Overall n=208ELECTIVE n=141 EMERGENT n=67Age in years,

Introduction. Pancreatic pseudocysts are a common complication of acute pancreatitis. Pancreatic pseudocyst's natural history ranges between its spontaneous regression and the settlement of serious complications if untreated, such as splenic complications, hemorrhage, infection, biliary complications, portal hypertension, and rupture. The rupture of a pancreatic pseudocyst to the peritoneal cavity is a dangerous complication leading to severe peritonitis and septic conditions. It requires emergent surgical exploration that is often of great technical difficulty and with important morbidity and mortality. Case Study. We present two cases of spontaneous rupture of pancreatic pseudocysts, managed differently according to the local and systemic conditions. Conclusion. The best surgical choice is the internal drainage of the cyst to the GI tract; however, in some conditions, the external drainage is the only choice available.

SummaryBackground Adult intussusception (AI) is a rare condition, usually with a lead point, and for which surgery is the treatment of choice. Given the risks and possible complications of untreated AI, an accurate preoperative diagnosis is of the utmost importance. Although AI remains difficult to diagnose, computerized tomography (CT) is presently considered the best diagnostic tool.Methods Sixteen patients of 20 years and older with intraoperative diagnosis of intussusception, who underwent surgery between January 2000 and December 2009, were reviewed retrospectively. Patients were assessed concerning clinical presentation, imagiological findings, surgical treatment, and postoperative histological evaluation.Results Most patients (93.8 %) were admitted via emergency room (ER) due to abdominal pain. Fourteen (87.5 %) AI cases showed an underlying organic cause, e.g., masses or tumors. The most frequent comorbidities were Peutz-Jeghers syndrome (PJS; 18.8 %) and HIV (12.5 %). Eight (50.0 %) intussusceptions were ileocolic and six (37.5 %) were in the small bowel. Total 43.8 % of lesions were malignant. Preoperative diagnosis of intussusception was possible in 50.0 % of cases by ultrasonography (US) and in 81.8 % by CT. US showed no predictive value concerning intussusception location. Total 27.3 % of CTs correctly identified the location, but only 9 % accurately identified the lead point.Conclusions We propose that all AI cases should be treated with surgical resection without attempting reduction, even when no lead point is detected by imaging studies, and this approach should be based on the oncological criteria. CT can be regarded as the most accurate diagnostic tool for intussusception, although its predictive value concerning location and lead point is still far from ideal.

A systematic and interdisciplinary approach is the key for success in rare challenging emergencies. Infrequent etiologies must always be considered as they need specific therapeutic approaches that defy paradigms.

PurposeSurgical intestinal resection margins in colon cancer are a longstanding debate in terms the optimal distance between the tumor and the colonic section line. The aim of this study is to define the oncological outcomes in relation to surgical margins, measured in terms or recurrence rate, time-to-recurrence, disease-free survival and overall survival in a population of node negative colon cancer patients.MethodsWe conducted a retrospective observational longitudinal single institution study. All patients submitted to colon cancer surgery between January 2006 and December 2010 were analyzed. Only node negative patients were included in the study, with analysis of 215 patient charts, divided in two groups (Intestinal margin lower than 5 cm—group 1; and 5 cm or higher—group 2).ResultsMean age of patients was 70.4 years (±11.7), with a male predominance (57.7%). Group 2 more frequently corresponded to Stage II (83 vs 71%; p = 0.05). Global mean total lymph nodes harvested were 12, and were higher in group II than in group I (13.8 ± 8.2 vs 10.4 ± 5.7; p = 0.001). In terms of time-to-recurrence patients of group 2 had longer time than patients of group 1 (32.3 ± 12.1 vs 21.8 ± 13.8 months; p = 0.03), as well as a lower recurrence rate in group I (13.7 vs 17.2%), despite not statistically significant.ConclusionsThis study has showed that patients with 5 cm or higher bowel resection margins had longer time-to-recurrence that was statistically significant. Recurrence rates were lower in the group of patients with longer surgical margins, however not statistically significant.