Volvulus of the sigmoid colon. Therapeutic strategy. About 38 cases

A retrospective study of 38 cases of sigmoid volvulus is reported. The relative frequency of this pathology among young people in Morocco is noted. In 82% of cases diagnosis was without difficulty; and in two cases an associated small bowel volvulus was found. When deciding on the therapeutic approach it is essential to differentiate between cases in which the sigmoid colon is necrotic and those in which the changes are reversible. In the latter, the authors recommend a non surgical reduction [using flatus tube or better: colonoscopy] with elective surgery performed at later date. If initial reduction proves impossible, colonic resection whith colostomy appears to give the best results

Peritoneal puncture lavage in closed abdominal injury. About 230 cases

In this work, the authors have studied especially the reliability and the limits of the perironeal puncture lavage. About 230 cases of abdominal trauma collected in the services of surgical emergencies and surgical intensive care of the Ibn Rochd Teaching Hospital of Casablanca from 1980 to 1984. In this series, the child and the young adult of masculin sex are the most concerned, the road accidents constitute the most frequent etiology. The reliability of the method in our experience is 93%. The caution of use are reminded; 11% of wrongly positive results concern particularly the retro-peritoneal hematoma; the problem of the tiny intra-peritoneal lesion is discussed, the risk of the wrongly negative results is of 3%. The indications, sensibility and specificity of the peritoneal puncture lavage are discussed. That is a practice and useful examination, which diminishes the delay of diagnosis and the mortality in the case of abdominal trauma without evident clinic sign, and in the polytraumatised

Surgical treatment of hemorrhagic complications of duodenal ulcer

Haemorrhage complicating duodenal ulcer is relatively rare compared with other complications of duodenal ulcer. Inspite of this fact, haemorrhage of duodenal ulcer is responsible for high rate mortality of complicated duodenal ulcer. The mortality rate is related to: severity of bleeding, recurrency, and also advanced age great help in the identification of the chracteristics and types of the ulceratives lesions showing the tendency of recurrent bleeding, hence, a more active attitude will be adopted rapidly as the risk of mortality is higher in these cases when recurrent massive bleeding arrives. In this study carride on 85 cases of haemorrhage complicating duodenal ulcer: 48 patients are operated upon, 45 with trunkal vagotomy with or without local hemostatic mesures, 3 cases of supraselective vagotomy were than. Mortality rate in this group was 10% [8 patients out of 85] 5 deaths happend before any intervention, other 2 deaths during surgical operation and related to massive or recurrency haemorrhage. The recurrent haemorrhage arrived for 2 patients after trunkal vagotomy was responsible of death for these two cases. According to this study, and also to other recent publications, we found that the Weinberg operation is the operation of choice, but the good results published recently by certain groups using supraselective vagotomy, obtained also in our group [3 cases] are encouragely to substitued trunkal vagotomy by this technic

Thyphic acute cholecystis

The acute typhoid cholecystis is a rare complication of typhoid fever in childhood. The authors report the observation of a 7 year old child operated of a perforation of a mortified gall bladder. The authors review the pathological aspects, the clinical features and the treatment of this affection

Analytic study of 1481 appendicular syndrome

Our work consists of a retrospective study of 1.481 appendicular syndromes collected in the service of surgical emergencies from June 1980 to December 1984. Summarizing the date count, it emphasizes from our study: The acute appendicitis is the most frequent of abdominal surgical emergencies, it attacks both sexes with a light male predominance, the clinical is very polymorphic, and the confrontation anatomo-clinical, trial shows the absence of paralylism between the clinic, the operatory explorations and the histology

Permanent cardiac stimulation

Our study covers twenty cases of "permanent electro-systolic pacers" used in the Cardiology Department of the Ibnou Rochd Hospital in Casablanca from 1976 to 1984. Our series have noted that: - The average relatively young age of our patients [48] with a predominance of complete congenital auriculo-ventricular blocks [BAV]. - The indications of stimulation have to be permanently watched because of the vital risk to our patients of repeated fainting and cardiac refractory insuffiency. - The almost exclusive adoption of endo-cavitory wey with the use of litium sentry batteries [QRS-] and monopolar probes. A conventional clinical, electrical and radiological supervision has been set up. - Immediately after the operation, where we have noted two displaced probes, which were put back in position on the ventricular right at the point level, and one infection of the casing put right by a change of batteries and probe. - The long term evolution after a period of 14 months is clear cut: - one case of worn sheath. - one case of displaced probe. - and two cases of worn out batteries. The reintervention in order to change the failed material has been practised in all cases

Galeazzi's fracture. About 28 cases

In a study of 28 cases involving a GALEAZZI Fracture or equivalent, the authors point out the relative importance of the arthrography of the wrist amongst the various radiologic explorations possible, and the necessity, in adult cases, of complete surgical treatemeat: that is, repair of all lesions of the triangular ligament of the wrist, the negligence of which can seriously affect the functional prognosis