[Endoscopic sphincterotomy in acute biliary pancreatitis: the complications]

The authors report on a multicentric trial performed on early endoscopic sphincterotomy in severe pancreatitis. A large figure (7.764) of biliary pancreatitis was collected and 4.285 sphincterotomies were carried out. The results have been highly satisfactory: removal of hypertension and infection in biliary tree, stopped the trend toward necrosis and infection in almost all cases precociously treated. However, answering to the many doubts raised by some colleagues about the danger of this method, the authors examined all the complications that were reported. Hemorrhages and perforations of the biliary tree were the most common one. There were 120 (2.8%) hemorrhages, most frequently treated by medical means; in 20 cases a surgical hemostasis (1 death) had to be performed. Perforations, 24 (0.56%) were treated by medical therapy in 18 cases; 6 patients underwent surgical approach, with no deaths. Other complications (cholangitis, stent ruptures), less frequent, were treated successfully without surgical operations. The authors believe the main cause of this complications to be lack of experience and delay of endoscopic procedure (papillary oedema, fragility). What they suggest, is that endoscopic sphincterotomy has to be performed by an expert endoscopist, and within 48-72 hours from disease onset. Observing also that contrast introduced in the biliary tree could be harmful, they suggest to practice cholangiography at low pressure, and always leaving a nose-biliary drain. Endoscopic sphincterotomy, therefore, if correctly performed, reduces the necessity of surgery in severe pancreatitis. In this way, operations have to be carried out only in those patients with septic complications, with encouraging results and a sharp reduction of mortality.

[Acute colitis with surgical involvement. A retrospective study]

A retrospective study of 34 patients with acute colitis--inflammatory, ischaemic and other--is presented in order to find out which clinical data are important for diagnosis and therapy. Early aetiological diagnosis and right timing of surgery are mandatory to improve the outcome of critically ill patients. Colectomy associated with proximal diversion and followed by secondary reconstruction led to the best results in patients with surgical indications.

[Annular pancreas: new findings?]

Four cases of anular pancreas are described and compared with the latest references in the literature. It is considered that new anatomic and surgical findings arising from recent studies permit early presurgical diagnosis and give better results with rational surgery.