HighlightsNew treatment options for challenging procedures in hernia surgery are necessary.Possibility of improving prosthetic compatibility and reducing future recurrences.Tissue engineering offers new strategies to improve fascial healing.Case of a surgeon – challenging abdominal incisional hernia.Treatment provided was PRP and BM-MSCs on a biological mesh.

Even if acute abdomen is associated with gastrointestinal (GI) perforation in more than 90% of cases, spontaneously perforated pyometra is a rare and misleading cause that gynecologists and general surgeons should suspect in elderly postmenopausal women. We report one case of diffuse peritonitis caused by spontaneous uterine perforation. A 94-year-old postmenopausal female was admitted to emergency department with signs of diffuse peritonitis and seven days history of abdominal pain. Abdominal contrast-enhanced CT-scan showed a large amount of ascites and a small amount of intraperitoneal free-air. One hour after the admission septic shock developed and emergency laparotomy was performed for suspected GI perforation. During laparotomy about 1500 mL of purulent, malodorous but not-fecaloid fluid was found in peritoneal cavity, without evidence of GI perforation. A 10 mm perforation on the anterior part of the uterine fundus was found. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Patients died on postoperative day four despite intensive care for multi-organ failure due to septic shock. The hysto-pathology examination showed absence of cancer. Pyometra perforation is a rare cause of acute abdomen with a not negligible mortality and it should be considered in the differential diagnosis of acute abdomen, especially in elderly patients. The aim of the study is to report our personal experience and a review of the literature of spontaneous perforation of pyometra in patients with no evidence of malignancy.

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The prognosis in patients with advanced gastric cancer with carcinosis remains poor with a median survival of less than one year. High rates of peritoneal recurrence of patients undergoing resection with potentially curative intent are strictly related with lymphatic spread and penetration of the serosa. To increase survival rates, during the last thirty years different strategies about screening and treatment have been tested and proposed. Early detection of occult peritoneal micrometastasis is a base step to reduce local and serosa recurrences and to offer a tailored surgical and neoadjuvant therapeutic treatment. The complete cytoreductive surgery, however, remains the cornerstone of treatment. It could be associated with different combinations of chemotherapy regimens. Adjuvant, neoadjuvant and intraperitoneal chemotherapy have been demonstrated effective in improving the survival. In the last years, a few new molecules have been introduced which enhance the effect of chemotherapy by biologically targeting its objective. Lastly the prevention of macroscopic peritoneal carcinosis in all those patients at high risk due to serosal infiltration by treating them with intraperitoneal chemotherapy has been demonstrated to be one of the future winning approaches. In patients with peritoneal carcionosis, multimodal comprehensive treatment should be mandatory, with a pivotal role of intraperitoneal chemotherapy associate to CC0 cytoreduction. Neoadjuvant chemotherapy followed by cytoreductive surgery and intraperitoneal chemotherapy gave promising results. The new molecules as monoclonal antibodies seem to improve outcomes.