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Pleural empyemas generally derive by pulmonary or bronchial infections, while pleural empyemas are typically caused by pulmonary or bronchial infections, they can rarely arise from abdominal pathologies where exudative effusions traverse the diaphragm through pre-existing defects or newly formed fistulas. A left pleural empyema occurred in 73 y-o female patient with ipsilateral retroperitoneal collection and trans-diaphragmatic fistula due to xanthogranulomatous pyelonehritys (XGP). The patient was admitted at the Emergency Department with fever, left flank pain, respiratory distress: whole body CT scan showed left empyema, ipsilateral lung atelectasis, perinephric abscess, non-functioning left kidney, nephrolithiasis and trans-diaphragmatic fistula; pleural and perinephric fluids percutaneously drained grew Klebsiella pneumoniae, which was treated with Piperacillin and Levofloxacin based on culture sensitivity. Despite a temporary improvement in respiratory conditions, the persistent pleural collections necessitated urgent combined urological-thoracic treatment, which involved retroperitoneoscopic radical nephrectomy with fistulectomy and diaphragmatic closure plus simultaneous video-assisted thoracoscopy (VAT) pleural decortication. Renal histology reported the presence of chronic interstitial pyelonephritis which is a hallmark of XGP. In cases of pleural empyema of unknown cause, a possible abdominal etiology, although rare, must be excluded. In these cases, the retroperitoneoscopic approach is recommended to avoid peritoneal contamination and to minimize the diaphragmatic distension which reduces the pulmonary capacity thus altering the respiratory compliance already compromised.

Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an “endotype-based” definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a “united airway” perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the “united airways”. It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.

In the last 20 years, growing interest in chronic rhinosinusitis (CRS) has become evident in medical literature; nevertheless, it is still difficult to identify the real prevalence of the disease. Epidemiological studies are few and focused on heterogeneous populations and diagnostic methods. Recent research has contributed to identifying CRS as a disease characterized by heterogeneous clinical scenarios, high impact on quality of life, and elevated social costs. Patient stratification with phenotypes and identification of the pathobiological mechanism at the origin of the disease (endotype) and its comorbidities are pivotal in the diagnostic process, and they should be addressed in order to properly tailor treatment. A multidisciplinary approach, shared diagnostic and therapeutic data, and follow-up processes are therefore necessary. Oncological multidisciplinary boards offer models to imitate in accordance with the principles of precision medicine: tracing a diagnostic pathway with the purpose of identifying the patient’s immunological profile, monitoring therapeutical processes, abstaining from having only a single specialist involved in treatment, and placing the patient at the center of the therapeutic plan. Awareness and participation from the patient’s perspective are fundamental steps to optimize the clinical course, improve quality of life, and reduce the socioeconomic burden.

Background: Anti-glaucoma eye drops have been investigated due to their production of fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. We aimed to assess whether these effects may impair the effectiveness of endoscopic endonasal dacryocystorhinostomy (EE-DCR). Methods: This is a single-center observational retrospective study on EE-DCR via a posterior approach. Resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). Results: Twenty patients (32 sides) were enrolled. Preoperatively, 93.75% (n = 30/32) presented severe (Munk 3–4) epiphora and 68.75% (n = 22/32) recurrent dacryocystitis. At T1, 50.0% (n = 16/32) were referred with residual epiphora (Munk ≥ 1) and 18.75% (n = 6/32) dacryocystitis. At T2, 31.25% (n = 10/32) still complained of epiphora (Munk ≥ 1) and 6.25% (n = 2/32) dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted in statistical significance (p < 0.05). At T2, 22 (68.75%) complete, 8 (25.0%) anatomical successes and 2 (6.25%) surgical failures were observed. Conclusions: Despite the chronic uptake of anti-glaucoma eye drops, EE-DCR guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis.

The integration of AI and natural language processing technologies, such as ChatGPT, into surgical practice has shown promising potential in enhancing various aspects of abdominopelvic surgical procedures. This systematic review aims to comprehensively evaluate the current state of research on the applications and impact of artificial intelligence (AI) and ChatGPT in abdominopelvic surgery summarizing existing literature towards providing a comprehensive overview of the diverse applications, effectiveness, challenges, and future directions of these innovative technologies. A systematic search of major electronic databases, including PubMed, Google Scholar, Cochrane Library, Web of Science, was conducted from October to November 2023, to identify relevant studies. Inclusion criteria encompassed studies that investigated the utilization of AI and ChatGPT in abdominopelvic surgical settings, including, but not limited to preoperative planning, intraoperative decision-making, postoperative care, and patient communication. Fourteen studies met the inclusion criteria and were included in this review. The majority of the studies were analysing ChatGPT's data output and decision making while two studies reported patient and general surgery resident perception of the tool applied to clinical practice. Most studies reported a high accuracy of ChatGPT in data output and decision-making process, however with an unforgettable number of errors. This systematic review contributes to the current understanding of the role of AI and ChatGPT in abdominopelvic surgery, providing insight into their applications and impact on clinical practice. The synthesis of available evidence will inform future research directions, clinical guidelines, and development of these technologies to optimize their potential benefits in enhancing surgical care within the abdominopelvic domain.

BackgroundAnisakiasis, a zoonotic disease caused by the nematode Anisakis, poses a significant concern for public health, particularly in regions with high consumption of raw or undercooked fish.Case PresentationWe present a case report of a 41-year-old woman who developed severe abdominal symptoms, ultimately diagnosed with intestinal obstruction due to Anisakis infestation, requiring surgery. Despite the absence of prominent eosinophilia or specific radiological findings, the diagnosis was confirmed through histological examination, highlighting the importance of considering anisakiasis in patients with a history of raw seafood consumption.ConclusionThe case underscores the diagnostic challenges associated with anisakiasis, emphasizing the need for increased awareness among healthcare professionals and the public regarding the risks of consuming raw or undercooked seafood. Effective management requires a multidisciplinary approach, including clinical assessment, imaging studies, and histological evaluation, to ensure timely diagnosis and appropriate treatment.

Endometriosis-associated intestinal tumors represent malignant transformation of gastrointestinal endometriosis. Clinical features are similar to colon tumor with abdominal or pelvic pain, dyschezia, or bloody stools. Intestinal occlusion or perforation has also been described as a first presentation. The diagnosis is often postoperative, and it is based on specific immunohistochemical patterns (CK7+/CK20−). We present a rare case of a woman with a malignant transformation of an endometriotic lesion of the sigmoid colon, who underwent emergency surgery for intestinal occlusion. She underwent an exploratory laparotomy and Hartmann resection. The immunophenotypic analysis of the specimens revealed the following pattern: CK20−, CK7+, compatible with the diagnosis of endometrioid adenocarcinoma. Endometrioid carcinoma is a rare tumor, difficult to diagnose preoperatively because of similar symptoms of sigmoid carcinoma. A high index of suspicion in conjunction with careful histological and immunohistochemical examination (CK7, CK20, CDX2, CD10, ER, and PR) is important for establishing a correct diagnosis.

Persistent Primitive Hypoglossal Artery (PPHA) is a developmental anomaly of the brain superficial arterial circulation and is classified as a condition of carotid-vertebrobasilar anastomosis persistence caused by lack of reabsorption of the vascular network running on the hindbrain surface between the 4th and 5th embryonic week. It has an incidence between 0.03 and 0.9%, it is the second most frequent seen persistence of carotid-vertebrobasilar anastomoses after the trigeminal artery (TA), representing 85% of all persistent vestigial arteries (0.1–0.6%). Here a case of Persistent Primitive Hypoglossal Artery (PPHA) is reported being detailed in its morphological and clinical aspects. The patient, a 55-year-old female patient with high cardiovascular risk without specific symptoms presents at radiological morphological examination with an anomalous bifurcation of the ICA which gives rise to the ICA itself, which ascends without collateral branches up to the carotid foramen in the cranial base, and to an accessory artery, which enters the hypoglossal canal on the contour of the great occipital foramen, as a PPHA. A comprehensive embryologic analysis of this anatomical variant is offered and clinical awareness on it raised in view of a more informed an effective realization of it in daily clinical practice.

First described during an anatomical dissection in 1889 (Batujeff1889), with its first angiographic description dating back to 1961 (Begg 1961), PPHA may occur in association with aneurysms (Nakamura et al. 2000) and its well-known association with the ipsilateral vertebral artery agenesia (VA) seems to play an ischemic role in the event of inflow reduction in ICA, which alone supplies vascularisation on its own side (Zhang et al. 2016). CASE REPORT A 55-year-old female patient referred to our Cardiology Outpatient Service with a high cardiovascular risk (i.e. smoking, high cholesterol levels) without specific symptoms: since atherosclerosis, as is currently known, is multi-district disease, there is a tendency shared between radiologists and cardiologists to perform a single exam to study both the coronaries and epiaortic vessels, thus benefiting from a single administration of contrast medium. The multi-slice CardioSync CT Scan (Siemens Somatom Volume Zoom) for the study of coronary arteries and epiaortic vessels after riodine non-ionic contrast medium administration was used: the volume rendering reconstruction (Fig. 1) of the epiaortic vessels shows an anomalous bifurcation of the ICA, which gives rise to the ICA itself, which ascends without collateral branches up to the carotid foramen in the cranial base, and to an accessory artery, which enters the hypoglossal canal on the contour of the great occipital foramen, as a PPHA. The arteries of the sixth branchial arch contribute to the formation of the two primitive pulmonary arteries with their proximate portion, while there is no scientific agreement on the role of the artery of the fifth branchial arch (Klostranee & Krings 2022). b. Vascular anomalies The most common vascular anomalies of the vessels of the neck (Fig. 5) include the common origin of the brachiocephalic trunk and leftCommon Carotid Artery (CCA), the aberrant right subclavian artery, also called arteria lusoria, the ICA aplasia or hypoplasia; ICA is embryologically divided into 7 segments (I - cervical, II - ascending petrosus, III - horizontal petrosus, IV - ascending cavernous, V - horizontal cavernous, VI - clinoid and VII - terminal): ICA hypoplasia is frequently seen close to the bifurcation (segment I) (Kathuria et al. 2011), while the aplasia is observed at carotid foramen (segment II, with canal of reduced caliber or even absent) (Given et al. 2001).

Minimally invasive pancreaticoduodenectomy (PD) is gaining popularity. The aim of this study was to compare the incidence of postoperative pancreatic fistula (POPF) after minimally invasive versus open procedures. Following the PRISMA statement, literature research was conducted focusing on papers comparing the incidence of POPF after open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD). Twenty-one papers were included in this meta-analysis, for a total of 4,448 patients. A total of 2,456 patients (55.2%) underwent OPD, while 1,992 (44.8%) underwent MIPD. Age, ASA score III patients, incidence of pancreatic ductal adenocarcinoma and duct diameter were significantly lower in the MIPD group. No statistically significant differences were found between the OPD and MIPD regarding the incidence of major complications (15.6% vs. 17.0%, respectively, p=0.55), mortality (3.7% vs. 2.4%, p=0.81), and POPF rate (14.3% vs. 12.9%, p=0.25). MIPD and OPD had comparable rates of postoperative complications, postoperative mortality, and POPF.