Gastrointestinal stromal tumours [GISTs]: a descriptive study on 29 cases

Background and study aim: Gastrointestinal stromal tumours [GISTs] are the most common mesenchymal tumours of the gastrointestinal tract, originating from Cajal cells in different sites of the digestive tract. The aim of the study is to report on epidemiological, clinical, histological, and therapeutic characteristics of GISTs

Patients and methods: A retrospective descriptive study of 29 cases of GIST in gastroenterology and general surgery departments of Mohamed Tahar Maamouri Hospital [Nabeul, Tunisia] was conducted from January 2005 to March 2012

Results: Among the 29 patients, there were 18 males [62%] and 11 females [38%] with a median age of 63 years [range, 30-96 years]. The main symptoms were abdominal pain [40%] and weight loss [28%]. The tumour was revealed by a complication in 5 cases [17%]. Six patients [20.7%] had metastatic lesions. The most common sites were the stomach [41.4%] and the small intestine [17.3%]. The median tumour size was 9.5 cm [range, 1-30 cm]. Spindle cell tumours were the main histological type [62%]. KIT was positive in the majority of cases [75%]. Twenty-one patients with primary disease [72%] underwent a surgical resection. Imatinib was prescribed in 7 patients [24%]. Sunitinib malate was indicated in 3 patients who had tumour progression under imatinib. Median survival was 17 months [range, 1-69 months]. Ten patients died

Conclusion: The management of GISTs has considerably evolved during the last years. Surgical resection, which remains the mainstay of treatment, was indicated in the majority of patients. Imatinib treatment has not improved overall survival in metastatic and/or inoperable cases

Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease

Background and study aims: Gastric outlet obstruction [GOO] is a rare complication of peptic ulcer disease [PUD]. The endoscopic balloon dilatation [EBD] associated with medical treatment of Helicobacter pylori is a successful method in the management of pyloric stenosis. The aim of this study was to describe epidemiological, clinical, and endoscopic characteristics of GOO related to PUD and to evaluate the effectiveness, safety, and outcome of EBD

Patients and methods: In a retrospective study of patients seen between 1999 and 2009 with symptoms of GOO secondary to PUD, pyloro-bulbar stenosis was confirmed by endoscopic examination. Balloon dilatation was performed when obstruction persisted after treatment with double-dose proton-pump inhibitor [PPI] intravenously for 7-10 days. The H. pylori status was assessed with histology, and eradication therapy was prescribed for infection

Results: A total of 45 consecutive patients [38 males, 7 females median age, 51.9 years; range, 20-58 years] with symptoms of GOO secondary to PUD underwent EBD. Median follow-up time of the 45 patients was 32 months [range, 4-126 months]. The immediate success rate of the procedure was 95.5%. Clinical remission was noted in 84.4% of the patients. Remission without relapse was observed in 55.8%, 30 months after the dilatation. Pyloric stenosis relapsed in 15 patients [39.5%] after a median period of 22.9 months. The dilatation was complicated in three patients [6.7%, two perforations and one bleeding]. A total of 13 patients [29%] underwent surgery. H. pylori was found to be positive in 97.7% of the patients, and was eradicated in 78.4% of them. Smoking and failure of H. pylori eradication were associated with the relapse of the stenosis

Conclusion: EBD is a simple, effective, and safe therapy for the GOO related to PUD, producing short- and long-term remission

[Anatomic variations of the hepatic artery: a study of 33 cases and review]

The hepatic artery is prone to numerous anatomic variations dictated by certain variables of the organogenesis. To research study the anatomic variations of the hepatic artery as well as their implications within surgical practice. Study of a post-mortem series of 33 cases of dissection of the hepatic pedicle with fresh corpses [deaths amounting no longer than 24 hours], carried out in conditions that are quite close to those met with the living ones. The common hepatic artery was divided at the foot of the hepatic pedicle into a gastro duodenal artery and into a proper hepatic artery in 94% of the cases. In 6% of the cases, we noticed a three level change, a branching of the average hepatic artery into a gastro duodenal artery, a right hepatic artery and a left hepatic artery. The proper hepatic artery represented the pedicle segment of the hepatic artery in 94% of the cases. In 36% of the cases, the liver was irrigated by two hepatic arteries. In 12% of the cases, there was the matter of the right hepatic artery, branch of the mesenteric artery. In 24% of the cases, there was the matter of the left hepatic artery branch of the left gastric artery. The perfect knowledge in preoperative and preoperative stages of the anatomic variations of the hepatic pedicle is quite essential. Actually, the lack of knowledge of these variations exposes to the risk of certain complications which are sometimes deadly during hepatic transplants, pancreatic surgery, cholecystectomies, through laroscopic way as well as in the treatment of gastro-esophagus surging

Digestive polyposis, a retrospective study of 20 cases

Three main polyposis syndromes are transmitted as an autosomal dominant disorder: familial adenomatous polyposis [FAP], juvenile polyposis syndrome [JPS] and Peutz-Jeghers syndrome. Evaluate this management of digestive polyposis. Our study included 20 patients which were collected in the departements of pathology surgery and garstroenterology of MT Maarmouri's Hospital, Nabeul city. We reported 15 cases of adenomatous polyposis with 2 family groups. We identified a family group of JPS with 3 members and 2 cases of Peutz-Jeghers syndrome. We found 11 cases of colonic adenocarcinoma out of the 15 patients affected by adenomatous polyposes. FAP is a generalized disorder involving the entire colorectum segment with numerous extra-colonic manifestations. The risk to develop colonic cancer is 100%. JPS is characterised by the development of numerous gastrointestinal juvenile polyps and occurs usually before 20 years old, the progression to cancer is rarely observed. Peutz-Jeghers syndrome consists in hamartomatous polyps associated to a characteristic mucosal pigmentation. The patients are usually young adults and have an increased incidence of cancer in extradigestive sites

[Comparative study of appendical mucocela and pseudomyxoma peritonei. About 25 cases]

Aim: to study the clinicopathological features of the different types of appendical mucocele and to compare them with those of pseudomyxoma peritonei

Methods: 25 cases of appendical mucocele were operated in the Cap-Bon region in Tunisia during a period of 13 years from 1994 to 2006

Results: 9 retentionnal cysts, 13 mucinous cystadenomas, one serrated adenoma, one hyperplasia of the mucosa and one cystadenocarcinoma were diagnosed. Five cystadenomas as well as the only case of cystadenocarcinoma were associated with pseudomyxoma peritonei. Pseudomyxoma peritonei occurred 20 years later than in simple appendiceal mucocele and complicated 5 cases of cystadenoma with low grade dysplasia and 1 case of cystadenocarcinoma

Conclusion: Preoperative diagnosis of appendical mucocele and pseudomyxoma peritonei should be made on scannographic features in order to assess the adequate surgical management

[Morgagni hernia in elderly patients: a study about two cases]

Two cases of retrocostoxiphoid hernia are reported. Both patients were adults. The hernia was strangled in one case and symptomatic in the second case. The diagnosis was confirmed by radiology. Reduction of the visceral hernia and closure of the orifice was carried out after laparotomy. A review of literature and of clinicopathological features are given in the present article. Histogensis and differential diagnosis are also discussed