[Surgical treatment of fistula between bladder and intestine secondary to Crohn's disease]

Crohn's disease [CD] is a chronic inflammatory disease of the intestine that can cause an attack by contiguity of the urinary tract. Although the shape is common and fistulizing 35% of all patients with CD, entero-urinary fistulas are rare and only seen in 2-8% of patients. To report the frequency of occurrence of this complication among the group of surgical forms of CD. Describe the different pathophysiological mechanisms of occurrence of entero-vesical fistula [EVF] during the CD. We report, retrospectively, seven observations of EVF complicating MC made during the period from 01/01/1998 until 31/12/2010. The mean age of patients was 30 years. There were 3 men and 4 women. All patients had clinical signs and radiological EVF. In six patients, CD was ileo-caecal and the ileo-vesical fistula was between the last loop and the bladder. In one patient, the CD was located only in colon, and the fistula was between sigmoid colon and bladder. Level of the bladder, it was a false EVF in five patients and a true EVF in two patients. In these last two, the fistula of 2 mm, was on the top of the bladder. Treatment consisted in all cases by a disconnect between the digestive tract and bladder, resection with restoration of digestive continuity, and if the case of true EVF, a freshening the edges of the fistula with suture of the bladder's wall and drainage. The postoperative course was uneventful in six patients and marked by an outbreak intraperitoneal abcess in one patient who had evolved under medical treatment. After a mean of eleven months, no recurrence surgery was noted. Despite advanced treatment in the context of CD, the indication in EVF is a surgical treatment. Surgery helps fight against the consequences of septic urinary tract, but also to launder bowel disease and reduce the risk of recurrence in the short term

[Inflammatory bowel disease and lymphoma]

The aims of this review are to precise the incidence of non- Hodgkin's lymphoma and Hodgkin's disease in inflammatory bowel disease and to assess the relationship between immunosuppressive therapy and lymphoma in inflammatory bowel disease. Population-based data show that incidence of lymphoma is not increased in patients with Crohn's disease or ulcerative colitis. There is an increased incidence of non- Hodgkin's lymphoma in inflammatory bowel disease patients on immunosuppressive therapy but overall risk is low in all cohort studies. Relationship between immunosuppression and lymphoma in inflammatory bowel disease is confirmed by frequency of cerebral lymphoma and association with Epstein- Barr virus

[Fatal miliary tuberculosis following treatment with infliximab]

We report the first tunisian case of miliary tuberculosis in a patient who received Infliximab for Crohn's disease with uretrorectal and ano-perineal fistula developed 4 weeks after the start of treatment. We suggest that diagnosis of latent tuberculosis infection is important before treatment with Infliximab is initiated and that antituberculous medication must be prescribed immediatly in case of occurrence of unexplained fever after treatment with Infliximab

[Multiple lymphomatous polyposis of the gastrointestinal tract a Tunisian case]

Multiple lymphomatous polyposis is a distinctive primary gastrointestinal lymphoma which endoscopical, histopathological et immunophenotypical characteristics are well known. This lymphoma is rare and its prognosis is bad because of frequency of stage IV patients. We report the case of a 75-yearold male patient with multiple lymphomatous polyposis affecting the rectum, the colon and the stomach associated with an involvement of lymphadenopathies, bone marrow and liver. Treatment by chemotherapy was ineffective and patient dead after 3 sessions of CEOP protocol