traumatismes doudeno-pancreatiques, a propos de 14 cas

Through a series of 14 cases brought over a period of 12 years, we realized a retrospective, analytical and descriptive study of these traumata. We aimed to release recommendations to improve their management. It was 2 women and 12 men, whose mean age was 24.4 years [extremes: 50 and 60 years], divided into 10 pancreatic injuries, 2 duodenal injuries and 2 duodeno-pancreatic injuries. Etiology was dominated by traffic accidents 7 cases [50%]. Trauma was closed in 13 cases [92%]. -Associated lesions were present among 13 patients [92%]. The traumatism appeared by an urgent surgical abdomen among 9 patients, secondarily in 3 cases, tardily in 2 cases: a case of deep suppuration 3 months after a traumata treated into ambulatory and a case of persistent ascites after a past unperceived traumata. Abdominal ultrasonography was made among 4 patients. It allowed diagnosing only a case. Scanner was made among 4 patients. It allowed diagnosing all the cases. Only a patient was treated medically, it was a post-traumatic acute pancreatitis. Surgical treatment was made in 13 cases: conservative in 7 cases and radical in 6 cases. Follow-up was complicated in 11 cases [78%] and non-complicated in 3 cases. Mortality rate was 7.1%

[Anastomotic ulcer after vagotomy for duodenal ulcer]

Between January 1981 and December 2000, 2609 patient underwent surgery for duodenal ulcer. 2274 underwent isolated vagotomy; 1590 had vagotomy associated with GI anastomosis. Only relapses of anostomic ulcers after vagotomy associated with gastrojejunal anastomosis were included in this study. 22 patients [20 males, 2 females] aged between 26 and 79 years had anastomic ulcer relapses [1.38%] after vagotomy and GI anastomosis. Incomplete vagotomy was diagnosed in 14 cases [93%] associated with a defect in setting in 2 cases. Despite the ongoing controversy about the role of Helicobacter in the pathogenesis of anastomotic ulcers, medical treatment remains the primary therapy, and a partial gastrectomy alone or with vagotomy is necessary only in unresponsive cases

Maladie de Crohn intestinale: Aspects chirurgicaux et facteurs predictifs de risque des recidives. A propos de 26 cas

Crohn disease is an inflammatory bowel disease of which one cannot declare itself healed. If is a considerably invalidating disease, and surgery is necessary with more than 80% of patients during its long evolution. After a recent review of the literature, we wanted to contribute to the study of the predictive factors of risk of relapse among 26 patients operated for an intestinal Crohn disease during a period of 1 6 years, from 1986 till 2001. Sex ratio was 0.3 and average age was 33.9 years. Six patients only [23.1%] were known undergoing and treated for Crohn disease. Surgery was indicated urgently in 12 cases [46.2%]. The gravity of urgently operated patients burdened the post-operative morbidity in 38-5% of cases of which 2 deaths. Six patients presented a post-operative relapse for an average delay of 40.8 months; among them 3 patients were operated, in our series, we noted that the relapse rate is more frequent with women that with men [42% / 21%], and age does not intervene in the relapse contrary to smoking. The rate of relapses was so much more brought up that Crohn disease is former. The relapse was more frequent when the edge of section was sick [5/6]. A post-operative medical treatment in the severe forms reduces fhe rate of relapses until 24%

Tumeurs carcinoides de l'appendice. A propos de 46 cas

Carcinoid tumors of the appendix are rare. The appendix constitutes the most frequent localization of these tumors. We studied of a retrospective way all cases that had an appendectomy in the service of general surgery of sfax on a period of 7 years going from 1995 to 2001. during this period 9584 patients had an appendectomy in our service. Among which, 46 cases [0.48%] of carcinoid tumor of the appendix have been diagnosed. In more than 95% of cases, patients were admitted due to acute appendicitis; but none of them had the signs of the carcinoid syndrome. The treatment was a simple appendectomy in 44 cases [95%]. The right hemicolectomy was necessary in two cases, because of an invasion of the appendicular base in a case and a tumor greater than 2 cm in the other case. There is no reported case of lymph node or systemic metastasis. The authors discuss data in the literature and analyse the features of the clinical picture, diagnosis, and try to define a convenient attitude of treatment of these tumors