R. Jouini

What remains to surgeons in the management of abdominal tuberculosis? A 10 years experience in an endemic area

BACKGROUND Tuberculosis (TB) is a common endemic disease in Tunisia. Abdominal location is rare. Early diagnosis of abdominal TB remains difficult due to its non-specific clinical presentations. The aim of our study is to highlight the characteristics of the different presentations, to characterize tools contributing to a positive preoperative diagnosis, and finally to assess the role of surgery in the management of this entity. MATERIALS AND METHODS A retrospective review from 2005 to 2015 identified 90 cases of confirmed abdominal TB managed in the Department of General Surgery of the Habib Thameur Hospital. The diagnosis was established by histopathology examination for all cases. This study was approved by the ethical committee. RESULTS The mean age of the patient was 44.13 years with a sex ratio (M/F) of 0.34. We collected 56 cases of peritoneal TB, 12 cases of abdominal lymph node TB, 10 cases of intestinal TB, four cases of hepatic TB, and two cases of gallbladders TB. For six patients, an association of many localizations was noted. The diagnosis was suspected on clinical, biological, and morphological arguments, but the confirmation was always made by surgical exploration and pathological examination of removed specimens. Surgical management was urgent in complicated cases (13.3%). Laparoscopy was performed in 71 cases (78.9%). Laparoscopic features of peritoneal TB were specific and always confirmed by histological examination. CONCLUSION Despite the wide range of examination available for the preoperative exploration of abdominal TB, diagnosis is usually late and difficult. TB is a medical condition. However, surgical exploration is frequently needed in the management.

P 92 : L’érythrokératodermie progressive symétrique

Introduction L’erythrokeratodermie progressive symetrique est une genodermatose rare a transmission variable le plus souvent autosomique dominante. Elle est proche de l’erythrokeratodermie variable, autre genodermatose hereditaire, mais s’en distingue par le caractere bilateral et symetrique des lesions. Ces dernieres apparaissent le plus souvent des les premieres annees de vie mais la maladie peut aussi debuter a l’âge adulte. Elles siegent principalement aux dos des mains et des pieds, plus rarement a la face ou au tronc. Sur le plan histologique, la maladie est caracterisee par une importante hyperkeratose orthokeratosique avec parfois, focalement une parakeratose. L’epiderme est hyperplasique, pa- pillomateux et acanthosique sans lesions de la granuleuse. Tout au plus, on peut noter des vacuoles claires perinucleaires dans les granulocytes. Le derme papillaire comporte un infiltrat inflammatoire peri-vasculaire d’abondance variable. Observations Un homme âge de 22 ans consultait pour des placards lichenoides, pigmentes, symetriques, localises au niveau des dos des mains et des pieds et evoluant depuis deux ans. L’examen histologique de la biopsie de la lesion de la main gauche montrait un epiderme legerement papillomateux, acanthosique surmonte par une importante hyperkeratose orthokeratosique. La granuleuse etait conservee avec par endroits des vacuoles peri-nucleaires. Le diagnostic d’erythrokeratodermie progressive symetrique a ete retenu. Le malade a ete convoque pour une enquete genetique.