Omar Toumi

Autoimmune pancreatitis mimicking pancreatic cancer.

Context: Autoimmune pancreatitis is a particular type of pancreatitis of presumed autoimmune etiology, it is an entity distinct from all others forms of chronic pancreatitis, characterized by clinical, histopathological, radiographic, serologic and therapeutic features. This benign disease resembles pancreatic carcinoma both clinically and radiographically. Case Report: A 27-year-old man presented with obstructive jaundice and evocative image of pancreatic tumor. A pancreaticoduodenectomy (Whipple operation) was performed and pathological examination of the specimen diagnosed AIP. Patient responded well to a course of corticosteroids with resolution of clinical and biological disorders. Conclusion: Accurate and timely diagnosis of autoimmune pancreatitis is particularly important because steroid therapy is effective and pancreatic resection is not necessary.

Intraperitoneal rupture of hydatid cysts

PurposeHydatid cyst rupture into abdominal cavity is a rare but a serious complication. The rupture can occur after a trauma, or spontaneously as a result of increased intracystic pressure. It is a surgical emergency with high morbidity and mortality rates. Early diagnosis and appropriate surgical management of this complication can be life saving. The objective of the current paper is to evaluate the clinical, and radiographic findings and surgical treatment of this complication.MethodsA retrospective study on 12 patients operated in our department for intraperitoneal rupture of hydatid cyst between January 1990 and May 2015. We reviewed age, gender, imaging findings, surgical treatment procedures, mortality, morbidity and recurrence.ResultsOur study includes 12 cases of intraperitoneal rupture of hydatid cysts; eight of the patients were men, and four were women. Four patients had a history of abdominal trauma and the other ruptures occurred spontaneously. All the patients had peritoneal irritation signs at presentation. All them underwent ultrasonography and CT scan. Imaging showed intraabdominal free fluid in all of cases. In 11 cases the cyst was unique and only in one case an associated mesenteric hydatid cyst was noted. Ruptured cysts were located in the right lobe of the liver in nine cases, in the left lobe in the other three cases. All the patients underwent emergency surgery after imaging. The procedure applied was conservative associated with drainage in all the cases. Some associated procedures were performed during the same operation. In only one case total pericystectomy for intraperitoneal cyst was performed. There were no post operative deaths. A total of five morbidities developed in three patients (one case of evisceration, three cases of biliary fistula and a case of pulmonary infection).ConclusionsHydatid cyst rupture in peritoneal cavity is a rare complication. Imaging assessment has an important role in diagnosis but clinical signs are mandatory. A quick diagnosis and emergency surgery can decrease postoperative death. Surgery and postoperative care constitute the basis of treatment.

Pelvic abscess complicating sigmoid colon perforation by migrating intrauterine device: A case report and review of the literature

Highlights • Intrauterine devices (IUD) are effective, safe, and widely used contraceptive devices. Their use is about 14.7% in the developing countries and 8.9% in developed ones.• The perforation of the uterus by the IUD is a relatively rare complication whose incidence is estimated between 1.3 and 1.6 per 1000 insertions, but the consequences can be very serious.• Ectopic migration of IUD with involvement of adjacent organs can cause catastrophic complications such as gastrointestinal perforation.• Ideal treatment of IUD migration remains controversial.

Adenosquamous carcinoma of the right colon: A case report and review of the literature

Highlights • Adenosquamous carcinoma is a rare colorectal tumor with both glandular and squamous histologic component.• To the best of our knowledge only few cases have been reported in the literature till date.• Adenosquamous carcinoma is a rare colorectal neoplasm with non-specific complaints.• Its clinicopathologic behavior is not understood.• Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment.

Post Traumatic Dorsal Mass of a Child Hand: Rhabdomyosarcoma Must Be Suspected

Rhabdomyosarcoma (RMS) is a highly malignant soft tissue tumor accuring in children. Strongly suggestive history of trauma is recognized as an etiological factor of RMS. rapidly growing, persistent firm, or non-mobile lesions appearing after trauma should raise the suspicion of malignancy. If doubt exists, radiological exams must be performed because appearance of RMS is highly suggestive. We report a case of 8-year-old girl with a history of trauma how’s developed RMS of the dorsum of his left hand and we describe radiological appearances suggesting this diagnosis

Ossifying fibromyxoid tumor of the trunk mimicking hydatid cyst: A case report

Highlights • Ossifying fibromyxoid tumor (OFMT) is a rare lesion that generally occurs in the soft tissues of proximal limbs.• OFMT most often presents as a single swelling arising from the subcutaneous soft tissues or skeletal muscles of the extremities. Multifocal presentation is exceedingly rare.• Complete surgical excision should be performed to prevent local recurrence.

Gastroblastoma, a biphasic neoplasm of stomach: A case report

Highlights • Gastroblastoma is a rare gastric biphasic tumor with both epithelial and mesenchymal components.• To the best of our knowledge only eight cases have been reported in the English literature till date.• Surgical excision remains the mainstay of treatment.

Primary Chest Wall Abscess Caused by tuberculous Costal chondritis: A case report

Introduction: Mycobacterium tuberculosis can affect almost any part of the body. Although tuberculosis of the bones is well known, tuberculosis involving the cartilages is rarely described. Presentation of case: We report a 30 year male, who presented with insidious onset pain and swelling of the right lower parasternal area which on evaluation was diagnosed as tubercular infection of costochondral junction. The patient had no evidence of tuberculosis anywhere else in the body. Discussion: Bone and joint tuberculosis is a rare location of extra-pulmonary tuberculosis. It predominates at the spine and large joints (hip, knee). The costal involvement is extremely rare location, and primary tubercular costo chondritis is an exceptional form and has been very rarely reported in the literature. Conclusion: This case illustrates that primary rib cartilage tuberculosis is a rare disorder worldwide, and needs high index of suspicion for diagnosis, based on clinical, radiological and microscopical backgrounds. Introduction Tuberculosis continues to be a major international problem especially in less developed countries. The rib is an extremely rare site for osteo-articular tuberculosis, and involvement of costochondral junction is among the rarest forms of tuberculosis even in countries where tuberculosis is common [1,2]. Chest wall tuberculosis is still a diagnostic and therapeutic challenge. Tubercular costochondritis usually presents with insidious onset, vague indolent symptoms with nonspecific pain and swelling, resulting in delay in the diagnosis. The diagnosis of rib cartilage tuberculosis is crucial in order to differentiate it from a benign or malignant bone tumor, or other kinds of bacterial infections [2]. A high index of suspicion for tuberculosis is essential in making an early diagnosis. The definitive diagnosis is suspected by typical radiological findings and confirmed by microbiological and histological evidence of tuberculosis. Treatment consists of antitubercular therapy with or without surgery. We here in report an unusual case of chondrocostal tuberculosis presenting as a swelling over the left lower parasternal area [3,4]. The objective of the current paper is to evaluate the clinical, radiographic findings and the management of this extremely rare condition. Case report A 35-year-old Tunisian woman, with no history of tuberculosis presented with chest pain and swelling over the lower left anterior parasternal chest wall without respiratory symptoms. The patient reported history of progressive weight loss and low grade intermittent fever, malaise and anorexia which began gradually one year back. She was BCG vaccinated and there was no history of contact with tuberculosis in the family. Correspondence to: Omar Toumi, Department of surgery, Fattoumabourguiba hospital, Monastir, Tunisia, Tel: +21652688551; E-mail: toumi.amor@rns.tn

Inflammatory Pseudotumor of Spleen: A Case Report

Introduction: Inflammatory pseudotumor (IPT) is a rare benign disease which presents as tumor like mass mimicking malignancy. The most common sites are lungs, liver, orbits and gastrointestinal tract. Splenic IPT is very rare. Presentation of Case: A 41-year-old woman presented with the complaints of left upper quadrant pain radiating to the back for a year. Abdominal ultrasound and computed tomography (CT) revealed a hypodense lesion of approximately 5 cm located in the splenic parenchyma near the hilum. Hydatid serology was negative. The patient was treated with splenectomy due to diagnostic dilemma and final diagnosis of IPT was made on histopathological examination of the resected spleen. Discussion: Splenic IPT usually affects middle aged women presenting as incidental finding on abdominal imaging. It is most often isolated but at times may be associated with IPT at other sites probably suggesting a systemic etiology. Radiological findings are non-specific leading to diagnostic dilemma. Splenectomy is useful for treating symptomatic cases and helps in making the accurate diagnosis in cases of diagnostic dilemma. Conclusion: Splenic IPT is a rare, benign condition which should be included in the differential diagnosis while evaluating a splenic mass.