O. Baraket

Predictive factors of morbidity after surgical treatment of hydatid cyst of the liver

BACKGROUND AND STUDY AIMS Hepatic hydatid cyst is a major health problem in endemic areas. Surgery is still the best choice for treatment of the hydatid cyst of the liver. However, it is still associated with high mortality and morbidity. The aim of the study was to evaluate the predictive factors for specific morbidity after conservative surgical treatment of the hydatid cyst of the liver. PATIENTS AND METHODS A total of 120 patients who underwent conservative surgical treatment between 2001 and 2011 were evaluated retrospectively. RESULTS Of the 120 patients, 64 were female subjects and 56 male subjects; the median age was 33 years (14-83 years). The mortality rate was 0%. The overall morbidity rate was 26.6%. The specific morbidity rate was 16.6%. The major specific complications were infection of the residual cavity in 10 cases and an external biliary fistula in eight cases. The predictive factors of morbidity in univariate analysis were bilious cyst content, location of the cyst in the hepatic dome, and size >10 cm. After multivariate analysis, only the size of the cyst was an independent predictive factor of morbidity. CONCLUSION The size of the cyst was the significant predictor of morbidity of conservative surgery for liver hydatid cyst.

Mature teratoma of the pancreas diagnosed by fine-needle aspiration

A 41-year-old female patient, presented with recurrent epigastric pain of 2 years duration. Physical examination revealed a 15-cm epigastric mass that was mobile and tender on palpation. Abdominal ultrasound revealed a 20-cm hypoechoic mass, containing multiple hyperechoic structures. The exact origin of the mass could not be clearly defined. CT scan of the abdomen revealed a well-circumscribed voluminous cystic mass measuring approximately 25 cm in size, with heterogeneous content. After the administration of contrast material, no enhancement of the mass

Ciliated Foregut Cyst of Gallbladder: A Little Known Entity

Ciliated foregut cysts are rare masses that develop from the tissues which remain from embryological foregut development. In the literature, a few cases have been described in various organs so far. The solitary cysts are characterized by ciliated pseudostratified columnar epithelium. They are usually located above the diaphragm but they can also arise in relation to the liver, gallbladder and pancreas. Although rare, there is a risk of development of squamous cell carcinoma from these cysts that typically bear benign features. Prognosis following the development of carcinoma is poor. Congenital gallbladder cysts are detected rather rarely. The diagnosis is suspected on imaging. Treatment using a laparoscopic surgical method is the first preference.

Management of Complicated Hydatid Cyst in Pregnancy. A Multicenter Study

BackgroundThe hepatic hydatid cyst is a major public health concern in endemic areas. It presents a therapeutic challenge when it occurs in pregnant women and exposes the mother and the fetus to a high mortality risk in the case of complications. The main complication is communication with the biliary tree, which fortunately is rare.MethodsA multi-center retrospective study was conducted spanning 7 years, from January 2009 to December 2015. In 17 departments of surgery across Tunisia, 24 cases were identified of pregnant women who were treated for complicated hepatic hydatid cyst. The data on their treatment and outcome were retrieved from the medical records.ResultsThe age range of the 24 patients was 23 to 40 years, median 30 years. The median gestational age was 15 weeks (range 5 to 29 weeks).The patients complained of a variety of symptoms, mainly abdominal pain (87.5%), fever (50%), jaundice (50%) and vomiting (21%). The laboratory examination showed leukocytosis (54.2%), cholestasis (41.7%), elevated liver enzymes (12%), and positive blood culture (6%). On abdominal ultrasound (U/S), dilatation of the common bile duct was observed in 41% of the cases, dilatation of the intra-hepatic bile ducts in 50%, and hydatid material in the duct in 12% of the cases. Most of the cysts were located in the right lobe of the liver, in the hepatic dome. All of the patients were treated surgically, by one of three types of intervention: Largot intervention (18 cases), internal transfistulary drainage (4 cases), and the Perdromo procedure (2 cases). Postoperative follow-up was complication-free for 20 patients. In the remaining four, complications included: purulent retention (1 case), biliary fistula (2 cases), pneumonia (1 case). There was no maternal death. A tocolytic agent was administered to 16 women and 21 had a live full-term birth. One spontaneous miscarriage and 2 neonatal deaths occurred.ConclusionsComplicated hydatid cyst in pregnancy is a serious condition which can be life-threatening for the mother and the fetus. The treatment is surgical, and patient management requires close collaboration between the surgeon, the anesthesiologist and the obstetrician-gynecologist.

Acute esophageal necrosis: A new case

Acute esophageal necrosis is an uncommon clinical entity. It is diagnosed with upper gastrointestinal endoscopy with the presence of strikingly black necrotic esophagus. Very often no definite etiology is identified, even though a large list of potential associations has been postulated. His treatment is primarily medical. A high mortality is usually related to the underlying medical co-morbidities and diseases. We report a case of acute esophageal necrosis occurring in a patient undergoing Fournier’s gangrene intervention.

An inflammatory pseudotumour of the head of the pancreas - A rare pancreatic tumour

Aim-backgroundAn inflammatory pseudotumour is an uncommon lesion originally described in the respiratory tract. It is currently established that it can occur in a variety of locations, including the pancreas. The aetiology is still not defined. Histological features include inflammatory and other mesenchymal cells without signs of malignancy.CaseThe authors report a case of an inflammatory pseudotumour arising from the head of the pancreas in a 74-year-old male patient. Due to local extension of the tumour, a resection of the tumour was not performed. The patient underwent a double diversion with a hepaticojejunal anastomosis and gastroileal bypass. A strict 4-year follow-up period did not reveal any signs of malignancy or local invasion.ConclusionInflammatory pseudotumour of the pancreas is a rare tumour that is very difficult to diagnose preoperatively. Surgical resection is the first option, in order to obtain histological confirmation of an IMT (inflammatory myofibroblastic tumour) and to resolve the symptoms.