[Rare causes of low digestive hemorrhage]

The lesions responsible for low digestive hemorrhage [LDH] are located at the lower part of the angle of Treitz. They are of origin colic in 90% of the cases. The lesions of hail are less frequent, with more difficult diagnosis and management. We report 2 observations of rare causes of LDH 47 and 44 years old respectively admitted both because of an anaemia with low digestive hemorrhage related to a stromal jejunal tumor in the first case and on a cavernous hemangioma of hail in the other case. The diagnosis is confirmed by the histologic study of the exeresis product

Surgical treatment of anoperineal lesions in Crohn's disease

The treatment of anoperineal crohn disease [APCD] is difficult and still a controversy subject. We reviewed 31 cases, which were 19 men. The middle age was 37 years. The lesions were represented by ulcerations in 14 cases, the fistulas in 28 cases and 2 cases of stenosis of the rectum. An hemorroidary disease was associated at nine patients with 1 case of malignant degeneration. The intestinal location was present at 63% of the cases and mostly in a distal part of the bowel. The biopsy of the APCD had objectives a granuloma in 15 cases and a malpighien carcinoma in one case. The treatment consisted, in addition to the treatment of the intestinal disease, on the hygienic and dietary prescription, metronidazol in 100% of the cases, ciprofloxacin in 7 cases. A treatment by immunosuppressor has been instituted for 2 patients. The surgical treatment done for 14 patients consisted in a drainage of the fistulas through fistulotomy [6 cases], incision of abscess [4 cases], progressive fistulotomy with elastic drainage [2 cases], resection of a fibrous diaphragm [1 case] and abdomino-perineal amputation in one case. The APCD is often invalidating with a real therapeutic problem: how can we treat the infectious process without compromising the sphincterian function