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Aims: The emerging biliary colonization of microorganisms in patients with biliary diseases may be devastating. Recent evidence suggests that age and gender may influence changes in the microbial composition of gut microbiota. To study the relationship between these parameters on bile microbiota, we retrospectively reviewed positive bile cultures following an endoscopic retrograde cholangiopancreatography (ERCP) in a QA-certified academic surgical unit of a single institution. Methods: 449 positive bile cultures from 172 Italian patients with diseases of the biliopancreatic system hospitalized from 2006 through 2017 were investigated for aerobic, anaerobic, and fungal organisms. The patients were stratified into four age intervals (22−66, 67−74, 75−81, and 82−93 years) and followed up for five years. Results: Gram-positive bacteria (GPB) was negatively associated with age only in multivariate analysis (Rpartial = −0.114, p = 0.017), with younger patients prone to harbor GPB and older patients likely to have Gram-negative bacteria (GNB). There was a definite link with the male gender using both univariate and multivariate analysis (p < 0.001). Enterococcus spp. was the most common strain identified in patients with GPB except for patients aged 67−74 years for male (95.2%) and female (80.9%) patients. Escherichia coli and Klebsiella spp. were most frequent than others in every group analyzed. Analogous results were found for bacteria Non-fermenting Gram-negative bacilli (NFGNB), such as Pseudomonas spp. and Stenotrophomonas spp. apart of the 2nd quartile. Conclusions: Our study strengthens the bond of age and gender with bile microbiota composition and suggests that further investigations may be required in targeting the aging microbiome. Other studies should also focus on Mediterranean epidemiological characteristics and antibiotic resistance surveillance system strategies

Hydatid disease is a worldwide zoonosis endemic in many countries. Liver echinococcosis accounts for 60–75% of cases and may be responsible for a wide spectrum of complications in about one third of patients. Some of these complications are potentially life-threatening and require prompt diagnosis and urgent intervention. In this article, we present our experience with common and uncommon complications of hepatic hydatid cysts which include rupture, bacterial superinfection, and mass effect-related complications. Specifically, the aim of this review is to provide key imaging features and diagnostic clues to guide the imaging diagnosis using a multimodality imaging approach, including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and endoscopic retrograde cholangiopancreatography (ERCP).

The duodenal injuries occur in the 3-5% of blunt abdominal traumas. The isolated intramural duodenal hematoma is a very rare lesion. An early diagnosis and an adequate therapy are crucial because a delay, beyond 24 hours, increases the mortality from the 11% to 40%. However, diagnosis is often hindered by a lack of specific symptoms. We report a case of a 21 years-old man with an intestinal obstruction from isolated intramural duodenal hematoma occurred after a blunt abdominal trauma in a sport competition. The patient was treated conservatively with total parenteral nutrition, gastric decompression and intravenous PPIs. The progressive spontaneous resolution of the hematoma was checked with periodical endoscopies. The discharge occurred after three weeks with no early complications. No late complications occurred at one-year follow-up. The endoscopy is a good and safe tool in the management of this intestinal obstructions with the possibility of conservative or interventional treatment.Il primo caso di ematoma duodenale fu pubblicato nel 1838 da McLaughlan che lo descrisse come una “fatale tumefazione pseudoaneurismatica”. Nei traumi chiusi dell’addome l’incidenza delle lesioni duodenali è approssimativamente del 3-5%. Il trauma duodenale isolato risulta essere un’evenienza molto rara. L’ematoma duodenale intramurale (IDH), una delle possibili lesioni duodenali, è solitamente complicanza di un trauma addominale chiuso in bambini o giovani adulti e si presenta solitamente con un quadro “insidioso” di occlusione intestinale alta insorgente circa 48 ore dopo un trauma. L’incidenza è maggiore nel sesso maschile con un rapporto M:F di 5:1. Dato lo stretto rapporto anatomico duodeno-pancreatico, una pancreatite ad eziologia traumatica è spesso associata all’IDH o ne può rappresentare una complicanza. Presentiamo un caso di occlusione intestinale alta da ematoma intramurale duodenale risoltosi con trattamento conservativo in assenza di complicanze tardive. La diagnosi di occlusione intestinale da ematoma duodenale intramurale è stata basata sulla storia clinica e sull’evidenza della lesione all’esame TC, confermata dall’ EGDS e dall’EUS. Il laboratorio more solito non era specifico. Le possibili strategie di trattamento includevano il trattamento conservativo, l’evacuazione chirurgica e il drenaggio percutaneo o endoscopico. Lo stretto controllo dell’evoluzione della lesione attraverso l’endoscopia tradizionale e l’ecoendoscopia ha permesso di non eseguire trattamenti operativi, che pur si era pensato di attuare. L’atteggiamento conservativo per IDH dovrebbe essere quello di scelta, riservando il trattamento operativo ai casi di persistenza del quadro occlusivo oltre le 3 settimane o ai casi di incremento volumetrico dell’ematoma. Il risultato del trattamento conservativo è buono, in termini di completa risoluzione dell’IDH generalmente entro 2-3 settimane, soprattutto nei casi diagnosticati precocemente.

A 21-year-old man was admitted 36 hours after a blunt abdominal trauma occurred during a sporting competition. He complained of colic epigastric abdominal pain, nausea, and vomiting. He was hemodynamically stable; blood counts and metabolic panel were normal. Abdominal CT showed an intestinal obstruction caused by an 8 x 6 x 11 cm hematoma on the right lateral duodenal wall without signs of active bleeding (Figure 1). He underwent gastric decompression and started total parenteral nutrition and intravenous pump inhibitors. Esophagogastroduodenoscopy (EGD) performed 48 hours after the diagnosis showed an extrinsic compression by a bluish obstruction in the first part of the duodenum resembling an extraparietal hematoma (Figure 2). After 5 days, repeat EGD revealed a massive parietal hematoma in the posterior wall of the duodenal bulb. Two weeks later, an endoscopic ultrasound to evaluate the possibility of endoscopic drainage showed a delimitation of the lesion below the third layer of the duodenal wall, surrounded by the remaining layers (Figure 3). Endoscopic drainage was not performed, and the patient was managed conservatively. Three weeks later, EGD showed complete reabsorption of the hematoma; a soft oral diet was started (Figure 4). On follow-up, the patient was asymptomatic.