[Surgical complications of colostomies]

The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. Aim: reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence.A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients [7%] developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases [reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases], a necrosis in 5 cases [reconfection of the colostomy], a plicature in 2 cases [reconfection of the colostomy] a peristomal abscess in 2 cases [reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case] and a strangulated parastomal hernia in 1 case [herniorrhaphy]. The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course

[Treatment of acute colonic pseudo-obstruction [Ogilvie's syndrome]. Systematic Review]

Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14%% [level of evidence 4, recommendation grade C]. Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose [evidence level 2, grade recommendation B]. Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt, a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% [level evidence 4, recommendation grade C]. PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression [evidence level 2, recommendation grade B]. The cecostomy is more effective and safer than conventional colostomy [level of evidence 4, recommendation grade C]. The cecostomy is highly effective in colonic decompression but associated with a high mortality [level of evidence 4, recommendation grade C]. Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression

[ lithiasic acute cholecystitis: laparoscopic treatment [about 106 cases]]

Summary To assess the feasibility and the advantages of the coelioscopy in the treatment of the acute cholecystitis. From January 1996 to December 2001, 106 laparoscopic cholecystectomies for acute cholecystitis have been collected. The diagnosis of acute cholecystitis has been confirmed for all cases by the pathologic exam. These 106 cases represent 12.4% of the set of the laparoscopic cholecystectomies practiced during the same period of survey. They are 78 women and 28 men. The mean age was 51.7 years. Eight patients [7.6%] presented an elevated operative risk [ASA III]. The diagnosis of acute cholecystitis has been kept before operation in 45.3% of the cases. Major or minor intraoperative incidents have been observed in 18.9% of the cases. The rate of conversion was 17%. The reasons are dominated by the difficulties of dissection in 10 cases [55.5%] and hemorragea in 6 cases. The research of the predictive factors of conversion found 5 factors, the hyperleucocytosis, the operative delay superior to 72 hours, the adhesions around the gallbladder, the gangrenous gallbladder and the pediculitis. The post operative mortality was nul. The morbidity rate was 12.3%. Among the 13 patients who had postoperative complications, 8 were after conversion. These results showed that the laparoscopic cholecystectomy for acute cholecystitis is an effective and good alternative with acceptable morbidity that should decrease with learning curve

[Isolated abscess of the thoracic and abdominal wall: an exeptional shape of tuberculosis]

The isolated thoracic parietal localization is a very rare shape of tuberculosis. It often leads to a diagnosis problem with the parietal tumours requiring surgical biopsy. We report a case of tubercular abscess localized in the antero-superior part of the thoracic wall with a second abdominal localization without any pulmonary localization. It was a 56-year-old woman presenting a swelling in the right side of the sternum accompanied after some months by a second swelling of the right flank of the abdomen, for one year. The radiological and biological explorations were in favour of a double localization parietal tumour. The diagnosis of certainty has been made by the histological exam of the surgical biopsy and the bacteriological exam of the trans-parietal withdrawal of the collection. The classic tuberculosis treatment has been maintained during 9 months with a good clinico-radiological evolution. Through this observation, we try to study the anatomo-clinical particularities and to clear the diagnostic difficulties of this affection

[Complications of the Meckel's diverticulum, about 42 cases]

Our aim was to report the main complications of the Meckel's diverticulum. Our retrospective study concerns 42 cases of complicated Meckel's diverticulum, collected during one period of 18 active years from January 1988 to December 2005. The yearly impact is 2, 33 cases / year. We excluded the asymptomatic Meckel's diverticulum, of fortuitous discovery during intervention. The middle age of our patients is 25 years, with extremes going from 2 to 74 years. The sex-ratio is 3, 2. The diagnosis before intervention of the complicated Meckel's diverticulum was not evoked in any time. The clinical features were an acute intestinal closure in 22 cases, an appendicitis in 13 cases, an appendicular peritonitis in 6 cases, and an acute intestinal intussusceptions in one case. In any case, it is the surgical exploration that permitted to confirm the diagnosis of a complicated Meckel's diverticulum. The approach way was median in 27 cases, Mac Burney in 13 cases, and laparoscopic in 2 cases. The surgical exploration showed peritonitis in 16 cases, one diverticulitis in 23 cases, an acute intestinal intussusception in one case, a tumour in one case, and haemorrhagic diverticulum's ulcer in one case. The treatment consisted in a segmental resection of ileum with end to end anastomosis [37 cases] and a cuneiform resection [5 cases]. The histological exam showed heterotopy of gastric tissue in 12 cases, of pancreatic tissue in two cases, and a Burkitt's lymphoma on a diverticulum in one case. We noted a precocious death following a septic shock. The Meckel's diverticulum constitutes a most common benign malformation of the digestive tube. The prognosis is related extensively to the gravity of its complications that can benefit, not only of the contribution of the laparoscopic diagnosis, but also therapeutic

[Clinical and therapeutic results of a retrospective study about 62 cases of epithelial ovarian carcinomas]

To report retrospectively the therapeutic results and prognostic factors of epithelial ovarian carcinomas throughout a series of 62 patients treated between 1993 and 2002. Patients were treated with primary surgery classified as optimal [complete], sub-optimal or minimal. Adjuvant ciplatin based poly chemotherapy [6 cycles] was indicated in FIGO stage Ic or more. Patients with minimal surgery received 3 or 4 cycles of chemotherapy followed by an interval debulking surgery. Overall survival was calculated according to Kaplan-Meier and univariate analysis done by the Log-Rank test for the following factors: age group, surgical excision, stage, histological type and presence or not of ascitis at diagnosis. Fifty five patients were operated. The excision was optimal, suboptimal and minimal in respectively 19,3%, 33.8% and 40.3% of the cases. Adjuvant or neoadjuvant chemotherapy was given to 50 patients [93,5%]. Interval debulking surgery was complete in 7 among 13patients. At the first evaluation, 14/58 patients were in complete response. The 3 and 5 years overall survival rates were respectively of 25% and 13%. Advanced stage was the only pejorative prognostic factor [P= 0.0002]. Incomplete surgery [minimal] and chemotherapy without taxanes based chemotherapy were associated with poor outcome in our patients. Our study confirmed the importance of disease stage as a prognostic factor

[Laparoscopic management of perforated duodenal ulcers results of a retrospective study]

Perforation of peptic duodenal ulcer is a frequent surgical emergency. The aim of this retrospective study is to evaluate the faisabiity and the results of laparoscopic management of perforated duodenal ulcers. Eighty-four patients had laparoscopic surgery for perforated duodenal ulcer. The duration of the study was seven years [2001 to 2007]. There were 81 men and 3 women aged from 16 to 64 years [mean: 28 years]. The mean duration between the onset of perforation and the time of operation was 20 hours [range: 6-72 hours]. The surgical procedure was suture and irrigation of the abdominal cavity. Conversion into laparotomy was performed in 14.2%of the patients. Mean operative time was 95 minutes. There was no post operative death. The morbidity rate was 15.4%. There was two surgical complications [post operative peritonitis and duodenal fistula] and ii medical complications. Mean hospital stay was 6 days. All patients were discharged with antibiotics for Helicobacter pylon eradication. Laparoscopic repair of perforated duodenal ulcer is a safe option providing low rates of morbidity, reoperation and mortality, and can be considered as the treatment of choice

Liver cystic echinococcosis: which cysts are correlated with false negative indirect passive hemagglutination [IHA]?

It's generally agreed that calcified liver cystic Echinococcosis [CE] is associated with negative serology; the influence of other cystic features on serologie result remains unclear. The aim of this study is to determine predictive factors of negative indirect passive hemagglutination [IHA] in liver CE. 119 patients operated on for liver CE, had preoperative IHA. Correlation was studied between serological result and sex, age of patient and number [single vs multiple], size, ultrasonic type [uni-locular, multivesicular, degenerative] and intrabiliary rupture of cyst. IHA sensitivity was 74.8%. Univaried analysis showed that false negative serology was correlated with age < 10 or > 20 years [p< 0.01], single cyst [p< 0.006], cystic size < 9 cm [p< 0.03] and unilocular or degenerative cyst in comparison with multivesicular type [p< 0.01 and p< 0.03 respectively]. in liver CE, cystic predictive factors of false negative IHA are single cyst, unilocular or degenerative type and size inferior to 9 cm

Sexual disturbances secondary definitive colostomy

Sexual disturbances after colostomy are various. However, they probably remain underestimated in societies where sexuality is still a taboo issue. The aim of this prospective study was to evaluate the possible sexual behaviour and the post operative sexual disturbances in patients whome underwent colostomy. The group was devided in 10 male and 11 female patients. Seventeen patients [81%] were married, 3 widowed and 1 unmaried. Sexual disturbances were found in 47% of patients. There was a lack of interest in sexual relations in 2 women, a resolved premature ejaculation in one case, post operative dysparenia in 2 female patients, a retrograde ejaculation in a 60-year-old man, impotence in a 46 years old patient, and a premature ejaculation in a 36-year-old man. The frequency of sexual disturbances [47%] in our series was close to that reported in the literature [50%]. The sexual disorders are more common in male patients, the most frequent being ejaculatory dysfunction. In women, dyspareunia is the most common disorder. The particular case of colostomy in homosexuals remains a current issue

acute hyperlipemic pancreatitis [2 cases]

The aim of this work was to study the clinical and therapeutic features of this affection. Our retrospective study concerned two cases of hyperlipemic pancreatitis treated during 6 years from 1998 to 2003. The incidence of this affection was 1.42%. Our patients were respectively a man aged 32 years without any significant history and a pregnant woman aged 24 years with a positive history of dyslipidemia. Clinical, biologic and radiological data didn't differ from those of other causes of acute pancreatitis. The hyperlipemic origin was confirmed by a lactescent serum and a rate of triglycerides greater than 10 g/1. The course was characterized by the recurrence of pancreatitis related to the increased triglycerid serum level over 10 g/1. Plasmapheresis and administration of heparin and/or insulin seem to be efficient in reducing the serum level of triglyceride and in improving the course. Hygieno-dietary measures and hypolipemiant treatment were necessary for the level of triglyceirdes in serum below 10 g/1. We in the absence of comolicatons, surgery seemed umnecessry in the two cases. the clinical pattern of acute hyperlipemic pancreatitis doesn't include any specific elements, but its treatment and prevention must take into account the associated hyperlipidemia