[Gastric bezoars]

Gastric bezoars are concretions sometimes mistaken for cancer, because of their polymorphous symptoms. Previous gastric surgery modifies anatomy and functions of the stomach and favours the bezoar deposition. Digestive endoscopy allows a correct diagnosis and therapy. A wide review of the literature is given.

Delivery through the bladder during cesarean section

A case is reported of simultaneous incision of the anterior and posterior bladder walls during cesarean section. Despite the serious surgical occurrence delivery was accomplished through the bladder, which was repaired successfully.

["Spontaneous" esophageal perforation. A rare emergency for surgical treatment]

Spontaneous esophageal perforation is a rare but not-exceptional occurrence. Its polymorphous symptomatology often prevents the early diagnosis. Surgery is the therapy of choice. The treatment is variable according to early or late diagnosis, severity of the lesion and associated conditions such as mediastinal sepsis, hydropneumothorax and loss of water, electrolytes and proteins. The mortality rate among the untreated patients is highest when compared with the treated ones (90-100% versus 28-65%). A conservative approach is justified only in the case of bad general conditions, contraindicating thoracotomy. A wide review of the surgical managements is given.

[Diagnosis and therapy of gastric carcinoma in the early stage]

The diagnosis of early gastric cancer is often allowed by endoscopy, which favours the surgical therapy with a five years survival rate of 79-99% of treated patients. Four personal cases are presented, whose evolution differed from their particular gastric localization, associated lesions and surgical treatment. A wide review of the literature is given.

[Diagnostic value and therapeutic limits of endoscopic polypectomy of the stomach]

Digestive endoscopy represents the current therapy of the gastric polyps. These lesions are endoscopically found in an unexpected number of patients, because of the frequent failure of radiology by itself. Furthermore endoscopic radical polypectomy is mostly possible for the inflammatory and adenomatous polyps. Otherwise endoscopy favours the early detection of malignant changes and coexisting per-cancerous gastropathy. A wide review of the literature is given.

[Presumed natural history of peritonitis caused by encapsulating membranes. Clinical aspects and therapy]

Incapsulating peritonitis is rare, casually detected by surgery or autopsy. Its pathogenesis and evolution are uncertain. Only 200 cases are reported in the world literature, but its frequency is diminishing probably in relation to the reducing spread of tuberculosis. Capsulating membranes seem to grow from a poorly cellular connective deposition in many layers on the intestinal peritonium, and are preceeded by inflammatory ascites. When mechanical occlusion occurs, surgery is the choice therapy, to remove the obstacle and, if possible, the membranes too. A wide review of the literature is given.

[Physiopathology and therapy of foreign bodies in the upper digestive tract]

Fibroendoscopy is the treatment of choice for foreign oesophageal and gastric bodies. Whereas the presence of objects in the oesophagus demands immediate endoscopic removal, gastric localization does not require any emergency treatment except for cases of perforation or incarceration, as most foreign bodies (80-90%) are eliminated naturally. Only two weeks after ingestion, in the case of failed expulsion, is it necessary to proceed to endoscopic removal so as to prevent decubitus or perforation erosions. Endoscopic extraction is made difficult by the length and weight of the object, on by its smallness and lack of texture, which make it hard to get hold of. In the case of suture stitches, it may be hard to cut them because of the presence of a gastric mucosa reactive granulomatous inflammatory process. Contraindications to endoscopic extraction are the failure of the patient to cooperate, acute oesophagitis (peptic and due to caustics) and perforating in the stomach, due to congenital or acquired malformations, means that surgery is necessary. The elimination of foreign bodies depends on the correlation between shape and size of object and the anatomo-functional components of the digestive ways. With reference to an approximate geometric schematization of transit organs, the physiopathology of foreign bodies may be expressed by means of mathematical formulae whose manifold variables sometimes make the natural elimination of the bodies unpredictable.