S. Bouchoucha

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.

Facteurs thérapeutiques affectant la cicatrisation au cours des gangrènes du périné

Fournier gangrene is a rare and severe necrotizing fasciitis. It is burdened with high morbi-mortality, requiring early and massive medical and surgical management. Initial treatment is based on patients resuscitation associated with surgical debridement. Subsequently, the main challenge is the healing process and its possible sequelae. Several therapeutic approaches are currently available to improve and accelerate the healing process. We conducted a retrospective study of 20 cases. The median age of our patients was 56 years. The study included 16 men and 7 women. Comorbidity was present in 15 patients. Antibiotic therapy was administered in all cases, with a median duration of 15 days. All patients underwent surgery. Iterative reviews were necessary in all patients, who needed, on average, 3 dressing changes. Colostomy was performed in 6 cases. Hyperbaric oxygen therapy was performed in 4 cases. Vacuum assisted closure was performed in 1 case. Soft tissue coverage was necessary in 2 cases. The mean duration of healing was 15 days with oxygen therapy versus 24 days in the absence of this treatment. The mean duration of hospitalization was 20 days. Four patients died. Healing process without sequelae is a therapeutic challenge. Despite the addition of new therapeutic approaches, outcomes are not satisfactory. However, multidisciplinary approach associated with oxygen therapy and vacuum assisted closure might improve patients outcomes.

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.

Syndrome de la pince mésentérique primitif : cause rare de la sténose digestive haute chez l’adulte

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 26 fevrier 2016

Laparoscopic approach in an incarcerated femoral hernia, with the ipsilateral fallopian tube as a single content

The right fallopian tube as a single content of an incarcerated femoral hernia is an uncommon condition. Due to its extreme rarity, preoperative misdiagnosis is frequent.Femoral hernias are more frequent among women. The strangulation rate is higher than in the other groin hernias. Thus, femoral hernias are usually operated on and diagnosed in an emergency setting which leads to higher postoperative morbidity and mortality.The main aim is to verify the vitality of the contents of the hernia sac. In the absence of ischaemic signs, the contents can be safely reduced back into the abdominal cavity. Otherwise, resection is inevitable. The authors report the case of a 20-year-old patient presenting an incarcerated femoral hernia containing the ipsilateral fallopian tube. At laparoscopic exploration, the fallopian tube was seen to be contained within the sac, without the ovary which was in the abdominal cavity. After checking out the vitality of the fallopian tube, it was reduced back into the pelvis. A resection of the hernia sac with a suture of the neck was performed. Postoperative recovery was uneventful and the patient was discharged on the second day following surgery. The patient was informed of the risk of an ectopic pregnancy that could prove fatal due to incarceration of the fallopian tube. To our knowledge, this is the sixth case to be reported in the literature, and the first time a laparoscopic approach has been used in such a case. Diagnostic and therapeutic aspects of this rare condition will be discussed, along with a review of previous reported cases.

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.

Difficultés diagnostiques et thérapeutiques de l’actinomycose abdominale : à propos d’une observation chez une patiente tunisienne

The Abdominal Actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. The diagnosis is difficult. It can have a variety of clinical manifestations and can mimic a malignancy. Its established by histology of surgical biopsy. We report a case of a 58 years old woman admitted to our institution for a pain of the right iliac fossa with a mass. The diagnosis was established after surgical intervention and histological examination. The treatment was surgical resection and antibiotherapy by amoxcillin during 6 months. The primary diagnosis of abdominal pelvic actinomycosis is difficult. All organs and anatomic structures of the abdomen can be involved. Even with extensive infection, combined operative and antibiotic therapy allows cure in most cases.

Difficultés diagnostiques et thérapeutiques de l’actinomycose abdominale : à propos d’une observation chez une patiente tunisienne@@@Therapeutic and diagnostic difficulties of abdominal actinomycosis: about one case in a Tunisian female patient

The Abdominal Actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. The diagnosis is difficult. It can have a variety of clinical manifestations and can mimic a malignancy. Its established by histology of surgical biopsy. We report a case of a 58 years old woman admitted to our institution for a pain of the right iliac fossa with a mass. The diagnosis was established after surgical intervention and histological examination. The treatment was surgical resection and antibiotherapy by amoxcillin during 6 months. The primary diagnosis of abdominal pelvic actinomycosis is difficult. All organs and anatomic structures of the abdomen can be involved. Even with extensive infection, combined operative and antibiotic therapy allows cure in most cases.

A solid pseudopapillary tumour of the pancreas

Solid pseudopapillary tumour of the pancreas is a rare neoplasm which, for the most part, affects young women and has a relatively favourable prognosis with low malignant potential. We report the case of a 48-year-old woman with a pseudopapillary tumour of the pancreas. Abdominal computed tomography and magnetic resonance imaging showed a solid, cystic mass in the pancreas. She was successfully treated with a cephalic duodenopancreatectomy. The SPT is an infrequent tumour, typically affecting young women. Surgical resection is generally curative, even in locally advanced or metastatic disease