[Primary necrosis of the ligamentum teres hepatis]

Report a new case of primary necrosis of the ligamentum teres hepatis and discuss preoperative diagnosis strategy and therapeutic options. This is a patient of 76 years, hypertensive, who was admitted for an acute abdomen. The diagnosis of acute pancreatitis was referred to the poor clinical examination and amylase to six times normal. Abdominal CT scan showed a normal pancreas appearance and hypodense infiltration extended along the round ligament of the liver to the anterior abdominal wall that did not take the contrast. The patient was operated 24 hours after admission to the signs of clinical and biological severity. There was gangrene of the round ligament and the suspensory ligament of the liver. We performed a resection of all necrotic tissue and cholecystectomy. The postoperative course was uneventful. Primary necrosis of the round ligament of the liver is an extremely rare cause acute abdomen. Its diagnosis is difficult despite the contribution of the abdominal CT scan. Treatment is surgical

[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

Rupture de varice duodenale. Une cause rare d'hemorragie digestive liee a l'hypertension portale

The duodenal varix rupture is a rare and serious complication of portal hypertension. The authors report one case of duodenal varix rupture in a 38 year old woman, revealing portal hypertension, which caused a massive gastro-intestinal bleeding. The endoscopy didn't allow to conclude to a diagnosis. An emergent laparotomy was necessary regarding the massive bleeding. A duodenal varix suture ligation was performed after pyloroduodenotomy. She had a well recovery. After a review of literature, the authors conclude that this abnormal situation is rare, its diagnostic is difficult and it has several therapeutic strategies