ABSTRACT
We report a series of 15 cases of secondary psoas abscess, showing its diagnostic and therapeutic difficulties aiming at evaluating the interest of precutaneous drainage role in its treatment. It is a monosentric retrospective study lasts for 5 years [January 2003- December 2007]. The study based on the clinical and operative reports, radiological and bacteriological findings. The study includes 15 cases aged 14 to 72 years old, the average was 31,4 years with slight male predominance 9 males to 6 females. Diagnosis has been done by the ultrasound and scanner examinations. 6 cases have [Crohm's disease, 3 retroc ecal apprendicitis, 2 tuberculous spondylitis 2 on top on colon tumors, 1 with diverticulitis and 1 post traumatic case. The most causative germes were gram-negative of digestive origin. In addition to the antibiotic treatment, 8 patients were operated from the start, 3 cases operated after a percutaneous drainage and 4 cases had a percutaneous drainage only which was effective. The secondary psoas abscesses are rare. As the clinical picture is less specific and hides the original pathology, which must be searched for and treated, diagnosis delayed. The most efficient treatment is the combined surgical and antibiotic one. The percutaneous drainage has its role in treating secondary psoas abscesses. At least it defers the surgical treatment to be done in better conditions latter on during the second step
ABSTRACT
It is the most common progressive and revealing complication of colon cancer. This urgent situation becomes grave by combination of both cancer and occlusion. The surgean must deal with the blockage as well as the cancer. This action takes into account several parameters, not only the patient's clinical state but also the site and stage of the tumor. It is concerning 18 patients who had a colonic occlusive cancer, throught a period of 5 years. The parameters include the clinical state of the patient, and site and stage of the tumor. Of 123 colo-rectal cancer patients operated during this period, 18 cases were suffering from occlusion, represting 15%. Average age was 54 years, ranging from 31 to 78 years, divioed to 10 men and 8 women with sex ratio of 1, 2. The location was predommataly in the left colon with 13 cases, 4 cases in the right colon and 1 case in medium rectum. The right colon 1 cases in medium rectum. The right localisations were operated in a one stage operation while the left and rectal cases were carried out in 2 stage: 1 with primary colostomy and 13 with surgical colostomy the morbidity rate was at 19%. Early diagnosis, an adapted resuscitation procedure and a rapide surgical interferance with colostomy, can reduce the morbidity and mortality rate. Tumoral resection witn continous restauration is the most pratical urgent surgical interference. An appropriate care, manily the patient's rehydration and rapide surgical interferance will reduce mortality and morbidity rates. While the treatment or right colon cancer can be done by an one stage surgery, the left occlusive colon cancer as it is more urgent is managed case by case and we recomond a colostomy with or without the first resection