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Unlabelled: Intra-abdominal infections are a common cause of nosocomial sepsis and are associated with a severe morbility, mortality and sanitary economy implications, especially for decentrated sanitary structures. Mortality due to diffuse suppurative peritonitis (fom 10 to 20%) nowadays continues to be unacceptably high. Patients outcome is significantly influenced by early adequate surgery and/or peritoneal drainage: moreover, even early and adequate empiric antimicrobial therapy influences patients morbidity and mortality. Multiple empirical regimens have been proposed, but rarely supported by reliable randomized-controlled studies. The authors report 201 cases of patients with fever and meaningful peritoneal involvement occurred since August 1999 up to August 2005: 110 cases were conservatively treated, 91 cases were surgically treated. The paper summarizes IDAB (Infection Disease Advisory Board) guidelines inheriting management of intra-abdominal infections: empiric antimicrobial therapy for the most common causes of abdominal infections is proposed for low-mid level risk patients, focusing on antibiotic treatment duration. High risk patients need to be evaluated paying particular attention to timely surgical infection source control., Conclusion: Despite of the progress in antimicrobial agents and intensive care treatment, peritonitis is still one of the most important infectious problems that a surgeon has to face.

Case Report: It has been demonstrated that paraesophageal hiatal hernia surgical repair can be performed by endoscopic means, but the procedure is not standardized and results have not been evaluated systematically so far. The Authors report a case of strangulated paraesophageal hiatal hernia occurred in a elderly man and treated with open approach. Eighteen months later, follow up has demonstrated the effectiveness of the repair and the total remission of the symptoms. Recurrences after paraesophageal hiatal hernias repair may decrease with usage of mesh in the hiatus; however uniform criteria for this procedure are lacking. After review of the literature inheriting this uncommon pathology, that present about 5% of the hiatal hernias, no conclusions could be drawn regarding the reliability of the laparoscopic procedure and the necessity for an additional antireflux repair. Moreover, uniform specific indications for the need of an esophageal lengthening procedure or preoperative assessment methods for shortened esophagus cases could not be detected., Conclusions: Treatment based on standardized protocols for preoperative assessment and postoperative follow-up is required to clarify the current controversies inherent surgery indications and approach.

Unlabelled: Retroperitoneal sarcomas (RS) are a rare group of malignant soft-tissue tumors. They generally grow until they reach large size before becoming symptomatic, often involving surrounding structures., Case Report: The paper reports the case of a particularly large retroperitoneal liposarcoma (diameter: 48 x 44 x 32 cm, weight: 13.500 kg) surgically treated in a 92-year old woman: the patient tolerated the procedure well and was discharged after a short hospitalization. The paper, moreover, focuses on the diagnostic and therapeutic aspects of this tumour. The need for radical surgery to remove the entire mass is certain, even if it is particularly large; furthermore, the patient must be carefully monitored since retroperitoneal recurrence is frequent and must be treated, wherever possible, surgically. After a review of the literature there is an evidence that higher tumor grade, non-liposarcoma histology, advanced stage, incomplete surgical resection, and microscopic infiltration of surgery resection margins were found to be significantly negative prognostic factors., Conclusions: The study underlines the role of liposarcoma surgery management in order to offer the best chance of long-term survival and, especially on elderly patients, a better quality of life.

Introduction: Gastrointestinal stromal tumors are the most frequent (0,5-3%) mesenchymal tumors in the gastrointestinal tract. They probably originate from the interstitial cells of Cajal and are characterized by an anomaly of c-kit receptor, for a stem growth factor, with tyrosine-kinase activity (c-kit). This mutation causes a permanent activation of the receptor and uncontrolled cell growth. These tumors are associated with low survival in cases of advanced or metastatic disease. Imatinib, a tyrosine kinase inhibitor, induces improved survival in these patients., Case Reports: The authors discuss two cases of gastrointestinal stromal tumors surgically treated and also review the pathophysiology, diagnosis difficulties, role of surgery today, and treatment-related outcome of this type of tumors.

Aim of the Study: There are several varieties of bilioenteric fistulae. The vast majority of fistulas result from chronic cholelitiasis disease. Other relatevely common causes are chronic duodenal ulcer disease, previous instrumentation to the biliary system, chronic bowel inflammatory disease, traumatism, infections., Case Report: The case of a 58-year-old patient is reported in whom one of the rare complications of longstanding duodenal ulcer, the cholecystoduodenal fistula, has occurred. Main symptoms were rapid weight loss (20 kg/3 months), abdominal pain, dyspepsia, vomiting. Perivisceral peritonitis developed a tumefaction (diam: 5 cm) involving duodenum, pancreas, biliary tract and gallbladder. That finding closely simulated a neoplasm evaluating it by CT scan, US scan and even in explorative laparotomy: tumefaction was impossible to isolate, so a duodenocefalopancreasectomy was performed.