic resonance angiography agreed in 81%. These data show that magnetic resonance angiography is less accurate than duplex ultrasound in the infrapopliteal segment. Adeguate training is necessary before duplex ultrasound can be used as the only preoperative imaging procedure.

A total of 89 diabetic patients with foot lesions were treated using amputation during the past 5 years at Niguarda-Ca' Grande Hospital. All patients suffered from gangrene which in 76% of cases was classified as Wagner's stage IV. The lesion was infected in 67 patients. Emergency surgical cleansing was performed in order to drain abscesses and remove necrotic tissue, taking care not to damage healthy tissue. An accurate multidisciplinary study was performed in all cases which included neurological, oculistic and vascular assessment. 83% of patients presented retinopathy and 62.5% were nephropathic. Angiographic tests revealed the presence of distal vascular lesions in 90% of cases. A femoro-distal by-pass was used in 17 cases and the limb was salvaged in 13 patients; ileal-femoral PTA was performed in 10 cases and the limb was salvaged in 7 patients. Amputations were limited wherever possible to distal segments: toes (55 cases), transmetatarsal (12 case), leg (12 cases), thigh (5 cases), atypical resections or ample cleansing of the foot (5 cases). This approach allowed us to record: 1) a low operative mortality (1 case); 2) higher quality of life; 3) the possibility of reoperating on more proximal portions of the limb in the event of immediate or long-term failure. This was necessary in 19 cases which can be classified as follows: reamputation of toe (11 cases), transmetatarsal (4 cases), amputation of leg (4 cases).

Fournier's syndrome is a disorder involving perineum and scrotum caused by invasive anorectal infection. Aerobic and anaerobic bacteraemia can lead to septic toxicity. Hence the importance of the multidisciplinary treatment and urgent surgical procedures including drainage and necrotic tissue removal is stressed. A case of Fournier's syndrome is reported.

Clinical follow-up of 71 patients subjected to major amputation of the lower extremities for atherosclerotic arteriopathy has been analysed for the purpose of ascertaining real possibilities of functional recovery and quality of life. Research results show that only a small number of patients (38%) can achieve an acceptable quality of life. The reasons have been identified in the objective difficulty of adequate physical and psychotherapeutic rehabilitation owing to structural shortcomings or the presence of associated pathology or the advance in the basic condition which does not permit application or frustrates results.

Pathophysiological mechanisms of Fournier's gangrene are reported. Variety and progression of clinical manifestations are stressed as well. The importance of an accurate therapeutic protocol in the treatment of this peculiar and serious disease is therefore underlined.

A clinical series of 580 patents (318, F, 199 M) personally observed at the Emergency Surgery and First Aid Division of the Fatebenefratelli and Ophthalmic Hospital Board of Milan between 1975 and 1980, and suffering from acute inflammation of the bile ways (gall bladder empyemas, acute cholecystitis, gangrene of the gall bladder, haemobilia due to gall bladder puncture), has been examined. Of these patients, 558 were subjected to surgery between 12 hours and 6 days after admittance. Operated patients are subdivided into 4 groups on the basis of their anatomo-pathological form and the average time interval between admittance and intervention. Critical examination shows that their behaviour with respect to acute inflammatory forms of the gall bladder can be split up as follows: 1) immediate surgery (within 12 hours) for empyematous and/or punctured forms; 2) emergency surgery (within 2 days of admittance) for cases with certain diagnosis backed up by historical and X-ray data pointing to calculosis of the gall bladder; 3) early surgery (within 3 days) for cases with certain diagnosis but without prior X-ray documentation; 4) deferred surgical intervention (within 6 days) for patients without X-ray documentation and in whom immediate medical treatment leads to a rapid improvement in the clinical picture. The very good clinical results obtained and the observation of a low mortality and morbility index (comparable to those of surgery of choice) suggest that early surgery is certainly the therapy of choice when dealing with acute cholecystitis.

During a two-year period, major operations were performed on 874 males and 649 females at the first-aid section of a major hospital. Acute appendicitis was the most common intraoperative diagnosis (45.63%), followed by intestinal obstruction (21%), gastroduodenal perforation (6.83%), abdominal injury (5.98%), angiosurgical emergency situations (5.19%, including amputation for gangrene), gynaecological emergency situations (3.74%), acute cholecystitis (3.35%), haematemesis (1.44%), acute pancreatitis (1.31%), and various other diseases. Further surgery as a result of complications was required in 2.63%. Mortality (1 year only) was 7.42%. The results achieved and the tactical criteria employed are discussed.

34 cases of acute peripheral ischaemia examined in recent years at the University of Messina General Surgery Clinic are presented. 16 were subjected to embolectomy according to Fogarty. The remaining 18 received protracted medical therapy. Some successes were obtained. In other cases, gangrene necessitated amputation of the affected limb. Satisfactory results were observed in 70% of the operated series. Success was more marked when only a short interval was left between the embolic episode, with progressively poorer results as the penalty for delay. The long-term results of embolectomy are related to the nature of the underlying disease and the treatment given after surgery.

70 peripheral amputations of the lower extremities in arteriosclerotic and diabetic vasculopathics have been examined. In a number of cases, the postoperative period was complicated by dehiscence of the suture on the stump, with lengthening of hospitalization time, risk of infection in the underlying bone and thus further amputation. To solve this problem, dehiscence was treated with dermo-epidermal autografts to cover the missing tissue area. The dehiscence was cleaned with compresses of 2% amuchina associated with topical instillations of Lincomycin hydrochloride. The cure percentage after grafting was about 80%.

A case of inguinogenital gangrene in a 63 years old man is reported. The patient was admitted to the hyperbaric medicine centre in a serious general condition. The use of HOT, antibiotics and selective surgery as treatment of metabolic disturbances effectively improved the patient's general condition, and HOT also proved effective in the treatment of hepatic insufficiency.