Charles Honore

Traumatic abdominal wall hernia: case report and review of the literature

Abstract Traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after an impact of the abdominal wall against a blunt object. The first case described was reported in 1906 and ever since, 46 cases have been reported. CT scan is mandatory in the diagnosis of TAWH but also because of a frequent association with significant intra-abdominal injuries. We report here the case of a 61-year-old man with a TAWH developed after impact against a bicycle handlebar. Hemodynamically stable and without associated injuries, the patient was monitored for 24 hours before hospital discharge. A successful elective hernia repair with a prosthetic mesh was performed 6 weeks later once cicatrisation was achieved.

Liver transplantation for hepatic trauma: Discussion about a case and its management

Liver transplant for trauma is a rare condition with 19 cases described in the literature. We report the case of a 16-year-old patient who suffered a gradeV liver injury with a vena cava tear after a car crash. After a computerized tomography (CT) scan, the patient was directly sent to the operating room where the surgeon performed a right hepatectomy extended to segment IV with a venous repair under discontinued hilar clamping. On day five, the patient developed acute liver failure and was put on an emergency transplant waiting list. He had a successful liver transplant 2 days later. Fifteen months after his transplant, the patient is alive and asymptomatic. This case report focuses on the patient’s initial management, the importance of damage control surgery and the circumstances which finally led to the transplant.

Esophageal cancer surgery in patients older than 75: long term results.

Abstract Purpose : The purpose of this study was to evaluate short and long term results after esophageal cancer resection in patients older than 75. Methods : We retrospectively analyzed the database of esophageal cancer surgically treated in our department between January 2003 and December 2009 to identify patients older than 75. The preoperative, operative, postoperative and long term characteristics were analyzed. Results : Among 137 patient, 23 were older than 75. The histological subtype was adenocarcinoma in 100%. The surgical techniques were a “Lewis-Santy” procedure in 43%, a trans-hiatal resection in 22%, a “Sweet” procedure in 13%, a stripping in 13% and a McKeown procedure in 9%. The in-hospital postoperative mortality was 13%. The in-hospital postoperative morbidity (Dindo-Clavien Grade > 2, deceased patients included) was 26%. In univariate analysis, no statistically significant risk factor of morbidity was found. A Charlson Comorbidity Index > 2 was, in univariate analysis, the sole risk factor of postoperative mortality (p = 0.0362). The mean hospital stay was 22 ± 12 days. The median survival was 24.2 months. The 5-year overall survival was 39% and the 5-year disease free survival was 26%. 57% of long-term deaths were not cancer related. Conclusion : Esophageal surgery performed in selected patients older than 75 has an acceptable morbidity and mortality but when a severe complication occurs, it leads to death in half of the cases. Surgery enables a long term survival benefit. This study confirmed our attitude of not considering age as a contra-indication for esophageal surgery but rather considering general status, self-reliance and associated comorbidities for patients’ selection.