[Budd-chiari syndrome a rare complication of hepatic echinococcosis; about 3 cases]

Hydatid disease is a parasitic infestation due to the development of echinococcus granulosus in the organism. This disease is particularly frequent in Tunisia where echinococcosis is endemic. Liver is the most common organ to be involved by hydatidosis and several complications have been described. Vascular complications secondary to hepatic echinococcosis such as Budd-Chiari syndrome have rarely been reported. We present herein, three rare cases of hydatid cyst complicated by Budd-Chiari syndrome. The cyst occupied at least two segments of the hepatic dome in all patients and his diameter was 12, 5 cm, 21 cm and 12, 5 cm respectively. According to the Gharbi classification, the cysts were type III in one case and type IV in the two others. The Budd-Chiari syndrome was chronic in one patient and asymptomatic in the two others. His diagnosis was established by abdominal US in two cases, completed by US Doppler and CT angiogram in one patient and by CT angiogram in the other. The diagnosis was established only by CT angiogram in the later case. The Budd-Chiari syndrome was due to compression of two hepatic veins in one case, compression of inferior vena cava in one case and compression of one hepatic vein and inferior vena cava in one case. Laparotomy was performed in all patients. The surgical procedure consisted in resection of the protruding hepatic tissue after puncture aspiration of the cyst in the three cases. The postoperative period was complicated by abscess formation in residual cavity, requiring drainage and by development of ascitis, in one case. Hydatid cyst should be remembered amongst the causes of Budd-Chiari syndrome in countries where the disease is endemic. Conversely, this vascular complication should be looked for routinely in patients with hydatid disease of the liver

[Inguinal hernia of the bladder a cases report]

Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritive and obstructive lower urinary tract symptoms. We report a case of left inguinal hernia involving the bladder in a 60 years old man who had obstructive lower urinary tract symptoms. The diagnosis was done on the retrograde urethrocystography. We performed inguinal mesh with herniated bladder reduction. The postoperative history was uneventful

Pancreas hydatic cyst: a case report

Echinococcal involvement of the pancreas is extremely rare. The clinical presentation is polymorph and the diagnosis is rarely evocated before surgery. We report a 60-year-old woman presenting with epigastric pain. Abdominal examination found an epigastric mass. Radiologie explorations [Abdominal ultrasound and a computed tomography scan] revealed a pancreatic cyst located in the corpus and in the tail. The diagnosis of hydatid cyst was made at laparotomy. The cyst was treated by aspiration and injection of hypertonic saline solution followed by cystectomy. Three years later, the patient was asymptomatic without recurrence of hydatic cysts. Epidemiological, clinical, biological and radiological data should allow better detection of hydatid cysts of pancreas. Surgical treatment depends on the location of the cyst in the pancreas

[Abdominal cystic lymphangiomas-Report of three cases]

Cystic lymphangioma are rarely observed in the abdomen. Their incidence varies between 2 and 10% of all localisations. The diagnosis is based on histopathological exam but can be suspected by radiology. Laparoscopic removal of the cyst is possible offering many adantages. We report the case of abdominal cystic lymphangioma occurring in women respectively 60, 65 and 68 years aged. Abdominal pain was the main symptom. Diagnosis was suspected before surgery in two cases thanks to the radiological findings. In these two patients, the cyst was removed under laparoscopic surgery. The third patient was operated by laparotomy. The diagnosis was established on histopathological study. With a mean follow up of 36 months, there were no signs of recurrence

Gastric stromal tumors, a retrospective - a study. About 19 cases

The purpose of this study is to define the therapeutic attitude to be adopted in front of a gastric stromal tumor, to estimate the results and to define the prognostic factors of these rare tumors. We report a retrospective study about 19 cases of gastric stromal tumors reported over a period of 12 years going from January, 1993 till December, 2004. All the patients were operated. Diagnosis was established by the histological and immunohistological study of gastric resection or biopsies. It was about 8 men and 11 women of whom the average age was of 62 years. The symptomatology was dominated by abdominal pain [63% of cases] and digestive bleeding [52% of cases]. A palpable mass was found in 16%of cases. The tumor location was antrum in 13 cases, fundus in 5 cases and under cardial in 1 case. A synchronous gastric and small intestinal locations was found in 1 case. The average tumoral size was 8.2cm ranging from 1.7 to 30cm. The tumor resection was achieved in 18 cases [95%]. It was widened to the adjacent organs in 1 case. Morbidity raised 5.2% and there was no operating death. At pathological examination the tumor was of weak rank of wickedness in 8 cases, high rank in 8 cases and in vague potential in 3 cases. The average follow-up was of 27 months [2 to 96 months]. During the postoperative follow-up, 3 cases of recurrence were diagnosed. The 2-year -overall survival was 83%. The prognostic factors influencing the overall survival were the high cellular density [p=0.01], local recurrence event [p=0.03] and high degree of malignancy [p=0.0002]. The treatment of gastric stromal tumors is surgical. Gastrectomy and wedge resections passing in macroscopically normal tissue are the mainstay of the treatment. Enucleating resection should be avoided. The lymph node dissection is not recommended. The new chemotherapeutic agents [the tyrosine kinase inhibitors] seem promising and could modify the current therapeutic attitude in the future

[Neuroendocrine tumours of the pancreas - a report of two cases]

Neuro-endocrine tumors of the pancreas are rare. Tumors can be discovered according to the endocrine syndrome produced. They are characterised by a slow evolution. Criteria of malignancy are metastasis to lymph node, liver or dissemination to other organs. Occurrence of multiple neuro-endocrine tumors may be seen forming multiple endocrine neoplasie type 1 or MEN-1