[Epidemiological profile and management of rectal cancer: what changed in 20 years?]

The incidence of rectal cancer is increasing in Western countries. What is it for us, do we have more rectal cancer? The change of our way of life, the aging population could be risk factors. Furthermore the management of rectal cancer has considerably progressed. The purpose of this study is to compare the epidemiological profil and the management of rectal cancer between two series collected to 20 years of interval. It is about two retrospective cases, the first one, collected from 1981 to 1985 [série A], includes 80 patients. The second one, recent, collected from 2005 to 2011 [série R], includes 94 patients. We analyzed for the epidemiological profile, the middle number of case per year, age, sex, seat of the tumor, histological type, metastatique stage. We analyzed for the management: operability rate, resection rate, type of intervention. The middle number of cancer of the rectum hospitalized per year in our formation is respectively 16 +/- 4.06 and 18 +/- 4.14 in serie A and the serie R [p = 0.91]. The mean age of patients was 49.5 +/- 14.7 for serie A and 48.6 +/- 13.3 for serie R [p = 0.674]. There is a masculine predominance in the two series [p = 0.7]. The three segments of the rectum are reached in the same proportions in the two series [p = 0.8]. The low rectum represented half of the cases [54.5% serie A, 56.9% série R]. The metastatique stage is more frequent in série R [32 [22.7%] vs 18 [34%] [p = 0.14]. Resection rate represents respectively in série A and série R, 68.9% and 84% [p = 0.428]. Abdomino-perineal amputation has been achieved in 45% of the cases in serie A and 30.3% of the cases serie R [p = 0.003]. The study found that the incidence of rectal cancer has not increased in our training in the space of 20 years, however, in two series, 25% of patients are aged less than 25. The management of this cancer was marked by systematic preoperative radiotherapy in the serie R for low rectal cancers, by reducing the safety margin to 2 cm and by reducing the number of abdominoperineal resection. Eidemiological profile did not change. However, the management of rectal cancer been influenced by the new data of the rectal surgery. This study showed that rectal cancer in Morocco had different characteristics than that in West country. Environmental and genetic studies may explain this difference

[Hydatid cust of the spigelian lobe of the liver: diagnosis and treatment]

Surgery of the hepatic of hygdated cysts is a current practical procedure in Marocco due to the endemic context it is generally simple, and the surgical technique is viell cadified. Nevertheless certain hepatic localization like segment I may engeder difficulties and operatory complications that the surgeon must know for a better management. This is a retrospective study over ten years, it concerns ten patients with hydatid cyst affecting the Spigelian lobe with or without other localization. There is a female predominance the mean age is 43 years. Four patients were already operated on for liver hydatid cyct: two had involvement of caudal lobe. The clinical symptoms were not specific. Diagnostic imaging is mainly based on ultrasound and CT. All the patients were operated by laparotomy. Five patients had an hydatid cyst in caudal lobe only, four other associated hepatic lesions, and one case had a peritoneal hydatid disease. Type I was found in 2cases, type III in 5, type IV in one case and infected cyst in 2 cases. At surgical exploration it was found that caudael lobe cyst was intimatel anterioly with the hilum and the hepatic pedicle and with the inferior vena cava retrohepatic posterioly and at the right sue. We performed resection of the prominent dome ; the residual cavity was treated with hydrogen peroxide and systematically drained. The immediate postoperative were simple, the postoperative hospital stay was between 8 and 18 days. The surgical treatment of segment I hepatic hydatid cyst obyes the principals of hydated surgery and involues an important large vascular or buliarg wound risk. The resection of the prominent dome is an intervention simple, rapid and hemorrhagic with low mortality, but fails to eluminate a residual cavity may be ne seat of callection. Conservative treatment remains the gold standard, provided that there is a good postoperative monitoring and adequate management of biliary complications or infection

[Primary linitis of the rectum: a difficult diagnosis]

Introduction: Primary linitis of the rectum is a rare carcinoma characterised by the difficuly to be diagnosed Histologically

Case report: A 25 years old female patient, presented with a subocclusive syndrome, secondary to an anal stenosis at 6 cm from the anal margin, of an inflammatory look. Surgical exploration showed pseudo inflammatory rectal tumour, colstomy was performed. Analysis of surgical biopsy did not find tumoral cells. Eight months later, stenosis progressed and invated the anal margin and the recto- vaginal partition. TDM showed and abdomino- pelvic mass. The pathological biopsy study, found a signet cell carcinoma. The patient died six months later

Discussion: The discordance between the histological study of different biopsies of stenosis, with the clinical picture which did not evoke an intestinal inflammatory diseace, prevented us to do an radical sollution for our patient. In spite many profound surgical biopsises which had been done, diagnosis of linitis did not proved

Conclusion: In cases of rectal stenosis of inflammatory picture which is not supported with a convinced anatomopathological arguments we must think of specific colitis

Leiomyoma of the colon [report of a case]

Leiomyoma of the colon is an extremely rare tumor. Reports are those of sessil intraluminal lesions. We report a case of extraluminal leiomyoma of the transverse colon. The diagnosis is suspected at laparotomy and confirmation of the precise nature of the neoplasm by histologic examination

Pilonidal sinus

Pilonidal sinus is a frequent benign disease, with a localization often sacrococcygeal. Its etiopathogensis is still badly clarified. Diagnosis is generally easy in typical forms: purulent flow by an opening situated at the level of inter gluteal furrow and containing some hairs. Some diagnosis traps secondary to aberrant localizations should be known. Open surgical excision and cicatrizationnn is the treatment of choice. To this effect, we report 29 cases of pilonidal sinus operated on by this method between 1990 and 1999. This pathology occupies the fourth place of proctological diseases 75% of the patients are young, aged between 20 and 40 years. Male predominance is clear with a sex ratio H/F=1,9. Chronic purulent flow is the main symptom found in 82,23 of cases. After a retreat of one to 10 years, a case of fake recurrence has been noted. A second resection without closure has been successfully done