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The solitary rectal ulcer (SRU) is a benign lesion of adults of either sex, which presents with chronic constipation, peculiar defecatory disorders, rectal prolapse and smaller psychological abnormalities. The characteristic appearance of this disease is a "neither being always ulcerate, nor always solitary" lesion, but often with polypoid or granular feature, typically localized in anterior rectal wall, a few inches from anal channel. Distinctive histopathological specimens are localized mucosal distortion, hypertrophic proliferation of muscularis mucosae and obliteration of lamina propria by fibroblasts and muscle fibres from the muscularis mucosae. Very few intermittent or recurrent symptoms are rectal bleeding and mucous discharge with defecations, difficulty of a complete ampullar evacuation and sometimes pelvic or rectoperineal pain. Clinical picture and endoscopic biopsies led to diagnosis. Barium enema, defecography, transrectal ultrasound, manometry and electromyography have an additional role. Medical treatment is performed by high-fiber diet, but biofeedback training is very helpful. Surgical management is as an excisional surgery, as a rectopexy if there is prolapse. Fecal diversion and rectocolic resection are considered only for patients with obstinate and severe symptoms. Even in patients who seem to advocate a surgical approach it is important to heal a dyskinetic puborectalis muscle.

The report presents a rare case of intestinal duplication in a 43-year old female. Intestinal duplication is a rare congenital malformation and is extremely exceptional in adults. A lot of etiopathogenic theories have been advanced to explain this malformation that can occur anywhere along the alimentary tract, even if the ileum remains the most common. It may be cystic or tubular. An important aspect of mucosal histology is the possibility of gastric heterotopy, conditioning a particular treatment. The literature shows 14 cases with clinical very different presentations and instrumental exams were rarely helpful for correct diagnosis. Treatment of choice is surgical complete resection of the duplication. When contiguous structures are involved intestinal bypass or Roux-on-Y anastomosis may be necessary with mandatory stripping of the mucosa when heterotopic gastric mucosa is present in order to prevent the risk of gastrointestinal haemorrhage or malignant transformation, an event possible in about 25% of the cases reported in the literature.

Once considered rare, Mallory-Weiss syndrome is today more frequently reported due to the introduction of endoscopy which reveals this syndrome in up to 15% of hemorrhages of the upper digestive tract. The etiopathogenesis is not limited to the three factors reported by Mallory and Weiss in 1929: vomit, alcohol and hematemesis. An important role is also played by ASA and the like. This syndrome is also frequently associated with hiatus hernia in which it appears to be a complication since the lesion seems to be caused by the difference between intragastric (above all in the pocket of the hiatus hernia) and intrathoracic transmural pressure. Every increase in the pressure gradient at this level appears to cause fissuration at the cardioesophageal junction. Even endoscopy using rigid instruments and unsufflation may provoke the onset. Anamnesis and an objective examination, common to other pathologies, are not of great value to diagnosis. Radiology also contributes little, unless an arteriography is performed within the context of a highly selective angiography. Endoscopy is the prime method of diagnosis and, in addition to revealing the site and extent of hemorrhage, may be used to achieve hemostasis. Preendoscopic hemostasis currently uses a wide range of methods ranging from sclerotherapy to the injection of drugs or chemical substances, such as ethanol, adrenalin and thrombin; monopolar and bipolar electrocoagulation, thermal probe, hemoclips and Nd:YAG laser are also used. According to the majority of authors, the course of the syndrome is benign unless there are complications such as mediastinitis, pneumonia ab ingestis or hepatic insufficiency. The degree of bleeding is also decisive and the number of blood units transfused is of particular importance in determining the prognosis. The authors report a 10-year survival rate of approximately 70%.

Lipoma is a benign tumour of mesenchymal origin which is not frequently localized in the gastroenteric tract; in anatomopathological statistics it is less rare: this is due to the fact that it rarely reaches dimensions which warrant surgical treatment. It is usually either an occasional finding during the course of laparotomy due to other motives or is the cause of complications, as in the present case of intestinal occlusion due to ileocolic invagination, resulting in emergency surgery. As a cause of occlusion tumours of the small bowel are second in terms of incidence to adhesive factors, volvuli and hernias. Invaginations account for 2/3 of small bowel occlusions caused by up to 80% of tumours: the lipoma is the most frequent benign tumour to cause invagination in its submucous polypoid and more or less scissile form. Symptoms are not specific and this causes a delay in diagnosis. Patients are often young subjects with a history of recurrent abdominal colic and sensitivity to anti-spastic drugs so much so that in the past they were diagnosed as "chronic colic" sufferers. Sometimes the only symptom is dyspepsia, or nausea and vomiting, or occasionally abdominal distension with constipation or attacks of diarrhoea. Radiology is not of great value in the diagnosis except for indicating the possible need for emergency surgery. There are no radiological tests, with or without contrast mediums, echography, CAT or MNR which can diagnose this pathology. The decision to operate is usually triggered by the presence of a complication, but perioperative extemporary histological tests are advisable for a correct surgical approach: if the form is scissile, segmentary resection of the small bowel is necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

The paper reports a case of splenic rupture during the course of chronic pancreatitis, an event rarely reported in the literature. The anatomical arrangement of organs and peripancreatic vessels is a predisposing factor for this complication. There are essentially three different but correlated pathogenetic hypotheses. The first refers to thrombosis of the splenic vein with portal hypertension documented by some researchers even in angiographical terms: during the course of chronic pancreatitis the spleen is sometimes palpable. Thrombosis and/or vascular compression make the spleen more fragile and its rupture more likely: this is particularly true during the course of calcific chronic pancreatitis and cases involving the tail. An enzymatic factor may also be responsible and this appears more clearly in pancreatitis with pseudocysts. In this case it is the direct action of pancreatic enzymes on the ileum or splenic parenchyma, which may also affect all organs surrounding the pancreas, which leads to hemorrhage or hematoma. Sometimes the cause of bleeding is a pseudoaneurysm of the splenic artery which is eroded by the contents of the pseudocysts themselves. There is also a mechanical hypothesis which some authors consider the sole possibility: in chronic pancreatitis the splenic compartment presents severe perisplenitis which fixes the spleen making it more vulnerable and even a mini-trauma will cause rupture. The patient is almost always an emaciated young alcoholic suffering from chronic pancreatic pathology.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this procedure is to obtain a permanent prosthesis (after mastectomy and the insertion of a tissue expander) that is similar to the contralateral breast in volume, morphology and inframammary border. The technique involves aspiration of the tissue expander fluid until the desired volume is obtained and the measurement of the fluid which indicates the volume of the prosthesis to be inserted. Given the satisfactory results obtained, the intention is to continue adopting this procedure.