Amoeboma cecal

Inflammatory pseudotumor uncommon parasite colon, the amoeboma cecal is a rare complication of intestinal amebiasis . Its clinical symptoms are nonspecific and a diagnosis problem. We report a case of a 61 years old patient, who had the right flank pain associated to a dysentery syndrome, the physical examination revealed a mass of the right flank. The abdominal scan showed an extra luminal tissue process of the right colon. The colonoscopy objective an extrinsic compression of the right colon obstructing the colonic lumen. The evolution was marked by the occurrence of an occlusive syndrome and the patient was operated urgently and a right colectomy was performed. Histological examination was in favor of a cecal amoebome. The postoperative course was uneventful and the evolution one year is favorable. The amoebome is difficult to diagnose, its radiological and endoscopic appearance can simulate colon cancer and lead to improper surgical treatment. Positive serology is the diagnosis and allows to initiate effective medical treatment. The amoebome should be considered in a process without extrinsic evidence confirming neoplasia, the diagnosis confirmed by serology avoids surgery

[Longo's technique in the treatment of hemorrhoids grade III and IV]

The purpose of this study is to show the interest of the Longo technique in the treatment of hemorrhoidal prolapse stage III and IV as to report as results too. Twenty-one patients were operated by the Longo technique. Hemorrhoids were classified as stage III and IV respectively in 13 and 8 patients. They have been followed in consultation at two months, six months and one year, allowing data collection. The mean duration of intervention was 38 minutes. The mean duration hospital stay was 2.2 days. There were no incidents during surgery. The mortality rate was zero. The complication rate is estimated at short, medium and long term, it was 23.80% [n=5]: two hemorrhages [9.52%] at the staple line, two acute urinary retention [9.52%] and external hemorrhoidal thrombosis [4.76%]. All patients didn't need any local treatment. The postoperative follow-up detected a bleeding at defecation in one patient; another one had a recurrence of the prolapse associated with rectal bleeding, the third had a completely asymptomatic moderate stenosis stapling site easily dilatable. Eighteen patients [85.71%] had no symptoms and were completely satisfied, two patients were moderately satisfied, and one was dissatisfied. The circular anopexy is an effective technique with 85.71% of patients satisfied in one year. The complication rate is low and the quality of results depends on the technical gesture

[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

Lymphome primitif du sein

They are rare tumors representing only 0,1% to 0,5% of all breast and chest neoplams. They have numerous diagnostical problems as well as clinical and anatomopathological difficulties. In fact the discordance between a benign mamographic image and clinical manifestations of malignancy should lead to suspicion of breast lymphoma. The histological examination should be completed by an immunohistochemical study that confirms the lymphomatous nature of the lesion. Prognosis is correlated to histological type. We reported a case of a female patient who consulted for a breast tumour and in whom the anatomopathological study confirms the diagnosis of a grand B cell lymphoma. We focus in our study on the clinical aspects of lymphoma and its therapeutic modalities with literateure review

Volvulus of the sigmoid colon. Therapeutic strategy. About 38 cases

A retrospective study of 38 cases of sigmoid volvulus is reported. The relative frequency of this pathology among young people in Morocco is noted. In 82% of cases diagnosis was without difficulty; and in two cases an associated small bowel volvulus was found. When deciding on the therapeutic approach it is essential to differentiate between cases in which the sigmoid colon is necrotic and those in which the changes are reversible. In the latter, the authors recommend a non surgical reduction [using flatus tube or better: colonoscopy] with elective surgery performed at later date. If initial reduction proves impossible, colonic resection whith colostomy appears to give the best results

Peritoneal puncture lavage in closed abdominal injury. About 230 cases

In this work, the authors have studied especially the reliability and the limits of the perironeal puncture lavage. About 230 cases of abdominal trauma collected in the services of surgical emergencies and surgical intensive care of the Ibn Rochd Teaching Hospital of Casablanca from 1980 to 1984. In this series, the child and the young adult of masculin sex are the most concerned, the road accidents constitute the most frequent etiology. The reliability of the method in our experience is 93%. The caution of use are reminded; 11% of wrongly positive results concern particularly the retro-peritoneal hematoma; the problem of the tiny intra-peritoneal lesion is discussed, the risk of the wrongly negative results is of 3%. The indications, sensibility and specificity of the peritoneal puncture lavage are discussed. That is a practice and useful examination, which diminishes the delay of diagnosis and the mortality in the case of abdominal trauma without evident clinic sign, and in the polytraumatised

Management of differentiated thyroid carcinoma. About 43 cases

This study is about 43 differentiated thyroid carcinoma. This form of cancer affects principaly women and young people between 20 and 40 years. Diagnosis is essentially based on the histological findings. Main treatment is surgery associated with hormonotherapy. We have practiced 43 operations: 9 unilateral thyroidectomies, 18 total thyroidectomies on one time, 8 total thyroidectomies on two times, 6 subtotal thyroidectomies, 2 tumors reductions, 6 neck dissections. The protocol that should be followed is the one that will give the best chances of survival with the lowest sequelae. Surveillance should last during all life

Surgical treatment of idiopathic megaoesophagus

About an analysis of 15 cas of mecaoesophagus, the authors underline it's clinical latency. The clinical features become clear when the megaoesophagus is already constitued after a certain delay. Heller's myotomy is the operation of choice that gives fonctionnals and anatomical results