Montassar Kacem

Acute pancreatitis due to pancreatic hydatid cyst: a case report and review of the literature

Hydatid disease is a major health problem worldwide. Primary hydatid disease of the pancreas is very rare and acute pancreatitis secondary to hydatid cyst has rarely been reported. We report the case of a 38-year-old man who presented acute pancreatitis. A diagnosis of hydatid cyst of the pancreas, measuring 10 cm, was established by abdominal computed tomography before surgery. The treatment consisted of a distal pancreatectomy. The postoperative period was uneventful. Additionally, a review of the literature regarding case reports of acute pancreatitis due to pancreatic hydatid cyst is presented.

Pseudoaneurysm of the Splenic Artery Presenting with Gastrointestinal Bleeding

Gastrointestinal bleeding from a pancreatic pseudocyst is a rare condition that is diagnostically and therapeutically challenging. A 78-year-old woman with a history of acute pancreatitis due to gallstones was hospitalized for abdominal pain and gastrointestinal bleeding. Gastroscopy revealed blood extruding from the papilla of Vater. A computed tomography scan revealed hemorrhage into a pancreatic pseudocyst. The patient was successfully treated by coil embolization.

Acinar cell carcinoma of the pancreas: A rare tumor with a particular clinical and paraclinical presentation

Acinar cell carcinoma (ACC) of the pancreas is a rare tumor with an extremely low incidence rate. While the number of reported patients with ACC is relatively small, a long-term survival rate has been noted in patients with neuroendocrine differentiation. A 39-year-old woman visited our emergency department for upper gastrointestinal bleeding. Endoscopy indicated extrinsic compression of the posterior body of the stomach, together with a large, 10-cm, central ulcer covered with necrotic tissue. Abdominal computed tomography (CT) indicated a lesion that involved the whole of the pancreas, with a fistula in the stomach, which was suspected of being a degenerative intraductal papillary mucinous tumor of the pancreas. Magnetic resonance imaging (MRI) of the pancreas was performed, and the results further strengthened our suspicions by demonstrating the presence of cystic lesions and tumor buds. A total duodenopancreatectomy, including total splenectomy and gastrectomy, was performed, along with two independent Roux-en-Y anastomoses (one esojejunal and one hepaticojejunal). The tumor also had a wide opening in the stomach. The patients postoperative course was marked by partial thrombosis of the portal vein, which was treated medically. Histopathological examination provided evidence of pancreatic ACC. The diagnosis of ACC should be considered in the presence of cutaneous lesions, which were absent in the case of our patient, and colonoscopy is also highly desirable because of the various forms associated with familial adenomatous polyposis. The prognosis, which includes a 5-year survival rate of 45%, in the population with an R0 resection is better than that for ductular adenocarcinoma, thus prompting the more aggressive management of this type of tumor.

Intraductal Papillary Mucinous Carcinoma of the Pancreas Associated With Pancreas Divisum: A Very Rare Entity

Pancreas divisum (PD) is a common congenital anomaly of the pancreas, which results from an abnormal fusion between the ventral and dorsal pancreatic ducts during fetal development. Association with Intraductal papillary mucinous neoplasm (IPMN) is extremely rare. The treatment of this entity will depend both on the malignant potential of IPMN and on the symptoms related to pancreas divisum. We report a rare case of Intraductal papillary mucinous carcinoma of the pancreas associated with pancreas divisum, one of the most difficult situations which the surgeon can be confronted to in his practice.

La colostomie à ouverture potentielle en chirurgie colorectale : un regain d’intérêt ?

Resume Introduction La desunion anastomotique en chirurgie colorectale est une complication grave. Ainsi, la protection d’une anastomose a risque par une colostomie ouverte temporaire permet d’en reduire la gravite. La colostomie a ouverture potentielle (COP) est une alternative permettant d’eviter les inconvenients de la colostomie ouverte. Le but de ce travail etait d’etudier les resultats de cette technique et d’en preciser les indications. Materiel et methodes Nous rapportons une serie retrospective de 34 cas de COP protegeant une anastomose colorectale a risque. L’indication de cette protection etait une mauvaise preparation colique dans 59 % des cas, une denutrition dans 11,5 % des cas, une inflammation locale dans 11,5 % des cas et une anastomose tres basse dans 17 % des cas. Resultats La colostomie a ete ouverte en postoperatoire dans 6 cas (18 %) de desunion anastomotique diagnostiques sur la clinique et/ou sur une opacification par voie basse aux hydrosolubles realisee systematiquement au 6 e jour postoperatoire. Aucune reprise chirurgicale n’etait necessaire. Dans les autres cas (82 %), les suites etaient simples et une reintegration facile du colon, sous sedation legere, etait realisee sans complication per- ou post-operatoire, en moyenne au 7 e jour postoperatoire. La duree moyenne de la reintegration etait de 10 min avec une duree de sejour moyen apres reintegration de 48 heures. Conclusion La COP de protection d’une anastomose colorectale offre plusieurs avantages, notamment une morbidite et une mortalite specifiques nulles, un court sejour hospitalier et un meilleur confort psychologique. Sa principale indication est la protection d’une anastomose colorectale a risque de desunion en chirurgie elective.