The worldwide prevalence of gallstones (GSs) is estimated to be between 10% and 15% in the general population. Gallbladder carcinoma (GBC) is the most common biliary tract neoplasia, and it is characterized by highly aggressive behavior and poor overall prognosis. Long-standing GSs and chronic inflammatory state represent the most common risk factors for GBC, promoting a carcinogenic microenvironment. Long-standing GSs expose patients to potentially severe surgical and oncological complications. A 71-year-old gentleman, who had never experienced biliary symptoms and had diabetes mellitus (DM), presented with severe peritonitis due to perforated acute calculous cholecystitis. The patient underwent an emergent laparotomic cholecystectomy. Histopathology found a rare pT2b poorly differentiated squamocellular carcinoma of the gallbladder. Although more difficult due to the concomitant inflammatory context, it is critical to identify suspicious lesions during preoperative imaging in patients at high risk of malignancy presenting with complex acute gallbladder pathologies. A review of the literature was conducted to gain a deeper insight into the relationship between long-standing GSs and GBC, evaluating also the difficult diagnosis and management of malignancy in the acute setting. Considering the existing literature, the choice to pursue a prophylactic cholecystectomy may be justifiable in selected asymptomatic GS patients at high risk for GBC.

Background and Objectives: In the current era of solid organ transplantation, the gap between available donors and patients on the waiting list is widening. Worldwide, surgeons are confronted with the challenge of optimizing the utilization of renal grafts, including the presence of multiple renal arteries (MRA), occurring in 20% to 30% of cases. The presence of a lower polar artery (LPA), which provides a significant vascular contribution to both the lower renal parenchyma and the upper urinary tract, constitutes an additional challenge, but its preservation is fundamental for the outcome of the kidney transplant (KT). The end-to-end (E/E) anastomosis with the recipient’s inferior epigastric artery (IEA) has been rarely reported in the literature, with variable results. The aim of this study is to report on technical aspects as well as on short- and long-term outcomes of this reconstruction in KT. Materials and Methods: A retrospective three-centre analysis was conducted on 13 KTs in which the graft’s LPA was anastomosed E/E with the recipient’s IEA. Results: Following an average follow-up period of 84 months, the patient and graft survival rate was 100%. Neither vascular nor urological complications were observed. Conclusions: In the event of KT with LPA, an E/E anastomosis with IEA performed with microsurgical technique is safe and provides excellent long-term results.

Background and Objectives: Considering the growing shortage of grafts available for kidney transplantation (KT) due to the increase in the number of end-stage renal disease patients, it is essential to utilize all transplantation options. The Karpinski score is a histological scoring system utilized for the evaluation of pre-implantation kidney biopsies from deceased donors. In contrast with Remuzzi Criteria, there has recently been a tendency to perform single KT using grafts with a Karpinski score of 4 or 5. This strategy allows two score 4 or 5 grafts to be used for two different recipients instead of a double-graft KT on one patient. The aim of this study was to analyze the outcomes of single-graft KT with a score of 4 versus 5, and to investigate possible correlations with the clinical characteristics of donors and recipients. Materials and Methods: Retrospective single-centre analysis of 100 KTs performed with a single Karpinski score 4 or 5 graft between January 2014 and December 2022. Results: Grafts with a Karpinski score of 5 harvested from donors older than 70 years of age had a statistically significant (p = 0.014) worse 5-year survival rate (50.0 +/− 18.6%) compared to younger donors (100% for score 5 grafts from donors aged 31–60, and 100% for score 5 grafts from donors aged 61–70). Conversely, donor’s age did not significantly affect the survival of score 4 grafts. Conclusions: The results suggest that a single-graft KT with a Karpinski score 5 graft may be a viable procedure with favourable outcomes. However, for Karpinski score 5 grafts, the use of an older donor beyond the age of 70 seems to be a significant negative factor for the long-term outcome. In such cases, a double KT would potentially be the optimal approach.

Background: Segmental arterial mediolysis (SAM) is a rare, non-inflammatory, non-atherosclerotic, non-hereditary arteriopathy of unknown etiology that typically affects medium-sized visceral arteries. The absence of reliable diagnostic criteria poses a significant challenge. Consequently, the diagnosis of SAM should be considered in the setting of a distinctive combination of clinical features, angiographic findings, and histopathology. Renal artery involvement is uncommon, and its occurrence in the donor graft during kidney transplantation (KT) has not previously been reported. Case presentation: We report the case of a kidney graft from a deceased donor in her seventh decade of life, transplanted into a recipient in her seventh decade of life. Donor–recipient ABO compatibility was confirmed, and both complement-dependent cytotoxicity crossmatch and flow cytometry crossmatch were negative. Cold ischemia time was 14 h, and warm ischemia time was 20 min. Immediately after declamping, massive thrombosis of the graft renal artery was observed and confirmed using an intraoperative flowmeter. The arterial anastomosis was taken down, the thrombus was removed, the artery was flushed with heparin, and the anastomosis was reconstructed using interrupted sutures. Despite revision, no arterial flow was detected, and the graft was deemed unsalvageable and explanted. Histopathological examination showed thinning of the tunica media, reduced smooth muscle cells on desmin staining, medial-adventitial dissection, and occlusive thrombosis, findings considered likely attributable to SAM. Conclusions: This case suggests that occult donor arterial wall disease compatible with SAM may present catastrophically during KT and may lead to immediate graft loss despite standard surgical salvage attempts. Although no validated strategy currently exists to screen for or prevent occult SAM in asymptomatic donors, awareness of this entity may assist transplant surgeons and pathologists in the evaluation of unexplained early graft arterial thrombosis, donor-graft vascular pathology, and communication with centres receiving paired organs from the same donor.

Background and Objectives: Few cases of spontaneous evisceration through umbilical hernia (UH) in adult patients have been reported in the literature. Although uncommon, it is a potentially life-threatening surgical emergency. This scoping review aimed to map the published cases and summarize the reported clinical settings, precipitating factors, pathophysiologic mechanisms, management strategies, and outcomes. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. The search was conducted through PubMed/MEDLINE and Scopus using the strings (“spontaneous evisceration” OR “spontaneous bowel evisceration” OR “umbilical hernia rupture” OR “umbilical hernia evisceration” OR “bowel evisceration umbilical” OR “umbilical evisceration” OR “bowel evisceration” OR “umbilical eventration”). Reports describing spontaneous evisceration of abdominal content through an UH in adult patients were included, whereas pediatric cases, non-umbilical eviscerations, traumatic eviscerations, animal studies, duplicates, and reports without extractable clinical data were excluded. Results: From the initial 2623 records identified, after thorough screening and reference tracking of the selected publications, 47 relevant reports for a total of 49 patients were identified. Cirrhosis was reported in 26 patients (53%), umbilical skin changes before the evisceration in 33 (67%), and death in 10 (20%). Conclusions: The available evidence suggests that spontaneous evisceration through UH is a surgical emergency that should be viewed not merely as a local mechanical event, but as the result of a multistep process involving chronic pressure overload, tissue fragility, and systemic decompensation, frequently in the setting of cirrhosis with ascites. Urgent repair is usually required, but the role of mesh reinforcement remains unclear and should be individualized according to contamination, defect size, patient condition, and ascites control.