Laparoscopic shaving for colorectal endometriosis: a literature review

Colorectal endometriosis is one of the most challenging conditions to manage. Surgical treatment is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Preoperative radiological examination should be extensive to determine the appropriate surgery: laparoscopic shaving, disc excision or rectal resection. We demonstrated that in the hands of experienced surgeons, shaving technique is possible in more than 95% of colorectal endometriotic nodules, with low complication rates compared to resection. Shaving and bowel resection are associated with comparable recurrence rates. As shaving is indicated whatever the size of deep lesions, surgeons should first consider rectal shaving to remove deep bowel endometriosis. Bowel resection should only be performed in case of major rectal stenosis (>80%), multiple or posterior lesions and stenotic colorectal nodules.

Breast tuberculosis: a case series

Tuberculosis is one of the leading infectious and contagious diseases, caused by bacteria belonging to the Mycobacterium family. Breast involvement ranks last among the extrapulmonary manifestations of tuberculosis but remains an important clinical condition that may present clinical and radiological similarities with breast cancer, thus requiring a thorough diagnostic approach including histological and/or bacteriological confirmation. This is a retrospective study conducted at the department of Gynecology and Obstetrics of the Military Hospital Moulay Ismail - Meknes, over a period of 4 years. A total of 6 cases of breast tuberculosis were observed, resulting in an incidence rate of 6 cases per 7600 women-years. The mean age of patients was 39 years. Signs of tuberculosis impregnation were found in 33% of cases. The clinical forms encountered, in descending order of frequency, were: diffuse form (50% of cases), nodular form (33% of cases), and sclerotic form (16% of cases). The radiological findings were almost always suggestive of a suspicious lesion. Diagnosis was primarily based on the histopathological study of breast biopsy. All our patients received a standard regimen of anti-tubercular treatment including: 4 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol followed by 2 months of Rifampicin and Isoniazid with favorable outcomes. Only one patient experienced a recurrence due to under dosing of Rifampicin, which was managed with a total of 9 months of treatment. One patient underwent additional surgical drainage. Early and thorough diagnosis of breast tuberculosis is crucial as it helps avoid mutilating surgery in often young women.

Giant juvenile fibroadenoma of the breast: a case report

Giant juvenile fibroadenoma is a rare benign breast entity. The clinical presentation can be dramatic mimicking malignancy. Meticulous surgical management is mandatory to ensure a fine balance between adequate tumor resection and the best cosmetic outcome for the mammary gland. We report a case of a 13-year-old girl who presented to our department with a 20×18 cm mass on her left breast. Imaging and histopathological investigations were suggestive of juvenile fibroadenoma. Conservative surgery was performed with good cosmetic results. Giant fibroadenoma must be considered in any adolescent female with a rapidly growing breast mass. Simple surgical excision is recommended to allow normal breast tissue to grow.

Atypical presentation of breast tuberculosis: a case report

Breast tuberculosis is a rare disease even in endemic regions. It often presents in young females as a breast lump and is confused with other benign and malignant lesions. We presented a case of 47-year-old woman, initially diagnosed with a breast carcinoma based on clinical examination and radiological imaging. However, breast biopsy with histopathological analysis revealed breast tuberculosis. Anti-tubercular chemotherapy was used during six months with good evolution. Given low specificity of clinical and radiological findings of mammary tuberculosis, histopathological study of any breast nodule is mandatory to exclude this rare entity and avoid unnecessary surgical procedure.

Wernicke’s encephalopathy complicating hyperemesis gravidarum: a case series

Wernicke’s encephalopathy is an acute neuropsychiatric syndrome due to thiamine deficiency. In most cases, it is associated with alcoholism and malnutrition and rarely can be secondary to hyperemesis gravidarum and arise during the first trimester of pregnancy. The clinical signs are specific to this disorder. However, they are unknown by most clinicians, especially obstetricians, delaying treatment and leading to serious problems including maternal mortality. We report a case series of three patients diagnosed with Wernicke’s encephalopathy during the first trimester based on clinical symptoms and radiological signs in two cases and only on clinical findings in case 2. A high dose of thiamine was started intravenously in all patients and the majority of symptoms resolved. Unfortunately, case 3 died, probably to a delay of diagnosis. Given this severity even with rapid treatment, prevention measures with low doses of thiamine supplementation remain at present the best treatment and should be applied in any patient presenting with hyperemesis gravidarum.