Lesappendicites aigues et leurs complications: a propos de 2000 cas

The aim of this work is to show through a series of acute appendicitis the gravity of the developed forms of the appendicitis and this by a comparative study all along the diagnostic, therapeutic and post-operative stage of the simple forms and the developed forms. Our retrospective study is about 2000 cases of acute appendicitis and their complications collected in the service of the Surgical emergencies in the IBNO ROCHD C.H.U. of Casablanca between June 1980 and June 1986 we have noticed 62,25% of the simple forms against 87,75% of the developed forms [Abscess, plastron peritonitis]. Their frequency is of 28% with regard to the abdominal emergencies, and there is a light masculin predominance 55,5% As to the age 86,35%patients are between 10 and 30 years old The developed formes occur more frequently in extrem ages. The acute appendicitis is a clinical diagnosis. The pain is the more constant sign. Found in 98% of the cases; the nauseas and vomits belong to the clinic board in 70%of the cases. The anomalies of the white form are inconstant. No complementary examination allows to do the diagnosis The acute appendicitis stays thena difficult diagnosis; in spite of all, still 5,6% of the pieces of appendicectomies do not show any inflamnatory sign to the pathology. As to the treatment, 91,4% of the cases have been appendicectomies, 90 patients have undergone a medical treatment and of whom for 82 cases the draining was the only therapeutic mean. At last, the complications may interest the two forms with clear predominance for the suppurated forms; this incites to put all in effect to diagnose and treat in time an appendicitis

Postoperative peritonitis after digestive surgery. About 92 cases

92 cases of post-operative peritonitis in digestive surgery are recorded: - Diagnosis is difficult inspite of the multiplicity of symptoms which are variable and non specific. - Clinical presentation is dominated by the frequency of infectious symptoms essentially fever, neuro -psychic, hemodynamic and respiratory disorders. Abdominal signs though advocatory are late. - Early reoperation represents the only possibility of survival for the patients. It must contain a way large, a complete peritoneal washing, an eradication of the source of peritonitis and an effective drainage. - A correct ressucitation effective before, during, and after operation is fundamental. - The prognosis of this fearful complication improves clearly in case of operation and the mortality rate declines from 100% [in absence of operation] to 47.4% [in case of operation]. Because of the high mortality rate, [44.4%], this post-operative complication has to be prevented

Intra-hepatic abcess of biliary origin. About 3 cases

Intra hepatic abcesses of biliary origin are the extension to the liver of suppurative cholangitis. They are mostly, multiple scattered abcesses, seldom is it a single large abcess. They are the most frequent of pyogenic liver abcesses. Their clinical study is uneasy because their signs remain drow in the cholangitis presentation explaining that they are discovered during surgery or even at necropsy. Treatment is medico-surgical but morbidity and mortality remains elevated, owing to delayed diagnosis because of lack of specific signs. About 3 [three] observations of intra hepatic abcesses of biliary origin, a review of the literature is made to specify their pathogenic, diagnostic, therapeutic and prognosis problems

Gastric Polyps. About one case

The authors report on a case of gastric polyposis diffuse and isolated. The affection is rare and not well known. We have tried to emphasize certain aspect of this affection, such as its positive diagnosis which has become easy by the current practice of high fibroscopy. The second problem relates to the evolving risk dominated mainly by the degeneration of adenomatous polyps, but the association of gastric polyposis with stomach cancer is not rare. The gastric polyposis is considered as a precancerous lesion; thus total gastrectomy constitutes the means of therapeutic safety

gastric leiomyosarcoma. About 2 cases

Our topic take into consideration two cases of leiomyosarcoma: the first one was duodenal; the second gastric, both admitted at Surgical Emergency in an advanced degree. Difficulties were faced at every level especially in the first case where initial diagnosis was a false pancreatic cyst. The leiomyosarcoma was found out only one year later through the cytological study of fragments after reoperation. Difficulties in treatment are due to the uncertainty of the diagnosis, the degree and place of the tumor. The study of different cases shows that the leiomyosarcoma is successfully cured thanks to surgical operation, on the contrary of the others digestive sarcoma. The life esperance overtaking 5 years are frequent. These studies shows also that gastric leiomyosarcoma gives higher rate of survival than leiomyosarcoma in other level of digestive tract. The duodenum leiomyosarcoma is more difficult to determinate because of difficulties in operation. That is why it's necessary to make treatment of any leiomyosarcoma forend out through an operation

Icteres par cancer des voies biliaires: problemes diagnostiques et traitement palliatif [a propos de 9 cas]

9 cases of bile cancer involving the common bile duct are reported. All the patients had jaundice This series concern 8 woman and 1 man. The median age is 54 years The diagnosis was always made per-operatively. This cancer is diagnosed with an important delay as all the patients in this series had metastases The treatment was always palliative, based on the treatment of jaundice All the patients were operated. 4 palliative by-pass and 1 dilatation of the tumor were carried out in the 3 other cases, an external drainage of bile was carried out. One patient died in immediately postoperative The prognosis is poor as the survival is less than one year

Les abces intra-hepatiques d'origine biliare: a propos de 3 observations

The intrahepatic abscesses of biliary origin represent the extension of cholangitis to liver. They are the most frequent of pyogenic abscesses of liver. Our study carry 3 [Three] observations and aim to clear their pathogenics, diagnosis, therapeutics and prognosis problems. The abscesses were multiple scettes, rarely single and with great size. The symptoms were the same of cholangitis explaining their discovery at operation or at necropsy. Their treatment is medico-surgical their mortality is very high because the diagnosis is late by want of specific signs of abcesses. Our 3 cases are female sex aged respectively 23; 30 and 50 years and were admitted for cholangitis. The diagnosis of intrahepatic abscesses was called in preoperatory for 2 ceses by scanning, and operatory in one case by cholangiography. Two patients were operated with ablation of obstacle and biliary drainage by Kehr in one case, and internal drainage by sphincterotomy in the second case. The surgical act was accompanied with antibiotherapy who the unique treatment for the third case operated, before for choledocolithiasis. In conclusion, an early diagnosis by actual means and treatment of all lithiasis's bowl who give an obstacle of choledoc and cholangite

Les localisations inhabituelles du kyste hydatique

The authors report 40 hydatid cysts of rare localization selected during a period of 11 years and represent 10,75% on the whole of the hydatid cysts operated during the same period all localizations dumbfounded. The splenic localization is the more frequent with 15 cases, so 4.9% it occupies the third place after the classic localizations [liver, lung]. The soft tissue and the peritoneum come in fourth position with 9 cases so 2,42% in relation to the whole of the hydatid cysts. A last group constitued by very rare localizations of which the frequency varies form 0,27 to 1,34%. This group includes the nephric pancreatic and mammary localizations. In general the diagnosis sets no problem. Clinically, it is the establishment of a cystic mass, of progressive evolution with conservation of the general state, which has evoked the diagnosis. Before the arrival of the echotomography, the confirmation of the diagnosis is particularly operative. Actually this exam allows an easy-per-operative diagnosis. The treatment is only surgical and adapted to each case. The post-operative results are satisfying. The authors deplore one death for second recurrent intra-peritoneal hydatidosis

Biliary digestive fistulas. About 31 cases

We report a serie of 31 bilio-digestive fistulae of lithiasis origin. Symptomatologia is often quite atypic. This discovery was fotuitous in 93.6%. Hence, plain X ray examination of the abdomen, and upper gastroduodenal series are of importtance. All our patients have been treated surgically with satisfactory results except one death

Surgical treatment of hemorrhagic complications of duodenal ulcer

Haemorrhage complicating duodenal ulcer is relatively rare compared with other complications of duodenal ulcer. Inspite of this fact, haemorrhage of duodenal ulcer is responsible for high rate mortality of complicated duodenal ulcer. The mortality rate is related to: severity of bleeding, recurrency, and also advanced age great help in the identification of the chracteristics and types of the ulceratives lesions showing the tendency of recurrent bleeding, hence, a more active attitude will be adopted rapidly as the risk of mortality is higher in these cases when recurrent massive bleeding arrives. In this study carride on 85 cases of haemorrhage complicating duodenal ulcer: 48 patients are operated upon, 45 with trunkal vagotomy with or without local hemostatic mesures, 3 cases of supraselective vagotomy were than. Mortality rate in this group was 10% [8 patients out of 85] 5 deaths happend before any intervention, other 2 deaths during surgical operation and related to massive or recurrency haemorrhage. The recurrent haemorrhage arrived for 2 patients after trunkal vagotomy was responsible of death for these two cases. According to this study, and also to other recent publications, we found that the Weinberg operation is the operation of choice, but the good results published recently by certain groups using supraselective vagotomy, obtained also in our group [3 cases] are encouragely to substitued trunkal vagotomy by this technic