Pseudoaneurysm of the splenic artery presenting with gastrointestinal bleeding.

Gastrointestinal bleeding from a pancreatic pseudocyst is a rare condition that is diagnostically and therapeutically challenging. A 78-year-old woman with a history of acute pancreatitis due to gallstones was hospitalized for abdominal pain and gastrointestinal bleeding. Gastroscopy revealed blood extruding from the papilla of Vater. A computed tomography scan revealed hemorrhage into a pancreatic pseudocyst. The patient was successfully treated by coil embolization.

Incidental paracaval retroduodenal hemangiolymphangioma in adult patient: report of case removed laparoscopically.

INTRODUCTION: Retroperitoneal hemangiolymphangioma is a benign tumor, only occasionally reported in adult patients. Surgical removal of the tumor is the best treatment option. The laparoscopic surgical approach, however, have never been reported. The authors report a case of retroperitoneal hemangiolymphangioma removed by laparoscopic surgery and discuss the role of laparoscopic surgery in the treatment of this tumors. CASE REPORT: A 45-year-old man was referred to the surgical unit for a paracaval retroperitoneal mass, detected occasionally by an ultrasound examination. An abdominal computed tomography scan confirmed a primitive retroperitoneal solid enhancing mass, 3 cm in diameter. Surgical removal of the mass was planned by the laparoscopic approach. With the patient in semilateral position, 3 trocars were inserted in the right subcostal region. With an intraoperative ultrasound, the mass was located close to the left side of the inferior vena cava. Then it was dissected and completely removed by the laparoscopic approach, without any damage to the surrounding structures. Operative time was 45 minutes and length of hospital stay was 2 days. No complications were observed either intraoperatively or postoperatively. No recurrence has been observed in an 8-month follow-up. Pathology revealed hemangiolymphangioma. DISCUSSION: Laparoscopic surgical removal of retroperitoneal hemangiolymphangioma seems to be a safe approach. Besides the well-acknowledged advantages of laparoscopy, the mini-invasive approach allows a better exposure of the operative field. Intraoperative ultrasound and experienced surgical team are, however, recommended.

Budd-Chiari syndrome secondary to hepatic echinococcosis.

OBJECTIVES: Hydatid cyst of liver is a parasitosis which is an endemic state in Tunisia and is a very rare cause of Budd-Chiari syndrome. The purpose of this study was to report the clinical features, radiological investigations and therapeutic management. PATIENTS AND METHODS: A retrospective analysis of 12 patients who underwent surgery for Budd-Chiari syndrome secondary to hepatic echinococcosis between January 1990 and December 2004 was performed. RESULTS: The series included ten females and two males with a mean age of 36 years. Budd-Chiari syndrome was subacute in 75% of cases. Ultrasound showed a compression of hepatic veins by cysts with a mean diameter of 13 cm situated in at least two hepatic segments. US Doppler and CT-scan of the liver provided the diagnosis in all cases. Laparotomy was performed in all cases. Operative mortality was 8% and morbidity 66% due to biliary fistula and deep abscess formation. Hepatic vein outflow was successfully re-established in four patients. CONCLUSION: Budd-Chiari syndrome is a rare but severe complication of hydatid cyst of the liver. Early diagnosis is necessary to improve prognosis.

[Endoscopic thoracic sympatecomy for hyperhidrosis]. / Sympathectomie par vidéo-thoracoscopie pour hyperhidrose palmo-plantaire.

BACKGROUND: Hyperhidrosis is a benin affection representing a social and professional problems and occupational handicaps in young patient. Endoscopic thoracic sympathectomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. AIM: We describe the technique used in our institut and present results METHODS: From 1995 to 2002, 32 patients were operated on for hyperhidrosis. There were 17 mens and 15 women raging in age from 15 to 32 years The intervention consisting on destruction by electrocoagulation to the sympathetic trunk RESULTS: There was no major complication and the mean postoperative hospital stay was 2 days. The disappearance of the palmar sweating was immediately after operation. 7 patients complained of compensatory sweating CONCLUSION: Endoscopic thoracic sympathectomy for hyperhidrosis is a safe effect technique for treating palmar and axillary hyperhidrosis. Compensatry sweeting represent the major that necessite a preable information