Idiopathic segmental infarction of the greater omentum

Idiopathic segmental infarction of the greater omentum is a rare cause of acute abdomen. The diagnosis is based primarily on the abdominal CT scan. A 20 year old male presented with right lower abdominal pain. Initial examination unremarkable and patient was kept under observation. Symptoms did not abate and CT scan showed an ovoid fat density mass in abdomen. Laparoscopy showed partially twisted omentum which was resected at open surgery

[Predictive factors of esophagojejunal fistula after total gastrectomy in gastric cancer patients]

The main complication observed after total gastrectomy is the oesophagojejunal anastomosic fistla. Its incidence varies between 7.4% and 11.5%. The mortality after anastomic leafage is high at around 20%, representing 30% and 54% of global mortality after total gastrectomy. This study aimed to evaluate mortality and morbidity after total gastrectomy and to determine their predictive factor. This is retrospective study about 80 cases of total gastrectomy for gastric cancer, collected in the departmentof General Surgery of the University Hospital Habib Thameur Tunis during the period 1 January 1995 to 31 December 2010. Reconstruction of the alimentary tract was achieved by Roux-en-Y-jejunal-loop. Esophagojejunal anastomotic leeakage developed in 14 patients [17%]. In 8 patients treatment of anastomotic leakage consisted of re-operation with surgical drainage and confection of jejunostomy. in one patient treatment required resutre of the anastomosis and drainage of an abscess. In one patient treatment required resuture of the anastomosis and drainage of an abscess. In 5 of the 14 patients with a proven leak of oesophagojejunal anastomosis, conservative treatment with parental alimentation, placement of an irrigation-aspiration system and systemic antibiotics was performed. This treatment was successful in all cases. The presence of anastomic fistula extends the median length of post operative stay in the hospital of 20 days compared for the payents withiut fistula.Global mortalilty was 8/80 [10%]. After esophagojejunal anastomotic leakage, the mortality was 3/8 [21%]. Leakage of the oesophago-intestinal anastomosis may occur after total gastrectomy for gastric cancer. It's serious complication contributes to mortality after total gastrectomy. Knowledge of the predective factors of esophagojejunal fistula after total gastrectomy in gastric cancer can decrease its incidence

Giant gastric lipoma mimicking well-differentiated liposarcoma

Gastric lipoma is a rare tumor, accounting for only 5% of gastrointestinal tract lipomas and less than 1% of all gastric tumors. Histological diagnosis is usually easy. However, the tumor may sometimes undergo significant inflammatory changes leading to a difficult differential diagnosis with well-differentiated liposarcoma. Authors report the case of a 51-year-old man, presenting with epigastralgia of recent onset. Physical exam was unremarkable. Endoscopy revealed a large, ulcerated, submucosal, and antral tumor. CT scan showed an antral mass with fat attenuation. The patient underwent a total gastrectomy. Macroscopic examination identified in the antral wall a 9-cm, well-circumscribed, nodular lesion, with a greasy cut surface. On histological examination, the tumor was composed of a mature adipocytes proliferation, showing significant variation in cell size, associated to some lipoblasts. Nuclei were sometimes large, irregular, neither with hyperchromasia nor mitosis. Diagnosis of a well-differentiated liposarcoma was suspected and hybridization. The diagnosis of lipoma was made. Twelve months after surgery, the patient is doing well. In conclusion, differentiating benign from malignant fatty tumors is sometimes difficult in morphologic features. In these cases, cytogenetic procedures are the only means for an accurate diagnosis

[Laparoscopic treatment of duodenal ulcer feasibility and results: about 160 cases]

The objective of this study is to evaluate the feasibility, efficacy and safety of laparoscopic repair for perforated duodenal ulcer. One hundred and sixty patients were treated by coelioscopic procedure for a perforated duodenal ulcer. The procedure consists of a suture of perforated ulcer associated with a peritoneal lavage. A medical treatment of Helicobacter pylori associated with an inhibitor of the protons pump was conducted. The coelioscopic procedure permitted to confirm the diagnostic of perforated duodenal ulcer in all cases. A simple suture of the ulcer was done in 155 cases. The conversion was compulsory in 5 cases, because of difficulties of the peritoneal lavage in 2 cases, a bleeding associated with perforation of the ulcer in one case and associated stenosis in 2 cases. Mean duration was 90 min [extremes 50 - 120 min]. Complications occur in 3.1%. There were post - operative peritonitis in 3 cases and duodenal fistulae in 2 cases. All patients were reviewed at 16 months. A recurrence, either clinical or endoscopic occured in 4 cases because of no adhesion to medical treatment. Coelioscopic treatment of perforated duodenal ulcer is a safe and efficacy method. It permits to avoid potential septic and parietal complications of laparotomy. The actual efficacy of medical treatment mustn't allow place to the radical treatment of ulcerous illness

[Common bile duct distomatosis managed by coelioscopic arroach]

Biliary distomatosis is caused a parasitis of trematode family: the fascialo hepatica. It is a rare affection in Tunisia. The diagnostic is often done in the status phase. Adult parasite stay preferentially at biliary ducts, cause obstruction and cholangitis. The authors report a case of biliary treated successfully by laparoscopic procedure

Filiation Hamartoma polyposis dysplasia and small bowel adeno-carcinoma

Peutz-Jeghers syndrome is a hereditary affection with dominant autosomal transmission. The risk of cancerisation is largely higher than that in the general population. Dysplasia is rare. Transformation of the polyposis hamartoma into a site of dysplasia then into adenocarcinoma has been rarely reported. The authors report the case of a 14 year-old patient, having a severe dysplasia on ileal polyposis hamartoma related to the syndrome of Peutz-Jeghers