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Introduction: The standard treatment of colovesical fistula is the removal of fistula, suture of bladder wall, and then colic resection with or without temporary colostomy. The open approach is more commonly used because the laparoscopic approach seems to have high conversion rates and morbidity. We report two cases of colovesical fistula treated with a laparoscopic conservative approach. We also focus on the long term outcome. Case presentation 1. A 69-year-old male with colovesical fistula that appeared after endoscopic polipectomy in the sigmoid diverticulum underwent a totally laparoscopic conservative treatment without colic resection. Operative time was 210 minutes and blood loss was 300 ml. Time to bowel movement was 60 hours. No complications or fistula recurrence occurred at 48-month follow-up. Case presentation 2. A 34-year-old male with colovesical fistula secondary to diverticulitis underwent totally laparoscopic conservative surgery. Operative time was 160 minutes and blood loss was 150 ml. Time to bowel movement was 72 hours. Fistula reoccurred two weeks after discharge. We performed Hartmann’s procedure and defunctioning colostomy with an open approach. No recurrence or complications were found at 36 months follow up. Conclusion: The laparoscopic conservative treatment of colovesical fistula is a safe and feasible technique. When there is no diverticular disease, the conservative approach is very effective. [ABSTRACT FROM AUTHOR]

Aim. A residual mediastinal thyroid ('forgotten goiter') is a well-known, though uncommon, complication of total thyroidectomy. Materials of study. The authors analyze their experience with three cases of goiter forgotten, observed in a series of 2946 thyroid resections in the period 2005-2010. In the study, a preoperative CT of the chest with three-dimensional reconstruction was always performed to examine the topographical relationships of the lesion. Excision was performed through cervicotomy, cervicosternotomic approach and cervicosternotomy, and posterolateral right thoracotomy. Results. There were no complications. Histological examination was suggestive of malignancy in one case (follicular carcinoma with pulmonary metastases). Discussion. The indication for surgery in cases of forgotten goiter is intrinsic to the diagnosis. Preoperative evaluation with accurate topographic imaging is required in all cases in order to understand the nature and location of mediastinal pathological tissue and to identify the most suitable access route. The cervicotomy is the ideal access for low surgical trauma and is easily extendable into a partial or complete sternotomy. A thoracotomy, on the other hand, which is usually reserved for the right side, must be planned preoperatively. [ABSTRACT FROM AUTHOR]

Introduction: Intestinal obstruction by congenital internal hernia is rare and unsuspected. Case report: We report the case of a 45 years-old-man diagnosed to have an intestinal obstruction caused by a double concomitant internal hernia. CT scan can provide a fast diagnosis in order not to delay the surgical intervention: the ileum had been entrapped into a big internal hernia between the transverse and the descending colon and the patient was diagnosed to have a paraduodenal hernia. During the intervention a concomitant mesosigmoid defect was found. Results: Our patient had a left paraduodenal hernia with much of the small bowel crowned into a round peritoneal membrane just in front and left to the duodenum and pancreas and between the transverse and descending colon. CT scan showed encapsulated cluster of small bowel loops in the hernia sac. He was taken up for surgery and an urgent laparoscopic access was performed for definitive diagnosis and treatment 4 days after the beginning of the symptoms. Conclusions: Congenital Internal Hernia should be considered as a cause of bowel obstruction in absence of previous abdominal surgery and, even if preoperative diagnosis of a paraduodenal hernia is difficult, it must be considered as part of differential diagnosis. [ABSTRACT FROM AUTHOR]