[Tubal choriocarcinoma. A case report (author's transl)]. / Choriocarcinome tubaire. A propos d'un cas.

The majority of the 82 cases of tubal choriocarcinoma reported in the published literature followed malignant transformation of a tubal ectopic pregnancy. The case presented was not related to ectopic pregnancy but was apparently the result of malignant changes in migrating trophoblastic elements during previous pregnancies not arriving at full term. The patient had two abortions by aspiration and had been on oral contraceptives ever since. Fifteen or so of the cases of extra-uterine choriocarcinoma published in the literature appear to have resulted from the same aetiopathogenic mechanism.

[Caecal lymphosarcoma. Prognostic and therapeutic interest of endoscopic diagnosis (author's transl)]. / Lymphosarcome caecal. Intérêt pronostique et thérapeutique du diagnostic endoscopique.

Primary lymphoreticulosarcomas aremare, scarely 0.3% of all malignant lesions of the digestive tract. Previously, only, slight clinical differences permitted differentiation before operation of this lesion from a common adenocarcinoma. Now the increasing use of colonic endoscopy permits one to determine preoperatively the lymphosarcomatous nature of a colonic tumour. Thus it is possible to carry out an appropriate preoperative assessment with lymphography and sternal marrow examination and also peroperative exploration with liver biopsy and lateral aortic lymph node biopsy. Treatment includes surgery, radiotherapy and chemotherapy, a more and more important place being reserved for the latter. Finally the recent histological classification of K. Lennert permits a more accurate prognosis.

[A rare abdominal emergency: acute phlegmonous gastritis (author's transl)]. / Une urgence abdominale rare : la gastrite aiguë phlegmoneuse.

In the light of a series of recent observations and a personal case, the authors recall that acute phlegmonous gastritis is a rare disease usually secondary to a bucco-pharyngeal infective focus, characterised by an acute abdominal syndrome accompanied by a very severe infective context. Only laparotomy leads to the diagnosis. Since antibiotics, the mortality has regressed from more than 80% to less than 50%. The prognosis of the antral forms is much less serious than that of the diffuse forms with mortalities of 28% and 71% respectively. In antral gastritis the best therapeutic attitude is early antibiotic therapy associated with 2/3 gastrectomy.

[Surgery of obturator hernia by closure of the obturator canal with the round ligament]. / Cure d'une hernie obturatrice par oblitération du canal obturateur au moyen du ligament rond.

Almost 2/3rds of obturator hernias occur after 70 years. Favoured by changes in pelvic and spinal position, this hernia is uncommon in women and exceptional in men. Revealed by strangulation, it is in one third to one quarter of cases, unrecognised before operation, often due to failure to recognise the cause of crural neuralgia in a patient with acute intestinal obstruction. Even when the diagnosis is made, laparotomy is the best approach. It makes intestinal resection easier, this is necessary in 50% of cases, and above all, it is easier to cure the hernia for which the authors propose the use of the round ligament folded on itself and fixed to the borders of the hernial orifice. Delay in treatment explains the high mortality in this rare hernia.

[Single ruptured pelvic hydatid cyst as an unusual manifestation of secondary peritoneal echinococcosis]. / Kyste hydatique pelvien unique rompu un aspect singulier de l'échinococcose péritonéale secondaire.

The authors report the case of a large pelvic tumour compressing the bladder, the ureters and the recto-sigmoid junction. Its sudden rupture into the peritoneum led to an emergency operation and the discovery of a hydatid cyst ruptured into the pouch of Douglas and a hepatic cyst. The most frequent presentation of peritoneal echinococcosis, peritoneal cysts are metastases from a hepatic or splenic cyst which has ruptured into the peritoneum. They are usually multiple. Single pelvic lesions are rare, their hydatid nature is in the absence of a past history of hydatid disease difficult to suspect before operation. The object of the latter is to treat in one stage the primary cyst and its peritoneal metastases. The narrow vascular connections of the pelvic cysts render cystectomy dangerous and make one prefer removal of the germinal membrane followed by marsupialisation or drainage of the remaining cavity. In the long term, the frequency of peritoneal recurrences makes prolonged supervision necessary.

[Compression of retropancreatic common bile duct by tuberculous lymph nodes causing obstructive icterus]. / Compression du cholédoque rétropancréatique par masse ganglionnaire tuberculeuse responsable d'ictère obstructif

Tuberculosis of the hepatic lymph nodes is among the rare causes of obstructive jaundice and portal hypertension. The authors report a case of compression of the bile duct by retroduodeno-pancreatic tuberculous lymphadenopathy, and recall the difficulty of diagnosis before operation. They emphasize the necessity of simple surgical measures. Removal of the lymph nodes is dangerous and should not be attempted. A biliary by-pass operation should be carried out and its type depends on the precise site of the compression. Antituberculous drugs are then given for 18 months after operation and lead to cure.