Sami Daldoul

T-tube drainage of the common bile duct choleperitoneum: Etiology and management

External drainage of the common bile duct by placement of a T-tube is a common practice after choledochotomy. This practice may result in the specific complication of bile peritonitis due to leakage after removal of the T-tube. This complication has multiple causes: some are patient-related (corticotherapy, chemotherapy, ascites), and others are due to technical factors (inappropriate suturing of the drain to the ductal wall, minimal inflammatory reaction related to some drain materials). The clinical presentation is quite variable depending on the amount and rapidity of intra-peritoneal spread of of bile leakage. Abdominal ultrasound (US), with US-guided needle aspiration and occasionally Technetium(99) scintigraphy are useful for diagnosis. Traditional therapy consists of surgical intervention including peritoneal lavage and re-intubation of the choledochal fistulous tract to allow for a further period of external drainage. When leakage is walled off and well-tolerated, a more nuanced and less invasive conservative therapy may combine percutaneous drainage with endoscopic placement of a trans-ampullary biliary drainage.

Jejunal GIST causing acute massive gastrointestinal bleeding: role of multidetector row helical CT in the preoperative diagnosis and management.

In this report, we describe a 34-year-old man with a jejunal gastrointestinal stromal tumour (GIST) accompanied by an unusual severe haemorrhage. Because oesophagogastroduodenoscopy proved inconclusive in determining the source of the bleeding and also because of gradually dropping haemoglobin levels and persistence of the melena not allowing colonic preparation, colonoscopy was cancelled and a mesenteric angio-computed tomography (angio-CT) was deemed necessary. The results of this analysis showed a 5-cm heterogeneous mass located in the jejunal loop surrounded by abnormal arterial structures. This multidetector computed tomography (MDCT) appearance was highly suggestive of GIST. The patient then underwent an urgent laparotomy and, peroperative findings being compatible with angio-CT descriptions, a small-bowel resection was performed. The results of the histopathological examination confirmed the diagnosis of GIST. Angio-CT helps define the size of GIST as well as its range and location and can be used as the primary routine test for patients suffering from lower-GI bleeding.

Unusual Presentation of a Colonic Sarcoidosis

Sarcoidosis is a multisystemic disorder of unknown cause that affects almost every tissue in the body. Colon is an extremely rare location of this disease. Clinical presentation, endoscopic appearances, and radiologic findings are not specific and may mimic much other affection. We report the case of a 64-year-old woman with inactive pulmonary sarcoidosis who presented alternating constipation and diarrhea. Colonoscopy revealed a stenotic tumor in the ascending colon. Histology failed to determine the nature of the lesion. Radiologic findings are those of a long stenotic tumor of the ascending colon associated with a multiple satellite lymphadenopathy. Endoscopic and radiologic descriptions are highly suggestive of a malignancy. The patient underwent a laparotomy, and a right hemicolectomy was performed. Examination of the resected specimen showed follicular structure with central epitheloid and giant cells and surrounding fibroblasts. These findings made the diagnosis of colonic sarcoidosis. The nonspecificity of the endoscopic and radiological signs of gastrointestinal sarcoidosis and the extreme rarity of colonic location make the preoperative diagnosis unlikely. The diagnosis will be then made only on histological examination of surgical specimens. We describe, through this observation, the results of paraclinical investigations that can suggest diagnosis and perhaps avoid surgery.

Vaginal cuff dehiscence and evisceration 11 years after a radical hysterectomy: A case report

Highlights • Vaginal cuff dehiscence (VCD) and evisceration (VCDE) is a rare but rather serious complication of any type of hysterectomy.• The overall incidence was ranged betwenn 0% and 7,5%.• Historically, laparotomy was recommended for VCD repair.• In our case we choosed to add a Polyglactine mesh and in the limit of our review it’s the only case reported.

Original treatment for ischaemic stenosis of colon interposition: Report of two cases

INTRODUCTION The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined. CASE REPORT We report two cases of patients operated for ischaemic stenosis of the cervical extremity of the colon interposition for caustic stenosis of the oesophagus. Treatment consisted of resection of the stenosis with creation of a new cervical anastomosis after complete release of the colon graft via a neck and upper midline incision in one patient and a new ileocolic graft exclusively replacing the stenotic segment of the oesophagoplasty in the second patient. DISCUSSION These two cases illustrate the complex treatment modalities required for this complication. CONCLUSION The treatment of choice of ischaemic stenosis of colon interposition is resection with creation of a new anastomosis, but repeat graft may sometimes be the only available treatment option.

La cholédochostomie transhépaticokystique dans le traitement des kystes hydatiques ouverts dans les voies biliaires : revue des indications et analyse des résultats d’une série de 25 cas

The treatment of hydatid cysts of the liver opened in the bile ducts is sometimes difficult and complex. The trans-hepaticocystic coledochostomy (CTHK) is one of these processes. We conducted a review of the indications for this surgical procedure and its perioperative outcomes through a series of 25 patients and then we analyzed predictor factors of complications. During the periods study, 909 patients with liver hydatid cyst went under the surgery. Ninety two (92, i.e. 10.1%) of them had an opening in the bile ducts through a large fistula. Twenty five (25, i.e. 27%) had a trans-hepaticocystic coledochostomy. The sex ratio was 0.6. The population was young with an average age of 47 years. The trans-hepaticocystic coledochostomy was performed because of a thick pericyst associated with a nonsutured fistula in 18 cases, a voluminous residual cavity with a soft pericyst but the fistula was unexposed in six cases and in a case where the pericyst was thick, fistula was exposed. Its suture was associated with a high risk of bile duct stenosis. Specific morbidity was 20% due to a length of the intraductal coledochostomy under 2 cm (P = 0.016), the absence of an epiploplasty (P = 0.004) and the existence of a leak of contrast material outside the fistula on the cholangiography (P = 0.005). The trans-hepaticocystic coledochostomy is a safe and reliable technique, often indicated when other conservative methods are failing. The application of its technical requirements and avoidance of mounting errors allow reducing its morbidity.

Gallbladder Adenosquamous Carcinoma Associated with Biliopancreatic Maljunction and Cystic Metastases of the Liver Miming Abscess

Gallbladder adenosquamous carcinoma is a rare tumor with glandular and squamous malignant components. We report a special case of this rare tumor with cystic metastasis of the liver miming hepatic abscess and associated with biliopancreatic maljunction.

Type IA choledochal cyst in adult

cument téléchargé le 28/02/2020 Il est interdit Choledochal cysts are rare congenital abnormalities. Its discovery in adulthood is even rarer. The diagnosis and the classification are carried by MRI. Once the diagnosis was made, the total resection of the choledochal cyst is needed to prevent neoplastic transformation. We report a case of a 27-year-old woman who was admitted with epigastric pain. She described several episodes of fever with icterus spontaneously resolved. Physical examination revealed a patient without jaundice. The abdomen was soft with a mild right upper quadrant tenderness. Laboratory studies indicated no data perturbation. Ultrasonography showed a cystic lesion of 4 cm in transverse diameter next to gallbladder (figure 1B). At laparotomy, the cystic tumor was 6 cm in diameter (figure 2). It was resected in totality (figures 3A and B) and biliary reconstruction was performed with a long defunctionalized Roux limb anastomosed to the upper biliary

Portomesenteric venous gas in acute small bowel infarction associated with acalculous gangrenous cholecystitis

Hepatic portal venous gas (HPVG), an ominous radiologic sign, was first described by Wolf and Evans in 1955 in infants with necrotizing enterocolitis [1–5]. The mechanism inducing this gas in the portal vein is not well understood. It has numerous causes, predominantly mesenteric infarction, which is associated with poor prognosis [3,5]. Abdominal computed tomography (CT) has become the key imaging procedure used to diagnose acute bowel ischemia and to detect faint signs of portomesenteric venous gas [6–9]. The radiologic presentation has some particularities that physicians must be aware of to avoid delaying treatment. We report a case of extensive portomesenteric gas due to acute small bowel infarction associated with acalculous gangrenous cholecystitis and discuss the pathogenesis and radiologic presentation of this rare entity.

Surgical treatment of late dysfunction of an esophagocoloplasty

Replacement of the esophagus by colon interposition often has late complications, frequently due to technical defects. We report the case of a patient who presented 12 years after surgery with complex dysfunctions of a colonic interposition, including cervical and retrosternal strictures associated with a redundant portion of the colon graft. The interest of this case lies in its combination of many late complications of this surgery in a single person together with the simplicity of the treatment.