[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

[Isolated Crohn's disease of the stomach presented as plastic linitis. One case report]

Introduction: Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Gastric involvement occurs rarely as an isolated entity. Upper endoscopy is sensitive for detecting subtle disease but more extended lesions can mimic neoplasms such us linitis

Exegese: A 74-year old female was admitted to hospital with abdominal pain, vomiting and weight loss. Upper endoscopy and radiology aspects was suspicious of gastric linitis. Multiple endoscopic biopsies of the stomach showed one granuloma, chronic inflammation and Helicobacter Pylori. Because of the importance of obstructive syndrome, the patient underwent surgery. The resected stomach concluded to a Crohn's disease

Conclusion: Through this observation, we review clinical characteristics, diagnostic difficulties and treatment options of Crohn's disease of the stomach

[Early gastric cancer - two case reports]

Gastric cancer is a serious disease with a high mortality rate. Early diagnosis of the disease improves its prognosis. We report two cases of early gastric cancer and we specify the clinical, endoscopic, histologic and therapeutic aspects of the disease. This study is about two female patients, respectively, 36 and 70 years old. The diagnosis of early gastric cancer was based on pathologic examination of the resected stomach.The two patients are in remission 2 years and 6 months later, respectively. The diagnosis of early gastric cancer is often made on nonspecific symptoms. Oeso-gastro-duodenoscopy shows gastric mucosal anomalies. Pathologic examination of gastric biopsies confirm the diagnosis of adenocarcinoma. Endoscopic ultrasound is essential; it specifies the submucosal infiltration and evaluates the lymph node invasion. Surgery is the primary treatment but in some cases endoscopic mucosal resection provides good long-term results. Early diagnosis of adenocarcinoma improves the prognosis of the disease, which remains poor nowadays

Role de la flore intestinale dans les maladies inflammatoires chroniques de l'intestin et place des probiotiques dans leur prise en charge

The pathogenic role of certain microorganisms of intestinal flora has been demonstrated in experimental colitis in animals and strongly suspected in inflammatory bowel disease in human, especially in Crohn's disease and pouchitis. Probiotics are living non pathogenic microorganisms that, upon oral ingestion exert benefits on human health by modulating enteric flora or by stimulation of local immune system. The aim of this article is to remind the role of intestinal flora in inflammatory bowel disease, the mechanism of inflammation induced by this flora and to review through the literature, the different clinical studies performed with probiotics in human