Spontaneous fistulization of hepatic hydatid cyst into the duodenum: an exceptional complication

Hydatid disease is a worldwide zoonosis and is localized in the liver in most cases. Its complications are numerous and include those related to the compression of adjacent viscera, infection of the cyst's contents or perforation of the cyst. Spontaneous rupture of the hepatic hydatid cyst into the duodenum is an extremely rare complication. The communication is, typically, not discovered until surgery. We present two cases of perforation of a liver cyst into the duodenum. One of them was diagnosed pre-operatively by a barium study. The surgical treatment of the lesion and its complications was complex but successful in both cases

Rare cause of a lower gastrointestinal bleeding

Leiomyoma of the colon are rare benign smooth muscle tumours. Report a new case of colic leiomyoma revealed by gastrointestinal bleeding. A 71-year-old man, diabetic, consulted the emergencies for acute per-rectal bleeding. The physical examination was essentially normal. Haemoglobin level was 3.7g/dl.. The upper digestif endoscopy was normal. The colonoscopy showed an active bleeding from the right colon but it was enable to specify the nature and the exact seat of the bleeding lesion. An emergent operation showed a tumor of the right colic angle of 8 cm. A right hemicolectomy was performed with immediate ileocolic anastomosis. Pathology showed a leiomyoma. Postoperative course mentioned a nosocomial pneumopathy. Colic leiomyomas are rare benign tumours. The determination of the mitotic index is of primary importance to differentiate them from the leiomyosarcomas of low rank of malignancy whose prognosis is unfavourable

Primary anorectal melanoma: a case report

Anorectal melanoma is a rare but highly lethal malignancy. Clinical symptoms are non-specific and treatment is still debated. The aim of this study was to report a case concerning diagnostic and management of Anorectal melanoma. A 66-year-old man was admitted in our surgical unit with a 3-month history of pain and rectal bleeding. Rectal examination revealed a tender mass arising from the 5 o'clock position of the anal canal that bled on touch. A provisional diagnosis of rectal polyp was made and it was removed by local excision under general anaesthesia. Histopathologic examination reported it as an anorectal malignant melanoma. The postoperative course was uneventful. Extension staging showed a 15 mm nodule on the left lung. The patient underwent a metastasectomy of the left lung. No adjuvant therapy was given. He died one year later. With this case we want to illustrate that malignant melanoma can be difficult to diagnose, as patients have non-specific symptoms and histology may be misleading. Surgery remains the mainstay of treatment. Wide local excision combined with adjuvant loco-regional radiotherapy should be preferred when technically feasible. Abdominoperineal resection has to be done only in the case of large tumors or when the anal sphincter is involved. Overall 5-year survival is less than 20%. It's correlated to extension of disease regardless of initial surgical therapy

[Odontogenic descending necrotizing mediastinitis]

Descending necrotizing mediastinitis [DNM] following an oropharyngeal infection is a rare disease with a rapid course and a mortality rate of up to 40%. The aim of this study, is to outline the diagnosis and the appropriate treatment of DNM. A retrospective study [1986-2007] of patients with DNM was made. Only patients with cervical cellulitis associated with DNM were included. Eight men and two women with an average age of 43 years were treated. Five had diabets. The average for diagnosis and treatment was eight days. In eight cases, we found a dental origin and in two cases a pharyngeal origin. The diagnosis of DNM was made thanks to cervico thoracic CT scan in six cases. In the others patients. they had at presentation clinical and radiological evidence of mediastinal diffusion. All patients were treated by broad spectrum antibiotherapy. All had cervical drainage. Mediastinal drainage was made by cervical approach in 2 two cases and via a right thoracotomy in eight cases. Eight patients died. Odontogenic DNM is a rare disease with rapid course Clinical diagnosis is difficult and early recognition with a lowi thresold for CT scanning is essential. CT is also useful for the treatment and in the post operative assessment. All affected tissue plane must be debrided. Surgical management and mediastinal drainage remain controversial about the indication of thoracotomy

[Primary carcnoid hepatic tumour: a case report]

Primary carcinoid tumour of the liver is rare and poses a diagnostic and management dilemma. Report a new cases. A 48 year-old patient man, with a 8-months history of abdominal pain and weight loss, was operated on in December 2000, in another centre with the diagnosis of caudate pancreatic cancer. At laparotomy, Resection was deemed to be not feasible. Histological examination of biopsy was for carcinoid tumor. The patient underwent post operative radiotherapy and four courses of chemotherapy and he was referred to our hospital. Physical examination was normal. Based on radiological examination, the diagnosis was endocrine tumor of the pancreas. The patient underwent relaparotomy, the lesion was independent from the pancreas but linked to the liver; the caudate lobe. Complete macroscopic resection was performed. Histological examination of operative specimen concludes to carcinoid tumor with invasion of hepatic margins. The patient underwent adjuvant chemotherapy; he was free from disease 6 months after surgery. The diagnostic of primary carcinoid tumors is based principally in the histopathological confirmation of neuroendocrine origin and the exclusion of non hepatic primary tumour. This requires preoperative imaging but most importantly a thorough laparotomy and rigorous follow-up. Surgical resection if possible is recommended

Deux cas de cancerisation des stenoses caustiques de l'oesophage

The incidence of carcinoma of the esophagus within patients with chronic esophageal stricture caused by ingestion of corrosive agents is reported to be significantly higher than in the general population. Two patients developed carcinoma of the esophagus respectively 25 and 40 years after corrosive injury. One of these patients had initially gastrostomy and repeated esophagal dilation. Taking into account the high incidence of carcinoma in the site of esophageal stricture, we conclude that the resection of the esophagus is indicated in patients with chronic caustic stricture if there is any finding suggestive of malignancies such as a long duration of the lesions more than 20 years particulary when the ingested agent was caustic soda or sudden aggravation of preexisting dysphagia