[Surgical treatment of fistula between bladder and intestine secondary to Crohn's disease]

Crohn's disease [CD] is a chronic inflammatory disease of the intestine that can cause an attack by contiguity of the urinary tract. Although the shape is common and fistulizing 35% of all patients with CD, entero-urinary fistulas are rare and only seen in 2-8% of patients. To report the frequency of occurrence of this complication among the group of surgical forms of CD. Describe the different pathophysiological mechanisms of occurrence of entero-vesical fistula [EVF] during the CD. We report, retrospectively, seven observations of EVF complicating MC made during the period from 01/01/1998 until 31/12/2010. The mean age of patients was 30 years. There were 3 men and 4 women. All patients had clinical signs and radiological EVF. In six patients, CD was ileo-caecal and the ileo-vesical fistula was between the last loop and the bladder. In one patient, the CD was located only in colon, and the fistula was between sigmoid colon and bladder. Level of the bladder, it was a false EVF in five patients and a true EVF in two patients. In these last two, the fistula of 2 mm, was on the top of the bladder. Treatment consisted in all cases by a disconnect between the digestive tract and bladder, resection with restoration of digestive continuity, and if the case of true EVF, a freshening the edges of the fistula with suture of the bladder's wall and drainage. The postoperative course was uneventful in six patients and marked by an outbreak intraperitoneal abcess in one patient who had evolved under medical treatment. After a mean of eleven months, no recurrence surgery was noted. Despite advanced treatment in the context of CD, the indication in EVF is a surgical treatment. Surgery helps fight against the consequences of septic urinary tract, but also to launder bowel disease and reduce the risk of recurrence in the short term

[ sigmoid diverticulitis]

The sigmoid diverticulitis is the most common complication of diverticulosis of the colon. The remaining questions concern the current risk factors for recurrence after a first acute episode, radiological asking immediately upon suspicion of diverticulitis and therapeutic management including the indications of surgical treatment, what to conduct and its principles. Literature review. Risk factors of recurrence are: persistent or recurrent diverticulitis, abscess, stenosis and / or fistula. Abdominal CT is recommended in all patients clinically suspected diverticulitis of the colon. Treatment of acute diverticulitis is medical. The emergency surgical treatment depends on the stage of Hinchey. Stage I: In case of failure of medical treatment, resection-anastomosis in an emergency time delay to be proposed. Stage II: a percutaneous drainage followed by resection-anastomosis in 1 time. Stage III: surgery in emergency sigmoid colectomy based on. Stage IV: Hartmann procedure is the procedure of reference. Prophylactic colectomy is proposed in the case of presence of risk factors of recurrence. Comparison with other literature review were allowed to find that ultrasound made by an experienced radiologist could replace abdominal CT, and for stage III and IV Hinchey, laparoscopic resection can be performed with an immediate restoration of digestive continuity in well selected patients

[Risk factors associated with pancreatic fistula after distal pancreatectomy]

Pancreatic leak [PL] remains a major cause of postoperative morbidity in patients undergoing pancreatic resection. To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy [DP]. 35 patients underwent DP during a 10-year period [2000- 2009]. Informations regarding diagnosis, operative details, and perioperative morbidity and mortality were collected. Nine risk factors were examined. Results: Indications for DP included primary pancreatic disease [n=23; 66%] and non-pancreatic disease [n = 12; 34%]. Postoperative morbidity rate was 43% and none patient died. No patients required a reoperation. Pancreatic fistula was occurred in 11 patients [31%]. On univariate analysis, incidence of pancreatic fistula rate was not significantly associated with these risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, additional procedures, intra operative bleeding and texture of pancreatic parenchyma. We observed significant statistical difference between male and female, 47% of females experienced a pancreatic fistula, while 17% males developed a pancreatic leakage [p =0.05]. The role of the technique of pancreatic stump closure in the development of pancreatic leak remains unclear because of the few number of patients on who we used stapler. The rate of pancreatic fistula after left pancreatectomy is 31%. The female was identified as a risk factor for occurrence of pancreatic fistula after left pancreatectomy. The role implicated in the use of a mechanical claw for the treatment of pancreatic stump requires a larger number of patients to conclude. The body mass index has not been studied in our series

[Hyperbaric oxygen in the treatment of prineal Crohn's disease era of Infliximab: a renewal interest?]

Despite the growing number of therapeutic methods and the recent introduction of new drugs more active in the therapeutic arsenal, lesions of the ano-perineal Crohn's disease remains difficult to support. Hyperbaric oxygen [HBO] was made before the era of infliximab, an interesting therapeutic approach in which the current position remains unclear. To assess HBO efficacy in the treatment of anal fistulas refractory Crohn's disease. Literature review. Hyperbaric oxygen therapy was used in the 90's when the biotherapy was not part of the armamentarium for Crohn's disase. Research conducted has identified only nine publications evaluating the efficacy of hyperbaric oxygen therapy in the treatment of anal fistulas refractory Crohn's disease. Among the nine publications, we have retained only four: two clinical trials and two clinical cases. The total number of patients was 22: 12 women and 10 men. The average age of patients was 37 years. The average number of session was 42 sessions. Remission was observed in 15 patients [68.18%] whereas with Infliximab rate is 66%. Adverse events were observed in 2 patients [16.6%]. Indeed, instead of considering them as two different alternatives, it should be combined to obtain a synergy to increase response rates, shorten the healing and especially to decrease the recurrence rate. Only a prospective randomized controlled trial [with two arms: biotherapy versus biotherapy associated with hyperbaric oxygen therapy] could accommodate this technique in the armamentarium of perineal lesions of Crohn's disease

[Malignant intraductal papillary mucinous tumours of the pancreas: a three cases report]

Intra ductal papillary mucinous tumors of pancreas are rare and are characterized by a risk of malignant transformation. To clarify their clinical presentation and the performance of different imaging examinations to determine their benign or malignant and achieve their staging. We report three cases of degenerate intra ductal papillary mucinous tumors of pancreas. The combination of CT, the pancreato- MRI and duodenoscopy has led to the diagnosis in all cases. A pancreaticoduodenectomy were performed in two cases. The various imaging techniques allow better detection and analysis of the tumor including the evaluation criteria of degeneration. The treatment of these lesions is still surgery

[Colo-urachal-cutaneous fistula in an adult]

An infected urachal cyst is an uncommon finding in adults. To report a case of a sigmoid- urachal- cutaneous fistula. A 51 years old adult male presented with fecaloid leaking from rupture of an infected urachal cyst. Definitive management consisted of resection of the urachus with a bladder cuff, along with removal of the affected bowel segments. Colo-urachal-cutaneous fistula is a rare condition; its management is rather complex

[Peripancreatic sporadic gastrinoma]

The peri-pancreatic sporadic gastrinoma represents a paradigm of digestive endocrinology. It was originally an abnormal secretion of gastrin fits the syndrome Zollinger-Ellison. The objective of our work is to clarify the diagnostic strategy and therapeutic conduct of gastrinoma. We report the case of a patient aged 42 years, hospitalized for bleeding duodenal ulcer, revealed a Zollinger-Ellison syndrome. The objective of our work is to clarify the diagnosis strategy and therapeutic conduct of gastrinoma. We report the case of a patient aged 42 years, hospitalized for bleeding duodenal ulcer, revealed a Zollinger-Ellison syndrome. The different explorations have shown that it was a primitive peripancreatique sporadic gastrinoma. In surgery, we discover a retropancreatique tumor associated to a stenosis post-bulbar ulcer. It was conducted a enucleation of the tumor with vagotomie troncular and normalization of the values of gastrinemie. The sporadic gastrinoma is rare, its emphasis in increasingly being facilitated by the technology of modern medical imaging. Treatment of pancreatic gastrinoma is multidisciplinary. Surgery is the only cure for this disease

[Early gastric adenocarcinoma]

the purpose of this study was to determine the epidemiological and clinical behaviour of the superficial adenocarcinoma of the stomach, to clarify its pathological characteristics, therapeutic as well as his its prognosis. Over a period of 14 years [1990-2004], 16 patients were operated for a superficial gastric adenocarcinoma among 155 gastric cancers treated during the same period in the service of general surgery [A] La Rabta. The superficial gastric adenocarcinoma represented 10.3% of our series. The mean age was 59 years. It was about 8 men and 8 women. Two patients was followed for a chronic stomach ulcer, a patient is followed for Biermer anaemia and another one for Menetrier disease. Among these cancers, 12 were intra mucosal and 4 invaded the submucousa. Lymph node involvement was present only in one case. The cancer was located in the antrium in 8 cases and was multifocal in 3 cases. One patient died in postoperative case because of a medical cause. The 5-year-overall survival was 65.6%. The recurrence had interested only one patient. the superficial gastric adenocarcinoma is rare. The follow up of precancerous states allows its diagnosis. The treatment is based on the gastric resection associated to the DI-type lymph node clearance. The multifocal character imposes a surveillance of the remaining gastric stump

[Gastric adenocarcinoma with lymphoid stroma: about nine cases]

The purpose of this work is to study the pathological features and the outcome of lymphoid stroma gastric carcinoma and its relation with Epstein-Bar Virus [EBV] and the importance of the EBV serology in detection of early reccurence. Between January 1990 and december 2004, 155 patients underwent gastric resection for gastric carcinoma. Nine of them had lymphoid stroma gastric carcinoma. Over all survival as well as disease free survival were determined. Detection of reccurence was based on clinical exam and on findings yielded by endoscopy, radiological exams and EBV serology. A comparison of survival rate of patients beteween current gastric carcinoma and those with lymphoid stroma gatsric carcinoma was done using the Log Rank test. the patients [7 men and 2 women] had a mean age of 61 years [41 to 82]. The tumor was in the antrum in 4 cases, in the body of the stomach in 3 cases and in the cardia in 2 cases. The mean tumor size was 8 cm with deep invasion of the stomach wall in 5 cases and ganglion invasion in 6 cases out of 9. EBV was detected in all patients by in situ hybridation. Post operative morbidity and mortality were nil. Global survival and disease free survival were, respectively, 53.3% and 65.6% in lymphoid stroma gatsric carcinoma, and 43.4% and 63.5% for current gatsric carcinoma. Three patients died of a reccurent disease after 6, 30 and 33 months. The remaing 6 patients didn't have signs of reccurence. lymphoid stroma gastric carcinoma is a bulky, local disease. In our patients, it was always associated with EBV. Over all survival was better than survival of current gastric carcinoma, although there was no significance. EBV serology can be an effective screening procedure of reccurence