[Peritoneal tuberculosis - report of 43 cases]

Peritoneal tuberculosis represents 0, 1 to 4% of all forms of tuberculosis. The aim of our study is to describe clinical, therapeutic characteristics and the outcome of peritoneal tuberculosis. Retrospective study of all cases of peritoneal tuberculosis diagnosed in gastroenterology B department - Rabta Hospital during a 12 years period [1996 to 2007]. Forty three cases of peritoneal tuberculosis were included: 15 male and 28 female with mean age of 38years [extremes: 16 to 85years]. Five patients were cirrhotic. Clinical manifestations were dominated by ascitis [83%]. Ascitic fluid were exsudative in 97% of cases and lymphocytic in all cases. The diagnostic was based on coelioscopy with peritoneal biopsy in 26cases demonstrating caseating granulomatous lesions in 64% of cases. Extra peritoneal tuberculosis was noted in 60, 4% dominated by pleuro-pulmonary localisations. Patients were given antituberculous therapy for a mean duration of 9, 8 months and the outcome was favourable in 93%. Peritoneal tuberculosis is still a medical problem in Tunisia. It is more common in young female. Diagnosis is based on the results of peritoneal biopsies during coelioscopy. The outcome is good in most cases after antituberculous treatment

Phlegmonous appendicitis revealed by pyogenic liver abscesses

Pyogenic liver abscesses are rare and severe. Early diagnosis and treatment lead to a better prognosis. Biliary cause of liver abscesses is the most frequent. Portal origin is secondary to a portal bactremia. Appendicitis was the most cause of portal infection, but actually, diverticulitis is most common. The aim of this study was to report a new case of pyogenic liver abscesses secondary to phlegmonous appendicitis We report a case of 47 years old man presented with fever and weight loss without abdominal pain. Laboratory investigations show signs of inflammation with high leukocyte and neutrophile rates. The diagnosis of liver abscesses was made on abdominal ultrasound and tomodensitometry witch shows also an inflammatory appendix. The outcome was good after antibiotics associated with percutaneous drainage of abscesses and laparoscopic appendectomy witch found a phlegmonous appendix. One month later, the CT scan showed a markedly decrease of the size of the abscesses

[Spontaneous intrahepatic porto-cava shunt associated with chronic pericarditis. A case report]

Introduction: Spontaneous intrahepatic portosystemic shunts are rare vascular anomalies that consist of a communiation between the portal system and the systemic venous circulation. We report a case of a porto-caval shunt associated with chronic pericarditis

Case report: A 47-year-old patient with post pericarditis cirrhosis and without encephalopathy and hypoglycaemia. The shunt was tubular in its initial segment and aneurismal just before joining the vena cava

Discussion: Spontaneous intrahepatic portosystemic shunt is a rare anomaly. Diagnosis can ve made by Doppler ultrasound and helical CT

Gastric malt lymphoma. A clinico-pathological study of 65 cases. Relationship to Helicobacter pylori

We report 65 cases of MALT gastric lymphomas. HP was looked for with Giemsa and Whartin Starry stains. Immunohistochemistry was done with PAP method. Anti-HP treatment was used in 9 cases. 38 were of low grade of malignancy, 23 were high grade, 4 were high grade with a low grads component. The mean age was 51.5 years, the sex ratio 1.5. Epigastric pain was the most frequent feature [87.7 percent of cases]. Endoscopically, low grade lymphomas presented as unique or multiple ulcerations [55.3 percent of cases] with antral localization [52.6 percent of cases]. 60 percent of our patients were stage IE, of which 61 percent had low grade lymphoma, 18 percent were at stage 112E, 10 percent at stage III and 10 percent at stage IV. From 23 operated patients, 29 percent had early lymphoma which was low grads malignant in 71.5 percent of cases, and 71 percent had lymphomas which were wi-dely spread beyond the submucosa. HP was found in 63 percent of cases. Histologic regression of two early lymphomas of low grade malignancy was achieved after HP eradication