Ahmed Bounaim

L’hydatidose péritonéale. À propos de 12 cas

STUDY AIM The aim of this retrospective study was to report on 12 cases of peritoneal hydatidosis observed in the same hospital from 1989 to 1998. PATIENTS AND METHODS Four men and 8 women (mean age: 37 years) were included in the study. Four of them had been operated on for liver hydatidosis, 3 to 9 years before. The peritoneal hydatidosis was asymptomatic (n = 2), revealed by pain and/or fever (n = 9) and by hydatid peritonitis (n = 1). Diagnosis was performed by ultrasonography in seven cases out of 10. Preoperative treatment with albendazole was given to one patient only during 1 month. All patients were operated on. Peritoneal cysts, with different locations, were secondary in 11 patients. Nine patients had concomitant liver hydatidosis and two concomitant retroperitoneal hydatidosis. Hydatid cysts were usually sterilized with oxygen water and treated by resection of the protruding dome. Postoperative treatment with albendazole was given to five patients. RESULTS Postoperative complications occurred in five patients: intestinal occlusion, abscess in a residual cavity, purulent fistulas, biliary fistulas with a favorable issue. With a mean 38-month follow-up, all patients were alive, with only one recurrence in a liver hydatid cyst. CONCLUSION Peritoneal hydatidosis was secondary in 11 out of 12 patients. Diagnosis was performed with ultrasonography in seven out of 10 patients. All patients were operated on. With a mean follow-up of 38 months, only one recurrence has been observed.

Delayed repair for traumatic abdominal wall hernia: is it safe?

Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed repair. A single case study can hardly be considered as a basis for profound changes in the management of post traumatic hernias. However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient.

Giant inguinoscrotal hernia containing intestinal segments and urinary bladder successfully repaired by simple hernioplasty technique: a case report

IntroductionGiant inguinoscrotal hernias are extremely rare nowadays, but they may still be encountered after years or even decades of neglect. Such hernias containing both bowel loops and urinary bladder have not been reported in the medical literature to date, to the best of our knowledge.Case presentationWe report a case of a 65-year-old Moroccan man who presented with giant right-sided and long-standing inguinoscrotal hernia with compromised quality of life due to walking difficulties and sexual discomfort. Computed tomography revealed a voluminous hernia sac containing small and large bowel loops, greater omentum, and urinary bladder. Surgical repair was done through the classical inguinal incision using the Lichtenstein tension-free hernioplasty technique. No debulking or abdominal enlargement procedure had to be performed, apart from a partial omentectomy.ConclusionsGiant inguinoscrotal hernia containing intestinal segments and urinary bladder is a challenging surgical disease. A Lichtenstein tension-free technique seems to be the best surgical procedure for both the patient and the operating surgeon. It should be used whenever possible in such cases.

Medial Pancreatectomy for a Neuroendocrine Tumor Invading the Splenic Artery and Vein

CONTEXT Pancreatic tumors in the midportion have traditionally been treated by an extended right or left pancreatectomy. A medial or central pancreatectomy is an alternative technique for benign or low-grade malignant neoplasms located to the left of the gastroduodenal artery and close to the splenomesenteric confluence. CASE REPORT A 38-year-old woman with no previous surgical history presented with epigastric abdominal pain. A computed tomography scan showed a 4 cm heterogeneous lesion within the pancreatic body. This tumor invaded the splenic artery and vein. There was no postoperative diabetes mellitus or exocrine insufficiency. The patient continues to be well after a 10-month follow-up without pancreatic insufficiency or local recurrence, and CT has demonstrated splenic perfusion by the collateral vessels. CONCLUSION We believe that a medial or central pancreatectomy may be a safe procedure where there is involvement of the large splenic vessels by a low grade malignant pancreatic tumor and that a systematic splenectomy is not justified.

Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases

INTRODUCTION Fourniers gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality. METHODS We carried out a retrospective study of 72 patients treated for Fourniers gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and non-survivors and potential prognostic factors were analyzed. RESULTS Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fourniers Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002). CONCLUSION Fourniers gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.

Primary hydatid cyst of the retroperitoneum

Retroperitoneal contamination may occur during the natural history of hydatid disease. Primary hydatid cyst of the retroperitoneum is extremely rare. The authors report a case of a giant retroperitoneal hydatid cyst. Clinicians and surgeons must be aware of this possibility and follow a policy of nonsystematic puncture of an abdominal cyst and avoid spillage during surgery. Symptoms are related to the size, location, or ensuing complications of a cyst. Its occurrence should be strongly suspected ahead of any abdominal cyst, especially in an endemic area, where it may act as a parasite. Total and careful surgical excision is the gold-standard therapy.

Giant Gastric Liposarcoma: A Fatal Exceptional Location

Gastric liposarcoma is extremely rare and only few cases have been reported in the literature. Esophagogastroduodenoscopy (EGD) is generally inconclusive, with frequent negative biopsy results. Imaging tests can guide the diagnosis toward a fatty tissue tumor; however definitive diagnosis is obtained only by histopathological studies. Treatment is not well-standardized; the mainstay is surgical resection for curative treatment and certain patients may be candidates for a multimodality treatment with chemotherapy and radiation. The prognosis is difficult to determine given the rare nature of the disease [1]. Our study is a case report of a patient who was diagnosed with a gastric liposarcoma, and our work intends to put emphasis on the diagnostic and therapeutic challenges that the disease poses.

Intestinal obstruction due to a left paraduodenal hernia: a case report

IntroductionA left paraduodenal hernia is a rare congenital malrotational anomaly of the midgut that occurs in the paraduodenal fossa of Landzert to the left of the fourth duodenum. It is responsible for approximately 1% of small bowel obstructions.Case presentationWe report a case of left paraduodenal hernia combined with small bowel obstruction in a 47-year-old Mediterranean woman who had a history of recurrent abdominal pain. An abdominal computed tomography scan showed a saclike mass clustered in the left upper quadrant but failed to yield a clear diagnosis. We describe the surgical anatomy of this disease and the emergency surgical management together with a short review of the literature.ConclusionsEven though a left paraduodenal hernia is rare, it must be suspected in any upper intestinal occlusion. The high morbidity and mortality rate of complicated cases should motivate preventive treatment in case of incidental operative discovery.

Pancreatic-pleural fistula in chronic pancreatitis.

Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed. We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45 years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage.

Métastases au niveau des sites d’introduction des trocarts secondaires à un adénocarcinome de la vésicule biliaire

Fortuitous systematic histological examination discovery of gallbladder adenocarcinoma after laparoscopic cholecystectomy performed due to acute cholecystitis is rare. It requires reoperation through subcostal approach for vesicular bed resection as well as excision of the trocar trajectories. We here report the case of a 73-year old female patient with a history of laparoscopic surgery for acute cholecystitis performed three years before. Anatomopathological examination had showed tubulo-papillary adenocarcinoma of the vesicle, but the patient refused reoperation. Currently, she presented with two masses in the anterior abdominal wall, one of which was ulcerated. Abdominal CT scan objectified two parietal and peritoneal tissue masses and CA19-9 dosage was largely positive at 946 U/ml (30 times the normal value). Biopsy under local anesthesia confirmed tumor recurrence and the patient was referred to the Department of Oncology for GEMOX chemotherapy before revaluation for possible surgery.