[ particular hepatocellular carcinoma combining the ordinary and the fibrolamellar variant]

Fibrolamellar carcinoma [FLC] of the liver is a rare variant of hepatocellular carcinoma [HCC] occurring on non cirrhotic liver. Since its first description by Hugh Edmondson in 1956, 200 cases of FLC have been reported in the literature, but only some cases describe the association of the ordinary HCC with the FLC within the same lesion. We report in this study the case of a 14-year-Old female patient with a hepatic mass whose radiological aspect evoked a nodular and focal hyperplasia. Histologically, this tumor was composed of area of FLC mixed with ordinary HCC. Staining for cytokeratine 7 was positive in the FL component and negative in the ordinary HCC component

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

Carcinome neuro-endocrine sur oesophage de braaett rapport d'un cas

The neuroendocrine tumours of the oesophagus are exceptional. They are a spectrum of heterogeneous tumours often not clearly defined in the literature. We report a case of moderately differentiated neuroendocrine tumour of the oesophagus arising from barrett's mucosa in 51- year- old man treated surgically and who was free of disease 28 months after excision. We discuss about this case, the classification, the histogenesis and therapeutic approaches of these tumours

Le cancer du colon, e'tude de 153 cas et comparaison avec une serie historique de 140 cas

The authors study the epidemiological, diagnostic and therapeutic features of 153 consecutive cases of colon cancers collected between 1985 and 1998. They compare the results with those of a previous study performed in the same hospital service [140 cases between 1966 and 1984]. It is a series of 79 men and 74 women [sex ratio= 1,07]. The mean age was 56,6 +/- 14 years old with 13,7% of the patients who were less than 40 years old. The operability and the resecability were respectively 98,7% and 83,7% with a global operative mortality of 7,9%. According to the Dukes classification, they were 2A stages, 73 B stages, 32 C stages and 45 D stages. Starting from 1993, 53% of the C stages an 48% of the B stages had an adjuvant chemotherapy, The comparison between our present results and those of our previous series does not show any modification in what regards the mean age, the cancer frequency in young people, the complicated forms proportion and time needed for the diagnosis by comparison to the beginning of symptomatology. The colic cancer prognostic improvement is attained through an earlier diagnosis, making it possible to reduce the developed forms and the complicated forms proportion, the consequence of which is the operative mortality decrease and the log-range survival increase

Les derivations porto-systemiques dans le syndrome de budd-chiari avec obstruction cave inferieure

We report two cases of the Budd-Chiari syndrome with obstruction of the inferior vena cava. The Budd-Chiari syndrome was caused in the first case by recurrent hydatic cysts of the liver that surgery was impossible in one single time and in the second case to a deficit in the protein C. A meso-innominated and a meso-atrial shunts were performed respectively. The first was complicated by thrombosis after five weeks, before treatment of the hydatic cysts whereas the second was patent during 37 months. In the absence of other therapeutic alternative apart from hepatic transplantation in the Budd-Chiari syndrome with occlusion of the inferior vena cava, the porto-systemic shunts are the procedures of choice in spite of the high risk of secondary failure related essentially to graft thrombosis. However, their modality still remains to be discussed

veine porte preduodenale: Apropos d'un cas

The authors report a case of a 53-year-old woman that was suspected as having a preduodenal portal vein in echoendoscopy. The diagnosis was confirmed at laparotomy performed for biliary lithiasis. No surgical procedure was performed because there was no evidence of duodenal obstruction by this preduodenal portal vein. The preduodenal portal vein is an exceptional congenital anomaly that must be considered as a rare cause of duodenal obstruction. The tomodensitometry and possibly the echoendoscopy allow the diagnosis. Many other congenital anomalies such as a duodenal atresia can be associated and must always be searched

Approche de l'epidemiologie dicriptive des cancers digestifs a travers l'activite d'un service de chirurgie generale

Pending the results of the cancer registry, it is difficult to study the epidemiological profile of the digestive cancers in Tunisia. We have trying to approach this profile through the activity of the surgery department A in the Charles Nicolle hospital during the lost 11 years period. Between 1987 and 1997, 22491 patients were admitted in our service among which, 644 had a primary digestive cancer [2.86%]. Concerning these 644 patients we have studied the following parameters: localisation, age, operative rate, resection rate, post-operative mortality and definitive histology. They were 375 men [58,2%] and 269 women whose the average age was 59,44 +/- 13,35 years. The most frequent localisation of the cancer was the stomach [25,9%], the colon [20,8%], the rectum [13%]. the pancreas [11.5%], the oesophagus [10,4%], the gall bladder [7%]. The average age varied with the localisation between 56,2 years [colon] and 67,8 years [biliary tracts]. Apart from the gall bladder cancer that occurred more frequency in women, the sex ratio [men/women] for the other localisation varied between 1,03 [colon] and 1,83 [stomach]. The resection rate varied with the localisation between 8,1% [pancreas] and 82% [colon and rectum]. The post-operative mortality was 12,5% [73 patients]. There is the some rate after surgery with tumour resection [12,3%] and palliative surgery without resection [12,8%]. This mortality was caused by a medical complication in 76% of the cases. In spite of many slants in keeping with the service recruitment and the selection of the patients confided to the surgery, this study allows on approach of some epidemiological characteristics of the digestive cancers in Tunisia

La lesion du nerf crural compliquant les cures des hernies de l'aine par plaque pre'-pe'ritone'ale. Apropos de 2 observations

Between January 1995 and September 1997, 83 patients having bilateral inguinal and/or crural hernia underwent. a prosthetic herniorrhaphy which is complicated in two cases by an iatrogenic lesion of the crural nerve. Reoperation was required in both of cases. In the first case [of late diagnosis], there is a fibrosis around the mesh sheathing the crural nerve. The follow up was favourable after neurolisis. The second patient was reoperated in the immediate postoperative period. The crural nerve was picked up by the mesh side fixing knot. The follow up was also favourable after neurolisis. The crural nerve iatrogenic lesion occurring during the groin hernia repair with a wide preperitoneal prosthesis must be prevented by a vigorous operative procedure particularly at the time of side attaching of the mesh. This side securing of the mesh is unnecessary. The arising of a pain or a leg functional disability during the post operative period must evoke a crural nerve lesion, and lead to a surgical exploration