Mohamed Ahallat

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.

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.

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.

The Trans-Diaphragmatic Hydatid Cyst: An Unconventional Surgical Strategy

Introduction: The hydatid disease is a zoonotic infection due to the tapeworm echinococcus granulosus (TEG). In 50-70% of the cases, the hydatid cyst is observed with a hepatic localization. The trans-diaphragmatic extension of a liver hydatid cyst is rarely reported in the literature. Here, we report the singularity of our observation which focuses on-an abdominal approach rather than a thoracotomy and the way we handle the diaphragmatic defect. Observation: A 34-year-old male patient presented with a right hypochondriac pain evolving since 2 years. The abdominal examination found a bulging just below the right costal margin. The ultrasound and computed tomography (CT) scan images show an enormous liver hydatid cyst covering the entire posterior right section and extending beyond the diaphragm to the right hemi-thorax. Our therapeutic strategy consisted of a resection of the protruding dome with aspiration and evacuation of all the hydatid material. We did not close the diaphragmatic defect because there was no communication with the thorax contents. Our management had no negative impact on the patient in 2 years of follow-up. Conclusion: Being rarely reported in the literature, the trans-diaphragmatic hydatid cyst is an uncommon situation. The surgical intervention is the main stay treatment. Our management of the diaphragmatic defect was unconventional. The singularity of our approach is to not close the diaphragmatic defect since we considered the remaining fibrous capsule as a closure, avoiding a laborious dissection and a complex diaphragmatic reconstruction.

Perineal skin recurrence on the site of Lone Star Retractor: case report

BackgroundLocal recurrence of colorectal cancer is a major cause of morbidity and mortality that usually implies a worse prognosis. Its etiopathogenesis is still a subject of debate. Recurrence on the perineal wound caused by anal retractor device is rarely reported.Case presentationWe present the case of a 75-year-old woman with perineal skin recurrence on the site of Lone Star Retractor™ from rectal adenocarcinoma. The patient underwent a curative proctectomy followed by a hand-sewn coloanal anastomosis using Lone Star Retractor™ 2xa0years ago for a tumor of the lower rectum. The recurrence was most likely caused by the seeding of exfoliated tumor cells into the perianal skin which was abraded by the retractor.ConclusionThis case is the fourth case reported in the literature and highlights the importance of the use of less traumatic endoanal retractors to prevent such perianal recurrence. Recurrence on the perineal wound caused by anal retractor device is rare but possible. Further studies are needed to define preventive measures able to reduce cutaneous implants.

Pancreatic solid serous cystadenoma treated by laparoscopy: Presentation of a new case report and review of the literature

Highlights • Solid-type serous cystadenoma of the pancreas is pauci-symptomatic.• Preoperative diagnosis is often misdiagnosis with other solid pancreatic tumors.• Laparoscopic resection is feasible for treatment with good prognosis.

Risk Factors for Conversion and Morbidity During Initial Experience in Laparoscopic Proctectomies: a Retrospective Study

The aim of this study was to determine the predictable factors for conversion during laparoscopic proctectomies, and for postoperative morbidity, in order to assist in defining the best candidates of patients for initial experience in laparoscopic proctectomies for rectal adenocarcinoma. A retrospective analysis of consecutive patients who underwent laparoscopic rectal resection for rectal adenocarcinoma operated by a single surgeon, between 2005 and 2012, were performed. Predictive factors for conversion and for postoperative morbidity were analyzed using univariate and multivariate analysis. Sixty-nine patients were included. There were 35 (50.7xa0%) men with a median age of 53xa0years. Forty-seven patients had tumors located below 8xa0cm from the anal verge, and sphincter-preserving surgery was performed in 52 (75.4xa0%) patients. Thirty-four patients were operated in the early period (before 2009). Conversion rate was 17.4xa0%. In multivariate analysis, the independent predictive factors for conversion were time period (before 2009) (pu2009=u20090.007, Exp. 19.9; CI (95xa0%) 2.2–177.4) and tumors located 8xa0cm above the anal verge (pu2009=u20090.028, Exp. 5.23, CI (95xa0%) 1.2–22.8). Twenty-two patients (31.9xa0%) had a complicated postoperative course. Only male gender was associated with postoperative complications (pu2009=u20090.01, CI (95xa0%) 1.3–11.8). Our study showed that conversion rate is influenced by surgeon’s experience, and height of the tumor and that male gender is a predisposing factor for a higher morbidity rate. These results suggest that women with low rectal tumors requiring colo-anal anastomosis or abdomino-perineal resection would be the best candidates for early surgeons’ experience in laparoscopic proctectomies for rectal adenocarcinoma.