[Rare causes of low digestive hemorrhage]

The lesions responsible for low digestive hemorrhage [LDH] are located at the lower part of the angle of Treitz. They are of origin colic in 90% of the cases. The lesions of hail are less frequent, with more difficult diagnosis and management. We report 2 observations of rare causes of LDH 47 and 44 years old respectively admitted both because of an anaemia with low digestive hemorrhage related to a stromal jejunal tumor in the first case and on a cavernous hemangioma of hail in the other case. The diagnosis is confirmed by the histologic study of the exeresis product

[ thoraco-Abdominal injury: about 78 cases]

The authors report a series of 78 cases of the thoraco-abdominal wounds collected between 1992 and 2002.The mean age of the patients is 27 years old [16- 60 years old] with male predominance [90%].The aggressions with a blade [stab] are the exclusive etiology [100%]. The left hemi thorax represents the Site of penetration in 80% of cases. The clinical symptoms at the admission were dominated by the respiratory detress. The chest radiography that has been achieved systematically. In all our patient, showed a hemothorax [39 cases] hemopneumothorax [20 cases], the radiography was normal in 27 cases. The abdominal ultrasound was done in 36 cases when the thoraco-abdominal injury was suspect, however the clinical examination and radiography were normal. It's showed a double peritoneal and pleural effusion in 36% of the cases. About the therapeutics, the treatment has been always surgical, so, the laparotomy has been necessary in 66 patients, the thoracotomy in 2 cases, the thoraco-laparoscopy in 4 cases, and the thoracoscopy in 2 cases. No death was noticed in this series The immediate following have been simple in the majority of the cases, in 6 patients, pleuro-pulmonary complications have been occurred. The thoraco-abdominal injuries have sometimes a problem of diagnostic, specially if only the diaphragm was injured. We believe that the thoracoscopy is the best exam to confirm the diaphragm injuries. The thoraco-laparoscopy can be the best surgical approach

Surgical resection of klmatskin tumor. About 6 cases

Hilar bile duct carcinomas or klatskin's tumors are rare that represent 1.5% of the digestive cancers and their prognosis is poor with a survival until 5 years less than 3%. From 1996 to 2001, 6 patients had beneficied from a surgical resection because of a tumor of the hepatic helium. It is about 2 men and 4 women aged from 34 to 51 year-old. Three patients had suffered from biliary lithiasis and all the patients presented a retential jaundice. Surgical procedure had consisted in a resection of the extrahepatic bile ducts [6 cases], pedicular ganglial curettage [6 cases] associated to a left hepatectomy in one case. The recovery of the continuity has been based in the patients on anastomosis between a well made bile mouth and a jejunal ansa in Y shape of 70 cm. The anatomopathologic study confirmed the diagnosis of a tubulosecreting adenocarcinoma in all patients. The operative mortality has been nil and the morbidity consisted in anastomatic fistula [1 case], pleuropulmonary infection [1 case], one patient died 9 months after a tumoral relapse. The radical surgical resection is the only therapeutic that permits to hope a prolonged survival and sometimes recovery