Postoperative peritonitis after digestive surgery. About 92 cases

92 cases of post-operative peritonitis in digestive surgery are recorded: - Diagnosis is difficult inspite of the multiplicity of symptoms which are variable and non specific. - Clinical presentation is dominated by the frequency of infectious symptoms essentially fever, neuro -psychic, hemodynamic and respiratory disorders. Abdominal signs though advocatory are late. - Early reoperation represents the only possibility of survival for the patients. It must contain a way large, a complete peritoneal washing, an eradication of the source of peritonitis and an effective drainage. - A correct ressucitation effective before, during, and after operation is fundamental. - The prognosis of this fearful complication improves clearly in case of operation and the mortality rate declines from 100% [in absence of operation] to 47.4% [in case of operation]. Because of the high mortality rate, [44.4%], this post-operative complication has to be prevented

Intra-hepatic abcess of biliary origin. About 3 cases

Intra hepatic abcesses of biliary origin are the extension to the liver of suppurative cholangitis. They are mostly, multiple scattered abcesses, seldom is it a single large abcess. They are the most frequent of pyogenic liver abcesses. Their clinical study is uneasy because their signs remain drow in the cholangitis presentation explaining that they are discovered during surgery or even at necropsy. Treatment is medico-surgical but morbidity and mortality remains elevated, owing to delayed diagnosis because of lack of specific signs. About 3 [three] observations of intra hepatic abcesses of biliary origin, a review of the literature is made to specify their pathogenic, diagnostic, therapeutic and prognosis problems

Gastric Polyps. About one case

The authors report on a case of gastric polyposis diffuse and isolated. The affection is rare and not well known. We have tried to emphasize certain aspect of this affection, such as its positive diagnosis which has become easy by the current practice of high fibroscopy. The second problem relates to the evolving risk dominated mainly by the degeneration of adenomatous polyps, but the association of gastric polyposis with stomach cancer is not rare. The gastric polyposis is considered as a precancerous lesion; thus total gastrectomy constitutes the means of therapeutic safety

gastric leiomyosarcoma. About 2 cases

Our topic take into consideration two cases of leiomyosarcoma: the first one was duodenal; the second gastric, both admitted at Surgical Emergency in an advanced degree. Difficulties were faced at every level especially in the first case where initial diagnosis was a false pancreatic cyst. The leiomyosarcoma was found out only one year later through the cytological study of fragments after reoperation. Difficulties in treatment are due to the uncertainty of the diagnosis, the degree and place of the tumor. The study of different cases shows that the leiomyosarcoma is successfully cured thanks to surgical operation, on the contrary of the others digestive sarcoma. The life esperance overtaking 5 years are frequent. These studies shows also that gastric leiomyosarcoma gives higher rate of survival than leiomyosarcoma in other level of digestive tract. The duodenum leiomyosarcoma is more difficult to determinate because of difficulties in operation. That is why it's necessary to make treatment of any leiomyosarcoma forend out through an operation

Les abces intra-hepatiques d'origine biliare: a propos de 3 observations

The intrahepatic abscesses of biliary origin represent the extension of cholangitis to liver. They are the most frequent of pyogenic abscesses of liver. Our study carry 3 [Three] observations and aim to clear their pathogenics, diagnosis, therapeutics and prognosis problems. The abscesses were multiple scettes, rarely single and with great size. The symptoms were the same of cholangitis explaining their discovery at operation or at necropsy. Their treatment is medico-surgical their mortality is very high because the diagnosis is late by want of specific signs of abcesses. Our 3 cases are female sex aged respectively 23; 30 and 50 years and were admitted for cholangitis. The diagnosis of intrahepatic abscesses was called in preoperatory for 2 ceses by scanning, and operatory in one case by cholangiography. Two patients were operated with ablation of obstacle and biliary drainage by Kehr in one case, and internal drainage by sphincterotomy in the second case. The surgical act was accompanied with antibiotherapy who the unique treatment for the third case operated, before for choledocolithiasis. In conclusion, an early diagnosis by actual means and treatment of all lithiasis's bowl who give an obstacle of choledoc and cholangite

Les splenomegalies chirurgicales principales etiologies

Surgical splenomegaly are frequent. Authors study the principal aetiologies. The spleen hypertrophy could be caused by a local disease, purely splenic, or due to a general one. Thus, many medical services could be confronted with this pathology. Authors insist on the surgery which is more and more conservative in certain aetiologies where splenomegaly is due to a local affection

Hemobilie post traumatique recidive apres ligature arterielle hepatique

The authors report a case of post-traumatic haemobilia in a children, 12 years old. A ligature of the right hepatic artery was performed. A severe recurrence of the haemobilia has occurred. The etiologies and treatment of the recurrence of the hamobilia after hepatic artery ligature are discussed

Surgical treatment of hemorrhagic complications of duodenal ulcer

Haemorrhage complicating duodenal ulcer is relatively rare compared with other complications of duodenal ulcer. Inspite of this fact, haemorrhage of duodenal ulcer is responsible for high rate mortality of complicated duodenal ulcer. The mortality rate is related to: severity of bleeding, recurrency, and also advanced age great help in the identification of the chracteristics and types of the ulceratives lesions showing the tendency of recurrent bleeding, hence, a more active attitude will be adopted rapidly as the risk of mortality is higher in these cases when recurrent massive bleeding arrives. In this study carride on 85 cases of haemorrhage complicating duodenal ulcer: 48 patients are operated upon, 45 with trunkal vagotomy with or without local hemostatic mesures, 3 cases of supraselective vagotomy were than. Mortality rate in this group was 10% [8 patients out of 85] 5 deaths happend before any intervention, other 2 deaths during surgical operation and related to massive or recurrency haemorrhage. The recurrent haemorrhage arrived for 2 patients after trunkal vagotomy was responsible of death for these two cases. According to this study, and also to other recent publications, we found that the Weinberg operation is the operation of choice, but the good results published recently by certain groups using supraselective vagotomy, obtained also in our group [3 cases] are encouragely to substitued trunkal vagotomy by this technic

Transection pancreatique par contusion abdominale chez un enfant de 12 ans

An isolated complete transection of the pancreas due to blunt trauma in a boy 12 years old is reported. The laparotomy is indicated because a guarding reaction of the left hypochodrium which appeared a few hours after the trauma. The treatment is a distal pancreatectomy conserving the spleen. The course is simple. No diabetes appeared at the first months later. The diagnosis of blunt trauma of the pancreas is difficult on emergency. The best management of the transection of the pancreas seems to be resection of distal pancreas

[Psoas hydatid cysts]

Inspite of the endemic nature of the hydatic disease in Morocco, some localizations are unusual, the one of the psoatic muscle is rare. The authors report 5 cases and stress the diagnostic difficulties of this localization. The extraperitioneal surgical way is preferred whenever the lesion is isolated. The organs of the proximity, essentielly composed of vessels and nerves make the complete perikystectomy dangerous and incite to a partial perikystectomy.

[Intermittent volvulus of the stomach with hepatic atrophy]

Concerning two observations of hepatic atrophy with intermittent volvulus of the stomach, the different etiologic and therapeutic factors are analised, the treatment of the duodenal ulcer often associated is thrown into relief to avoid the recurrency of the torsion