Hydatid cyst of the pancreas: a report on seven cases

Primary hydatid cyst of the pancreas is rare, representing 0.2-2% of all human cases. It is usually single and located in the head of the pancreas. The aim of this study was to describe clinical, radiological and therapeutic aspects of hydatid cysts of the pancreas. This study was carried out in the Department of Digestive and General Surgery in Sahloul University Hospital, Sousse in Tunisia during the period 1993-2009. Seven patients were treated for hydatid cyst of the pancreas, three men and four women with an average age of 30 years. The clinical signs were variable according to size and location of the cyst within the pancreas and the degree of biliopancreatic involvement. The main symptoms were pain in left upper quadrant, jaundice, fever and epigastric and right upper quadrant pain. The preoperative diagnosis was established in six patients by ultrasonography and computed tomography [CT]. However, the diagnosis was established during laparotomy in one case. The echinococcal immunological test [ELISA] was positive in only two cases. Surgical treatment included resection of the prominent lump [cystectomy] in five cases, and distal pancreatectomy with splenic preservation in one case and with splenectomy in one case. The postoperative period was uneventful in six cases. Acute postoperative pancreatitis occurred in one case. The patients were free of symptoms and were followed up for 12 months without any recurrence as revealed by abdominal ultrasonography and CT scan. Hydatid cysts in the pancreas are rare. Even if rare, these should be considered in the differential diagnosis of cystic lesions of the pancreas. The surgical treatment is to be considered whenever possible

[Laparoscopic treatment of duodenal ulcer feasibility and results: about 160 cases]

The objective of this study is to evaluate the feasibility, efficacy and safety of laparoscopic repair for perforated duodenal ulcer. One hundred and sixty patients were treated by coelioscopic procedure for a perforated duodenal ulcer. The procedure consists of a suture of perforated ulcer associated with a peritoneal lavage. A medical treatment of Helicobacter pylori associated with an inhibitor of the protons pump was conducted. The coelioscopic procedure permitted to confirm the diagnostic of perforated duodenal ulcer in all cases. A simple suture of the ulcer was done in 155 cases. The conversion was compulsory in 5 cases, because of difficulties of the peritoneal lavage in 2 cases, a bleeding associated with perforation of the ulcer in one case and associated stenosis in 2 cases. Mean duration was 90 min [extremes 50 - 120 min]. Complications occur in 3.1%. There were post - operative peritonitis in 3 cases and duodenal fistulae in 2 cases. All patients were reviewed at 16 months. A recurrence, either clinical or endoscopic occured in 4 cases because of no adhesion to medical treatment. Coelioscopic treatment of perforated duodenal ulcer is a safe and efficacy method. It permits to avoid potential septic and parietal complications of laparotomy. The actual efficacy of medical treatment mustn't allow place to the radical treatment of ulcerous illness

[Liver regeneration after major hepatectomy, evaluation of dogs hepatectomy]

The aim of our study is to evaluate anatomic regeneration and metabolic derangement of the liver after major resection in dogs This is an experimental study on 9 dogs; we divided the dogs in two groups: the first group [5 dogs] underwent at one go major hepatectomy [90% of the liver].The second group [4 dogs] underwent successively a resection of 75% of the liver and a second resection of 90% of the restored liver six months later. All dogs underwent a metabolic and morphologic studies of the liver and of their kidney function In the first group; all dogs which underwent 90% hepatic resection died 48 hours after the surgical resection of hepatic insufficiency. The ultra microscopic study shoud the role of portal hypertension in hepatic degeneration on the first group. In the second group, the dogs survived the first resection, and our study shows a regeneration of the liver after resection and sub normal hepatic function The liver is able to regenerate after minimall resection but major resection must be done by successively resection to avoid hepatic dysfunction, but the time between resection must be evaluate later