[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

[Post hemorroidal anal stenosis]

Anal stenosis represents a rare post hemorroidectomy complication which is difficult to manage. We report a series of eight cases, five male and three female, aged 29 to 67 years old, through a period of 12 years, in whom anal stenosis occurred 2 to 16 months after hemorroidectomy, which was of pedicular type in 5 cases, circular in one case and of a non precise type in 2 cases. We performed three sphincterotomy with anoplasty, two dilatations associated with lateral sphincterotomy, one Bellan's anoplasty and an Y-V flap's anoplasty. All our patients regained their proper anal diameter, with amelioration of the discriminatory sensibility, the medium recurrence time was three years and half [maximum 9 month and 7 years]. The anoplasties provide good results. The best treatment is prophylaxis done by choosing the safety technic and respecting the rules of hemorroidectomy

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

megaoesophage primitif chez l'adulte: a propos de 50 cas

The authors review 50 cases of idiopathic mega-oesophagus of the adults treated. An extra-mucous oeso-cardiomyotomy was performed via an abdominal approach in all the patients. An anti-reuex operation, type Loartat-Jacob or a hemivalve mechanism was performed. Functional results were found excellent to good in short and long term follow up. The persistant stasis demonstrated by baryum study but without symptoms constitute a radiological failure only

chirurgie dans les stenosis peptiques de l'oesophage: a propos de 9 observations

The authors report nine cases of oesophagus peptic stenosis. The treatment is essentially surgical. If the conservative interventions off most of operative security, the radical give best results on the functional and stability fried

[Surgical traumas of the main biliary duct]

The authors report 21 cases of operative traumatisms of the main biliary duct seen at the Medical School Hospitals of Rabat and Casablanca between 1971 and 1979. Eight accidents immediately admitted during the surgical procedure have been repaired with success. Thirteen accidents operated on secondarily ended in 3 deaths and 10 favourable results. The authors analyze the gravity factors of the complications dominated by the angiocholitis, the restenosis and the evolution to the biliary cirrhosis