[Malignant intraductal papillary mucinous tumours of the pancreas: a three cases report]

Intra ductal papillary mucinous tumors of pancreas are rare and are characterized by a risk of malignant transformation. To clarify their clinical presentation and the performance of different imaging examinations to determine their benign or malignant and achieve their staging. We report three cases of degenerate intra ductal papillary mucinous tumors of pancreas. The combination of CT, the pancreato- MRI and duodenoscopy has led to the diagnosis in all cases. A pancreaticoduodenectomy were performed in two cases. The various imaging techniques allow better detection and analysis of the tumor including the evaluation criteria of degeneration. The treatment of these lesions is still surgery

[Colo-urachal-cutaneous fistula in an adult]

An infected urachal cyst is an uncommon finding in adults. To report a case of a sigmoid- urachal- cutaneous fistula. A 51 years old adult male presented with fecaloid leaking from rupture of an infected urachal cyst. Definitive management consisted of resection of the urachus with a bladder cuff, along with removal of the affected bowel segments. Colo-urachal-cutaneous fistula is a rare condition; its management is rather complex

[Totally implantable venous access ports by cephalic vein cut-down for patients receiving chemotherapy]

The use of an implantable room has become indispensable in the clinical practice for the cancer patients. The increasing use of these devices was associated with a greater incidence of complications. To verify the feasibility of the cephalic vein cut-down technique for placement of venous access devices. A prospective study of 58 port placements was performed at our department of general surgery. The surveillance of devices was collectively insured by the operator and by the oncologists. The indication for implantation was the infusion of intravenous chemotherapy in patients with colorectal cancer in 55.1% cases and breast cancer in 27.5%. The specific complication rate was 7%. The cephalic vein cut-down approach was used successful in 45 [77.5%] patients. When the cephalic vein could not be used, a percutaneous technique was employed using the subclavian vein in 22.4% of the patients. Cephalic vein cut-down technique should be considered a safe and feasible approach for placement of venous access devices

[Mesenteric panniculitis simulating malignancy]

Panniculitis mesenteritis is a rare, benign, and chronic fibrosing inflammation disease with unknown aetiology that affects the mesentery of small bowel and colon. To report a new case of this entity and to highlight its diagnostic difficulties especially when it affects the mesocolon. A 37 years-old women presented with chronic abdominal pain; physical examination found mass of left ilaca fossa. Closcopy and abdominal CT scan showed a thickness of bowel wall with negative biopsies. The patient underwent a colectomy. Histologic examination concluded to the diagnosis of Mesenteric panniculitis without malignant lesion. Mesenteric panniculitis is a rare pathology which diagnosis is difficult to establish. It can simulate malignancy. A better knowledge of its clinical and radiological features could ovoid unecessary digestive resection

Appendicitis in strangulated femoral hernia: a case report

Herniation of the appendix into a femoral hernia also called De Garengeot hernia-is a rare but well-recognized entity. It is typically discovered incidentally during hernia repair. Acute appendicitis in a strangulated femoral hernia is even more uncommon. Report a new case. We report on a patient admitted for a painful groin mass. She underwent emergency surgery. Exploration identified acute appendicitis in a strangulated femoral hernia sac. Appendectomy associated with Mac Vay's herniorrhaphy were performed. The outcome was uneventful. Surgeons should be aware of the existence of this infrequent and atypical presentation of appendicitis and femoral hernia

[Peripancreatic sporadic gastrinoma]

The peri-pancreatic sporadic gastrinoma represents a paradigm of digestive endocrinology. It was originally an abnormal secretion of gastrin fits the syndrome Zollinger-Ellison. The objective of our work is to clarify the diagnostic strategy and therapeutic conduct of gastrinoma. We report the case of a patient aged 42 years, hospitalized for bleeding duodenal ulcer, revealed a Zollinger-Ellison syndrome. The objective of our work is to clarify the diagnosis strategy and therapeutic conduct of gastrinoma. We report the case of a patient aged 42 years, hospitalized for bleeding duodenal ulcer, revealed a Zollinger-Ellison syndrome. The different explorations have shown that it was a primitive peripancreatique sporadic gastrinoma. In surgery, we discover a retropancreatique tumor associated to a stenosis post-bulbar ulcer. It was conducted a enucleation of the tumor with vagotomie troncular and normalization of the values of gastrinemie. The sporadic gastrinoma is rare, its emphasis in increasingly being facilitated by the technology of modern medical imaging. Treatment of pancreatic gastrinoma is multidisciplinary. Surgery is the only cure for this disease

[Early gastric adenocarcinoma]

the purpose of this study was to determine the epidemiological and clinical behaviour of the superficial adenocarcinoma of the stomach, to clarify its pathological characteristics, therapeutic as well as his its prognosis. Over a period of 14 years [1990-2004], 16 patients were operated for a superficial gastric adenocarcinoma among 155 gastric cancers treated during the same period in the service of general surgery [A] La Rabta. The superficial gastric adenocarcinoma represented 10.3% of our series. The mean age was 59 years. It was about 8 men and 8 women. Two patients was followed for a chronic stomach ulcer, a patient is followed for Biermer anaemia and another one for Menetrier disease. Among these cancers, 12 were intra mucosal and 4 invaded the submucousa. Lymph node involvement was present only in one case. The cancer was located in the antrium in 8 cases and was multifocal in 3 cases. One patient died in postoperative case because of a medical cause. The 5-year-overall survival was 65.6%. The recurrence had interested only one patient. the superficial gastric adenocarcinoma is rare. The follow up of precancerous states allows its diagnosis. The treatment is based on the gastric resection associated to the DI-type lymph node clearance. The multifocal character imposes a surveillance of the remaining gastric stump

[Laparoscopic appendicectomy versus conventional appendicectomy prelliminary results of a retrospective comparative study]

The value of laparoscopic surgery in appendicitis is not established. Studies suffer from many controversies. The aim of this study is to compare the safety and benefits of laparoscopic versus open appendectomy in patients with clinically non complicated acute appendicitis. One hundred thirty nine patients wore analyzed retrospectively following either laparoscopic or open appendectomy. We excluded peritonitis, appendicular abscesses and patients with history of digestive surgery. The main outcome measures wore operative duration, postoperative complications and length of hospital stay. There was no mortality. The overall complication rate was similar in both groups [13,9%versus 7,4%in the laparoscopic and open groups respectively p=0,22]. Operating duration was significantly longer in the laparoscopic group [62 minutes versus 40 minutes p=0,001] while there was no difference in length of stay. Laparoscopic appendectomy did not offer a significant advantage over open appendectomy in acute non complicated appendicitis. The choice of the procedure should be based on surgeon or patient preferences

[Gastric adenocarcinoma with lymphoid stroma: about nine cases]

The purpose of this work is to study the pathological features and the outcome of lymphoid stroma gastric carcinoma and its relation with Epstein-Bar Virus [EBV] and the importance of the EBV serology in detection of early reccurence. Between January 1990 and december 2004, 155 patients underwent gastric resection for gastric carcinoma. Nine of them had lymphoid stroma gastric carcinoma. Over all survival as well as disease free survival were determined. Detection of reccurence was based on clinical exam and on findings yielded by endoscopy, radiological exams and EBV serology. A comparison of survival rate of patients beteween current gastric carcinoma and those with lymphoid stroma gatsric carcinoma was done using the Log Rank test. the patients [7 men and 2 women] had a mean age of 61 years [41 to 82]. The tumor was in the antrum in 4 cases, in the body of the stomach in 3 cases and in the cardia in 2 cases. The mean tumor size was 8 cm with deep invasion of the stomach wall in 5 cases and ganglion invasion in 6 cases out of 9. EBV was detected in all patients by in situ hybridation. Post operative morbidity and mortality were nil. Global survival and disease free survival were, respectively, 53.3% and 65.6% in lymphoid stroma gatsric carcinoma, and 43.4% and 63.5% for current gatsric carcinoma. Three patients died of a reccurent disease after 6, 30 and 33 months. The remaing 6 patients didn't have signs of reccurence. lymphoid stroma gastric carcinoma is a bulky, local disease. In our patients, it was always associated with EBV. Over all survival was better than survival of current gastric carcinoma, although there was no significance. EBV serology can be an effective screening procedure of reccurence