A. Hrora

Primary retroperitoneal mucinous cystadenocarcinoma in a male patient: a case report

In the literature, 51 cases of primary retroperitoneal mucinous cystadenocarcinoma have been published. We report the fourth case occurring in a male patient. The 42-year-old patient presented with multiple retroperitoneal cystic masses causing abdominal discomfort without alteration of the global clinical state. The masses were totally removed by a two-stage surgery. No other treatment has been introduced. After a follow-up of 6 months, the patient is disease-free. This rare tumor most likely arises from the mucinous metaplasia of peritoneal inclusion cysts rather than from ectopic ovarian tissue or ovarian teratomas. The occurrence of such a tumor in a male patient supports this theory. Preoperative diagnosis is mostly difficult. Clinical behavior and treatment are still controversial.

Peritoneal Echinococcosis: Anatomoclinical Features and Surgical Treatment

BackgroundPeritoneal hydatid disease is a rare and poorly known disease. We report our experience with 17 patients treated for peritoneal echinococcosis. The main objectives were to analyze and discuss the specific features of the anatomic peritoneal lesions along with their surgical treatment.MethodsWe analyzed retrospectively all patients treated in our unit for peritoneal echinococcosis between January 2001 and December 2008. Preoperative description of the lesions, and the surgical procedures were carefully reported.ResultsPeritoneal hydatidosis represented 6.3% of all abdominal localizations. There were 10 women (58.8%) and 7 men (41.2%). Median age was 34xa0years. Ten patients (58.8%) had had previous surgery for abdominal echinococcosis. Ten patients (58.8%) had synchronous abdominal localization of hydatid disease, and two patients had synchronous pulmonary localization. Sixteen patients were operated on by laparotomy. We classified the anatomic lesions into four groups: localized form (nxa0=xa06, 37.4%), disseminated form (nxa0=xa08, 50%), “hydatid carcinomatosis” (nxa0=xa03, 18.7%), hydatidoperitoneum (nxa0=xa01, 6.25%). One patient had a ruptured hydatid cyst of the left liver. We performed total cystectomies in 10 patients, partial cystectomies in 8 patients, and omentectomy in 5 patients. Two patients (12.5%) had surgical complications. One patient (6.25%) died owing to a pulmonary embolism. Anthelmintic chemotherapy was given to two patients before surgery and to nine patients postoperatively. Recurrences were seen in two patients (14.2%).ConclusionsPeritoneal echinococcosis can cause a large variety of specific and complex anatomic lesions. The disseminated form is the most common, and therefore the surgical treatment is challenging in most cases.

Spontaneous rupture of a recurrent hepatic cystadenoma

Biliary cystadenoma is a rare cystic tumor of the middle aged woman that usually arises in the liver or occasionally in the extrahepatic bile ducts. It has a strong potential for recurrence and for malignant transformation. The lack of specific clinical and biological features hinders diagnosis before surgery. The spontaneous rupture of a hepatobiliary cystadnoma is a very rare and potentially life-threatening complication, with only two reported cases in the English literature. We report a case with spontaneous rupture of a recurrent hepatobiliary cystadenoma in a 32 year-old woman.

L'opération de Heller sans système anti-reflux. À propos de 123 cas

Resume Introductionxa0: Le traitement chirurgical de l’achalasie du sphincter inferieur de l’œsophage est la myotomie de Heller, habituellement associee a un systeme anti-reflux (SAR), du fait d’un risque eleve de reflux gastro-œsophagien postoperatoire. L’interet de ce SAR est discute. Le but de ce travail etait d’evaluer retrospectivement les resultats de la myotomie de Heller sans SAR mais realisee selon une technique adaptee afin de prevenir le reflux postoperatoire. Patients et methodesxa0: Entre 1975 et 1999, 123 patients ont eu une intervention de Heller pour achalasie, sans adjonction systematique d’un SAR. Le diagnostic d’achalasie de l’œsophage etait porte cliniquement et confirme par les explorations paracliniques (transit baryte, fibroscopie et manometrie). La myotomie a ete faite par voie abdominale chez 116 (94xa0%) patients. La dissection respectait les moyens de fixite œsophagienne, notamment le meso-œsophage posterieur. La myotomie portait sur l’œsophage et ne descendait pas sous le niveau du cardia. Une fundoplicature posterieure a ete associee chez deux patients. Resultatsxa0: Un patient (0,8xa0%) est decede d’une inhalation massive. La morbidite (1,6xa0%) etait representee par une peritonite et une occlusion postoperatoire. A distance (recul moyenxa0=xa05 ansxa0; extremesxa0: 1–20), les resultats fonctionnels etaient satisfaisants (excellents et bons) chez 112 (92xa0%) patients. Sept patients (6xa0%) ont developpe un RGO postoperatoire, dont un seul a necessite un traitement chirurgical. La dysphagie a persiste chez trois patients (2xa0%) qui ont du etre reoperes. Conclusion xa0: Les resultats de cette serie montrent que l’adjonction systematique d’un SAR n’est pas necessaire dans l’intervention de Heller pour achalasie du sphincter inferieur de l’œsophage.

Adénocarcinome des glandes anales

Resume Ce travail avait pour but de rapporter l’observation d’un patient de 64 ans qui avait un adenocarcinome des glandes anales revele par un abces de la marge anale. L’hypothese de la transformation maligne d’une fistule anale est discutee. Les symptomes cliniques sont non specifiques. Le traitement est centre sur l’amputation abdominoperineale du rectum et la radiotherapie adjuvante n’a pas fait la preuve de son efficacite.

Abdominal wall recurrence of a gastrointestinal stromal tumor: case report

IntroductionThe gastrointestinal stromal tumors (GIST) are mesenchymal tumors, most commonly affecting the stomach and small bowel. Only few cases of port-site recurrence after laparoscopic treatment have been reported. We herein report the case of a parietal recurrence on the extraction incision site, 7xa0years after laparoscopic surgery for small bowel GIST.Case reportA 47xa0years-old female patient was hospitalized in November 2007 for isolated pelvic pain. CT scan showed an intestinal tumor with a benign aspect measuring 50xa0mm. A laparoscopy-assisted resection was performed. Surgical exploration found a 7xa0cm small bowel tumor. It was extracted through a supra-pubic transversal incision without a wound protector and then resected. Histologic analysis revealed an intestinal GIST with high aggressive potential (five mitosis per field), with CD117 positive at the immunohistochemical examination. The patient had no adjuvant chemotherapy. Seven years later, the patient was readmitted for an abdominal mass at the site of the supra-pubic scar. Abdomino-pelvic CT scan showed a 10xa0×xa07.5xa0cm solid mass of the abdominal wall. Percutaneous biopsies were done and the pathological analysis revealed a mesenchymal-cell tumor, positive to CD117 and DOG1 at the immunohistochemical examination. Final diagnosis was abdominal wall recurrence of GIST secondary to tumor-contamination during the first surgery.ConclusionAbdominal wall recurrence of GIST after laparoscopic surgery is rarely reported. This complication should be avoided with preventive measures such as the use of extraction bags or wound protectors.

Imaging features of adrenal ganglioneuroma: a case report

BackgroundAdrenal ganglioneuroma is a rare tumor constituting 20–30% of all ganglioneuromas. It is a benign tumor and can present diagnostic problems when confused with other adrenal solid tumors.Case presentationWe herein report a case of adrenal ganglioneuroma in a 28-year-old Arabic patient and emphasize the diagnostic role of cross-sectional imaging modalities (computed tomography and magnetic resonance imaging).ConclusionImaging of adrenal ganglioneuromas is diagnostically challenging. Differentiation between adrenal ganglioneuroma and other solid adrenal tumors can be difficult. However, some suggestive features on computed tomography and magnetic resonance imaging are helpful in achieving a correct diagnosis.

Pseudotumeur inflammatoire de la rate

Inflammatory pseudotumor of the spleen is a very rare benign lesion of unknown etiology. Splenectomy is recommended to obtain histological diagnosis and to eliminate a malignant tumor.

Asymptomatic intra-peritoneal rupture of hydatid cyst of the liver: case report

BackgroundIntra-peritoneal rupture of hydatid cyst is a rare complication and there is no consensus about its treatment.Case presentationThe reported case concerns a 25xa0years old female patient who had been complaining for four months from a moderate pain in the right upper quadrant. No clinical or biological signs of sepsis or allergic reactions were witnessed. Ultrasound and CT examinations showed a multilocular hepatic cyst in addition to multiple unilocular cysts in the abdomen. The suspected diagnosis was hepatic and peritoneal HC and a surgical treatment was scheduled four weeks later. Surgical exploration showed a large ruptured HC on the left lobe of the liver, with daughter cysts in the peritoneal cavity. Left lobectomy of the liver with complete ablation of all daughter cysts and a wide peritoneal lavage were performed. For the three months following the surgery, Albendazole had been given to the patient. No recurrence occurred after four years of follow-up.ConclusionIntra-peritoneal rupture of liver HC could be asymptomatic. This case showed that in some cases, occurrence of complications is not systematic. This suggests that urgent surgical treatment is not always mandatory in the absence of alarming signs. Well-conducted medical treatment would reduce the risk of occurrence of secondary peritoneal hydatidosis.

La réparation sphinctérienne directe: points techniques, indications et résultats

Lincontinence anale est un handicap physique, psychique et social majeur qui a de nombreuses causes différentes. Les méthodes actuellement disponibles pour améliorer les symptômes de cette incontinence sont les méthodes médicales et de rééducation dune part et les méthodes chirurgicales dautre part. Quatre techniques chirurgicales répondent à ces objectifs pour la plupart des malades: la sphinctérorraphie, la neuromodulation des racines sacrées, et les deux techniques de substitution que sont le sphincter artificiel et la graciloplastie dynamisée. La réparation sphinctérienne directe est la technique la plus utilisée dans le traitement chirurgical de lincontinence anale (IA) par lésion sphinctérienne. Cette technique est envisageable chez les malades ayant une incontinence fécale en rapport avec des lésions limitées du sphincter anal externe. La technique chirurgicale est simple (myorraphie par suture directe ou en paletot) et bien codifiée. Les résultats fonctionnels sont imparfaits et se dégradent avec la durée du suivi. Une continence parfaite après réparation sphinctérienne est rarement acquise de façon durable: le malade candidat à cette approche thérapeutique doit en être averti.