Babou Soilihi Karimdjee

Laparoscopic Repair of Intrathoracic Mesenterioaxial Volvulus of the Stomach in an Adult : Report of a Case

Intrathoracic gastric volvulus is an uncommon entity, in which the stomach undergoes organoaxial torsion occurring in the chest due to the concomitant presence of an enlargement of the hiatus. We herein report an unusual case of acute intrathoracic mesenterioaxial volvulus of the stomach. Gastric rotation occurred at the transverse axis and the mobile pylorus herniated in the chest through a large hiatal defect. Following a reduction of the volvulus through the use of a nasogastric tube, the patient underwent an elective laparoscopic repair. The mechanisms of volvulus with the relative diagnostic and therapeutic implications are discussed.

Therapeutic laparoscopy for blunt abdominal trauma with bowel injuries.

In the setting of abdominal trauma, laparoscopy is used mainly for diagnosis, and its role in definitive operative repair is still debated. We report the case of a 50-year-old woman who underwent diagnostic and therapeutic laparoscopy after being subjected to blunt abdominal trauma in a traffic accident. Multiple injuries to the small bowel and colon were repaired laparoscopically with a favorable outcome. Surgeons with experience in advanced laparoscopy and trauma care can use laparoscopy in the diagnosis and treatment of selected patients with blunt abdominal trauma.

Video-mediastinoscopy in management of patients with lung cancer: a preliminary study.

Cervical mediastinoscopy is widely employed for biopsy of mediastinal lymph nodes and staging of lung cancer. The application of video-assisted technology to mediastinoscopy in a series of patients with lung cancer has not been reported. Preliminary experience with the use of video-mediastinoscopy in diagnosis and staging of lung cancer is presented. Fifteen patients with lung cancer were studied. Results of previous computed tomography scans had shown the presence of enlarged mediastinal lymph nodes in the retrovascular plane in all of the cases. Video-mediastinoscopy was performed under general anesthesia using a specifically designed rigid scope connected to a mono-charged-coupled device video camera (model INH 002756; Karl Storz-Endoskope, Tuttlingen, Germany). Neither fatalities nor major complications related to the procedure were observed. In all cases, video-mediastinoscopy proved useful for diagnosis or staging of lung cancer, therefore contributing to clinical decision making. The optimal visualization of mediastinal structure and the possibility for the surgeon to operate with both hands are appreciable characteristics of this technique.

Gas gangrene of the breast: management of a potential life-threatening infection

IntroductionGas gangrene of the breast is a rare infection and potentially mortal.Case reportWe report a case of a fast extension of a painful right breast erythema whose starting point was a right parasternal cutaneous abscess. A diagnosis of gas gangrene of the right breast was made. A right mammectomy was carried out in Emergency and an antibiotherapy adapted to the germs was given.ConclusionMixed anaerobic and aerobic florae are often responsible for the infection. Its medico-surgical management is an emergency.

Rupture spontanée de rate sur pancréatite chronique calcifiante: À propos de 3 observations

Resume La rupture spontanee de rate (RSR) est une complication rare de la pancreatite chronique calcifiante (PCC). L’anemie et l’etat de choc hemorragique ne font pas toujours partie du tableau clinique initial et peuvent retarder le diagnostic. Malgre un traitement conservateur efficace, le traitement doit etre chirurgical car la rupture de rate est liee aux effets locaux de la pancreatite chronique calcifiante. Nous rapportons trois observations de cette complication peu frequente. La rupture spontanee de rate inaugurale a permis de faire le diagnostic de pancreatite chronique calcifiante chez deux malades. Le traitement a consiste en une splenectomie en urgence. Le diagnostic de pancreatite chronique calcifiante etait connu chez le troisieme malade mais l’absence de saignement actif a justifie un traitement conservateur qui s’est solde par un echec. Nous discutons l’interet d’une pancreatectomie caudale dans le meme temps que la splenectomie afin de reduire les taux de complications post-operatoires et de reinterventions. Nous discutons aussi de la place de la radiologie interventionnelle et de la laparoscopie.Spontaneous rupture of the spleen is a rare complication of chronic calcifying pancreatitis. Anemia and hemorrhagic shock may not occur, making diagnosis more difficult. Favourable response to conservative treatment does not prevent the need for splenectomy, as calcifiying chronic pancreatitis may progress locally. We report three cases of spontaneous rupture of the spleen. In two cases, splenic rupture revealed calcifying chronic pancreatitis and both patients underwent urgent splenectomy. In the third case, the patient was known to have calcifying chronic pancreatitis, and splenectomy was performed because of unsuccessful conservative treatment. We discuss the role of distal pancreatectomy during splenectomy to reduce the rate of postoperative complications and additional surgery. We also discuss the role of arterial embolisation and laparoscopy in the management of this rare condition.