Exploring rare locations of hydatid disease: a retrospective case series.

INTRODUCTION: Hydatid disease, endemic in Mediterranean countries, primarily affects the liver, but can manifest in diverse organs. Non-hepatic and non-pulmonary cysts often pose diagnostic challenges. This study examines patients with hydatid cysts in atypical locations. METHODS AND RESULTS: From 2013 to 2020, our center treated 250 echinococcosis patients, among whom 11 cases (4.4%) with hydatid disease in uncommon sites were retrospectively reviewed. The distribution of unusual cyst locations and their clinical implications are discussed. CONCLUSION: Diagnosing hydatid cysts in uncommon locations is a formidable challenge. Surgeons should always contemplate the prospect of an unconventional cyst location when encountering patients with cystic masses in endemic regions. Failing to consider this possibility could lead to unfavorable outcomes.

A rare association of adenocarcinoma of the small bowels and coeliac disease: A case report.

INTRODUCTION: Coeliac disease is a long-term autoimmune disorder that primarily affects the small intestine. It is due to an adverse reaction to gluten. The treatment is based on a strict gluten-free diet. Evolution can be marked by the occurrence of malignant complications that can modify the prognosis of the disease by increasing mortality. These complications are dominated by lymphoma; however, carcinomas can occur. CASE PRESENTATION: We report the case of a 52-year-old patient with celiac disease. The patient was not respecting the gluten-free diet. She was presented with chronic abdominal pain. Imaging findings promote small bowel neoplasia. The suspicious segment was removed, and it was found to be an adenocarcinoma. CLINICAL DISCUSSION: Coeliac disease occurrence in adults is rare, and it is reflected by paucisymptomatic forms long misunderstood sometimes revealing malignant complications which are presented essentially by lymphoma. Small bowel adenocarcinoma is extremely rare. Its etiopathogenesis remains unknown. CONCLUSION: Adenocarcinomas of the small bowels associated with celiac disease, although uncommon, should be suspected in the face of any recrudescence of symptoms and/or primary or secondary resistance of the strict gluten-free diet.

Surgical management of a locally advanced jejunal stromal tumor: A case report of a challenging condition.

INTRODUCTION AND IMPORTANCE: Locally advanced jejunal stromal tumors stand as a captivating and relatively rare entity, garnering attention for several reasons. Their inaccessible location by conventional endoscopy poses a diagnostic challenge. Further, treatment decisions necessitate a multidisciplinary approach, compounded by the absence of high-level evidence studies. CASE PRESENTATION: A 54-year-old patient was admitted to our surgical department with abdominal pain and chronic anemia. Abdominal CT imaging confirmed the presence of a non-metastatic sizable jejunal tumor. The patient underwent laparotomy, revealing a locally advanced jejunal tumor contracting the ileum and the ascending colon. A monobloc oncological resection was performed, followed by the restoration of digestive continuity. Anatomopathological analysis delineated a locally advanced Stromal Tumor with a high risk of recurrence. The patient underwent a course of tyrosine kinase inhibitors for 3 years, with no reported recurrence during the subsequent 3-year follow-up. DISCUSSION: Locally advanced jejunal stromal tumors are rare. Most patients present with unspecific symptoms. Diagnosis remains challenging due to their intricate anatomical location. Decisions regarding management must be deliberated within a multidisciplinary framework, tailored to each patient's unique characteristics. While combined therapeutic modalities have demonstrated efficacy in recent studies, prudence is advised given the heightened incidence of both short and long-term complications. CONCLUSION: In the absence of randomized controlled trials, the management of locally advanced jejunal stromal tumors underscores the imperative of multidisciplinary collaboration in treatment deliberations. A wide, sometimes mutilating excision is only permissible if it is complete.

Zinc Tetrafluoroborate-Mediated Ring Expansion of trans-Aziridine-2-carboxylates to cis-2-Iminothiazolidines and cis-Thiazolidine-2-iminium Tetrafluoroborates and Evaluation of Antimicrobial Activity.

Cis-2-iminothiazolidines and cis-thiazolidine-2-iminium tetrafluoroborates were successfully produced from trans-N-alkyl aziridine-2-carboxylates and phenyl/alkyl isothiocyanates mediated by zinc tetrafluoroborate in refluxing DCE. Reactions were performed via a complete regio- and stereoselective process to give the title iminothiazolidines and cis-thiazolidine-2-iminium salts in moderate to good yields (35 to 82%) with a wide substrate scope. In addition, the antibacterial activity evaluation of these compounds, as well as the minimum inhibitory concentration (MIC) determination, revealed that only four cis-thiazolidine-2-iminium salts showed growth inhibition against Bacillus cereus.

LAPAROSCOPIC APPENDICECTOMY: RISK FACTORS FOR CONVERSION TO LAPAROTOMY.

BACKGROUND: Laparoscopic appendectomy is the gold standard surgical procedure currently performed for acute appendicitis. The conversion rate is one of the main factors used to measure laparoscopic competence, being important to avoid wasting time in a laparoscopic procedure and proceed directly to open surgery. AIMS: To identify the main preoperative parameters associated with a higher risk of conversion in order to determine the surgical method indicated for each patient. METHODS: Retrospective study of patients admitted with acute appendicitis who underwent laparoscopic appendectomy. A total of 725 patients were included, of which 121 (16.7%) were converted to laparotomy. RESULTS: The significant factors that predicted conversion, identified by univariate and multivariate analysis, were: the presence of comorbidities (OR 3.1; 95%CI; p<0.029), appendicular perforation (OR 5.1; 95%CI; p<0.003), retrocecal appendix (OR 5.0; 95%CI; p<0.004), gangrenous appendix, presence of appendicular abscess (OR 3.6; 95%CI; p<0.023) and the presence of difficult dissection (OR 9.2; 95%CI; p<0.008). CONCLUSIONS: Laparoscopic appendectomy is a safe procedure to treat acute appendicitis. It is a minimally invasive surgery and has many advantages. Preoperatively, it is possible to identify predictive factors for conversion to laparotomy, and the ability to identify these reasons can aid surgeons in selecting patients who would benefit from a primary open appendectomy.

EMERGENCY SURGERY FOR OBSTRUCTING COLON CANCER: MORBIDITY AND RISK FACTORS OF EARLY POSTOPERATIVE MORTALITY - A COHORT STUDY OF 118 CASES.

BACKGROUND: Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10-27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial. AIMS: The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer. METHODS: A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission). RESULTS: In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors. CONCLUSION: This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.

Laparoscopic appendicectomy: risk factors for conversion to laparotomy / Apendicectomia laparoscópica: fatores de risco de conversão para laparotomia

ABSTRACT BACKGROUND: Laparoscopic appendectomy is the gold standard surgical procedure currently performed for acute appendicitis. The conversion rate is one of the main factors used to measure laparoscopic competence, being important to avoid wasting time in a laparoscopic procedure and proceed directly to open surgery. AIMS: To identify the main preoperative parameters associated with a higher risk of conversion in order to determine the surgical method indicated for each patient. METHODS: Retrospective study of patients admitted with acute appendicitis who underwent laparoscopic appendectomy. A total of 725 patients were included, of which 121 (16.7%) were converted to laparotomy. RESULTS: The significant factors that predicted conversion, identified by univariate and multivariate analysis, were: the presence of comorbidities (OR 3.1; 95%CI; p<0.029), appendicular perforation (OR 5.1; 95%CI; p<0.003), retrocecal appendix (OR 5.0; 95%CI; p<0.004), gangrenous appendix, presence of appendicular abscess (OR 3.6; 95%CI; p<0.023) and the presence of difficult dissection (OR 9.2; 95%CI; p<0.008). CONCLUSIONS: Laparoscopic appendectomy is a safe procedure to treat acute appendicitis. It is a minimally invasive surgery and has many advantages. Preoperatively, it is possible to identify predictive factors for conversion to laparotomy, and the ability to identify these reasons can aid surgeons in selecting patients who would benefit from a primary open appendectomy.

RESUMO RACIONAL: A apendicectomia laparoscópica é o procedimento cirúrgico padrão-ouro realizado atualmente para apendicite aguda. A taxa de conversão é um dos principais fatores utilizados para medir a competência laparoscópica, e importante para evitar perda de tempo em um procedimento laparoscópico e proceder diretamente à cirurgia aberta. OBJETIVO: Identificar os principais parâmetros pré-operatórios associados ao maior risco de conversão para determinar o método cirúrgico indicado para cada paciente. MÉTODOS: Estudo retrospectivo de pacientes admitidos com apendicite aguda, submetidos a apendicectomia laparoscópica. Foram incluídos 725 pacientes, sendo que destes, 121 (16,7%) foram convertidos para laparotomia. RESULTADOS: Os fatores significativos que predizem a conversão, identificados por análise univariada e multivariada, foram: presença de comorbidades (OR 3,1; IC95%; p<0,029), perfuração apendicular (OR 5,1; IC95%; p<0,003), apêndice retrocecal (OR 5,0; IC95%; p<0,004), apêndice gangrenoso, presença de abscesso apendicular (OR 3,6; IC95%; p<0,023) e a presença de dissecção difícil (OR 9,2; IC95%; p<0,008). CONCLUSÕES: A apendicectomia laparoscópica é um procedimento seguro para tratar apendicite aguda. É uma cirurgia minimamente invasiva e tem muitas vantagens. No pré-operatório, é possível identificar os fatores preditores de conversão para laparotomia, e a capacidade de identificar essas razões pode ajudar os cirurgiões na seleção de pacientes que se beneficiariam de uma apendicectomia aberta primária.

Emergency surgery for obstructing colon cancer: morbidity and risk factors of early postoperative mortality - a cohort study of 118 cases / Cirurgia de emergência para obstrução do câncer do cólon: morbidade e fatores de risco de mortalidade pós-operatória precoce - estudo de coorte de 118 casos

ABSTRACT BACKGROUND: Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10-27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial. AIMS: The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer. METHODS: A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission). RESULTS: In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors. CONCLUSION: This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.

RESUMO RACIONAL: A oclusão é a complicação mais comum do câncer de cólon. A cirurgia está associada à elevada morbimortalidade (10-27%) e pior prognóstico. É necessário indicação imediata, evitando perfuração cólica e peritonite. O aumento da mortalidade na cirurgia de emergência do câncer de cólon é multifatorial. OBJETIVOS: Identificar os fatores de risco de mortalidade pós-operatória precoce que levaram a destacar a estratégia terapêutica no manejo do câncer de cólon obstrutivo. MÉTODOS: Estudo retrospectivo em pacientes admitidos no Departamento de Cirurgia Geral, entre 2008 e 2020, por câncer de cólon obstrutivo e operados de emergência (dentro de 24 horas da admissão). RESULTADOS: Foram operados 118 pacientes e a mortalidade pós-operatória precoce foi de 10,2%. A análise univariada destacou que escore American Society of Anesthesiology III ou IV, tumor perfurado, uma complicação pós-operatória e duas complicações pós-operatórias simultâneas foram considerados fatores de risco significativos de mortalidade pós-operatória precoce após cirurgia de emergência no câncer de cólon obstrutivo. Na análise multivariada, apenas a perfuração tumoral e a ocorrência de duas complicações médicas pós-operatórias foram fatores de risco significativos. CONCLUSÃO: Este estudo mostrou que a complicação pós-operatória é a principal causa de mortalidade pós-operatória precoce após cirurgia de emergência de câncer de cólon obstrutivo. Otimizar o manejo pós-operatório desses pacientes de alto risco ainda é necessário e pode reduzir a taxa de mortalidade.

Case Report: Portal cavernoma related to multiple liver hydatidosis: A rare case of fatal cataclysmic haemorrhage.

Clinical presentation of liver hydatidosis can vary from asymptomatic forms to lethal complications. We report a rare case of a 27-year-old male from a rural Tunisian region who presented with large-abundance haematemesis, haemodynamic instability, and marked biological signs of hypersplenism. Endoscopy showed bleeding esophageal varicose veins that were ligated. Abdominal ultrasound concluded the presence of three type CE2 hydatic liver cysts causing portal cavernoma with signs of portal hypertension. Despite resuscitation, the patient died of massive rebleeding leading to haemorrhagic shock. Hepatic hydatid cyst should be considered as an indirect cause of gastrointestinal bleeding in endemic countries. Early abdominal ultrasound in varicose haemorrhage is essential in orienting the diagnosis.

Efficacy of bilateral erector spinae block for post-operative analgesia in liver hydatid surgery.

BACKGROUND: Erector spinae plane (ESP) block is a recently described interfacial block, and since 2016, studies have shown that it is a safe technique related to the lower risk of neurovascular and pleural injury comparing to epidural or paravertebral blockade. The application of ESP block in abdominal surgery is relatively limited to case reports and small population studies, which is why we believe every new case of its application should be a valuable contribution. CASE PRESENTATION: With this present case, we explored the efficacy of bilateral ESP block as a post-operative analgesia technique for liver hydatid surgery on a 56-year-old patient. Ultrasound-guided bilateral ESP block was applied at T7 level, while the patient was awake before general anaesthesia induction. The local anaesthetic used was 20 mL ropivacaine (0.375%) and 2 mg dexamethasone on each side. After recovery from anaesthesia, she reported mild pain (visual analogue score of 5 on effort). After 12 hours post-operatively, she received only one dose of paracetamol 1 g considered as rescue analgesic. She did not experience nausea and vomiting episodes. We noted a sensory block extending from T4 to T10. CONCLUSION: To our knowledge, it may be the first adult bilateral single-shot case report for this specific procedure. This technique appears to be safe and effective on post-operative analgesia for this type of surgery; however, prospective studies comparing ESP block to other techniques are needed.

Dynamic Kinetic Resolution Processes Based on the Switchable Configurational Instability of Allenyl Copper Reagents.

The configurational instability of allenyl copper reagents is unveiled. An experimental study highlights the crucial role of Li+ and of the reaction temperature in the control of the configurational stability of allenyl copper reagents. A judicious choice of the reaction conditions allows efficient dynamic kinetic resolution processes and gives a one-pot access to homopropargylic alcohols or amines bearing up to four contiguous defined stereogenic centers.

Acute cholecystitis due to a gall bladder torsion.

INTRODUCTION: Gallbladder torsion is an unusual cause of an acute abdomen that can be mortal. It is presenting in variable ways, but the most common is symptomatology similar to acute cholecystitis. Clinical manifestations and imaging features can facilitate diagnosis, and treatment is detorsion with cholecystectomy. CASE PRESENTATION: A 26-year-old male presented to the emergency department with intense abdominal pain, vomiting. The patient did not respond to symptomatic treatment and continued to present pain, nausea, and vomiting. The Ct scan showed signs of acute cholecystitis. The patient underwent laparoscopic cholecystectomy and found that the gallbladder was gangrene, enlarged due to torsion. Detorsion and cholecystectomy were carried out without complications.

Adult small bowel obstruction due to congenital peritoneal belt: A case report.

INTRODUCTION: Peritoneal bands on the virgin abdomen are an extremely rare etiology of occlusive syndrome. Congenital bridles can be in 0.7 to 2% a cause of small bowel obstruction. PRESENTATION OF CASE: We report a case of a 21-year-old woman who was admitted with symptoms of bowel obstruction. The patient had no surgical or traumatic history. Laparotomy was done and the findings showed a congenital belt extending from the antimesenteric wall of the ileum to the vesical dome, causing bowel strangulation. Band's ligation proceeded smoothly after the operation. DISCUSSION: Congenital flanges present an uncommon situation. These bands are usually difficult to classify and define. They are usually observed in childhood. Therefore, this situation represents an unusual surgical problem in diagnosing clinically unexpected elderly patients. CONCLUSION: Congenital or spontaneous flanges are an uncommon cause of occlusion, which presents a challenging diagnosis. Exploratory laparotomy or laparoscopy is mandatory.

Case Report: An unusual case of small bowel volvulus due to appendicitis associated with pneumatosis intestinalis: Review of the literature.

Pneumatosis cystoid intestinalis is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. It usually presents as a marginal finding resulting from various gastrointestinal pathologies. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Further, detorsion, retrograde draining, and appendectomy were performed because there were no signs of necrosis and the appendix was pathological. The postoperative course was uneventful. This case is exceedingly rare in the literature, because it was featured by the ileal volvulus due to appendicitis.This case report emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis associated to an acute abdomen.

Gastric EBV-positive mucocutaneous ulcer: A rare pathological entity.

The gastric location of EBVMCU is extremely rare. The pathology examination and immunochemistry are mandatory for the diagnosis. It is essential that physicians be aware of this new entity to accurately diagnose and handle this disease.

Prognostic significance of poorly cohesive gastric carcinoma in Tunisian patients.

BACKGROUND: While the incidence of gastric cancer has decreased worldwide in recent decades, the incidence of poorly cohesive carcinoma (PCC) is rising. The prognostic significance of gastric PCC remains a subject of debate. OBJECTIVE: To analyze the prognosis of gastric PCC in a Tunisian cohort. METHODS: A total of 122 gastric adenocarcinoma patients who underwent curative gastrectomy from 2001 to 2014 at Habib Thameur hospital in Tunis, Tunisia were included. The clinicopathological parameters and prognosis of PCC were analyzed in comparison with non PCC (NPCC). RESULTS: Sixty one patients (50%) presented PCC. Patients were younger in PCC group (p = 0,001). There was no difference in sex distribution between the two groups. PCC was more likely to be stage T4 (55.7% vs 34.4%; p = 0.033), N3 (67.8% vs 30%; p < 0.001) and have a higher metastatic lymph node ratio (p < 0.001). Hepatic metastases were more frequent in NPCC group (p = 0.031) whereas peritoneal carcinomatosis was more common in PCC group (p = 0.004). Perineural invasion was more frequent in PCC group (p = 0.001). Resection margins were more often positive in PCC group (31.1% vs 9.8%; p = 0.004). There was no difference in recurrence rate between the 2 groups (p = 0.348). The 5-year survival was similar in the NPCC and PCC (respectively 43% vs 23 %; p = 0.247). Survival rates were also comparable in early stage (100% vs 80% respectively for PCC and NPCC; p = 0.527) as well as for advanced stage (16% vs 35% respectively for PCC and NPCC; p = 0.538). PCC was not a prognostic factor for survival. Interestingly, advanced age, adjacent structures invasion, positive resection margins were specific prognostic factors for PCC. CONCLUSION: In our study PCC was not a prognostic factor for survival. Advanced age, adjacent structures invasion and positive resection margins were specific prognostic features for this histological subtype.

Reliability testing of a modified MISTELS score using a low-cost trainer box.

BACKGROUND: Training programs such as the fundamentals of laparoscopic surgery (FLS) that are based on simulation are being currently used in several western countries. FLS allows skill acquisition and evaluation of competency in laparoscopic surgery. On the practical side, evaluation is determined by the MISTELS metrics (MISTELS is the acronym for the McGill inanimate system for training and evaluation of laparoscopic skills). This training program may be modified so that it can be implemented in countries with limited resources using a low-cost trainer box. Would the use of a low-cost trainer box alter the reliability of the MISTELS score? OBJECTIVE OF STUDY: The aim of the study was to evaluate the reliability of a modified MISTELS using a low-cost trainer box. METHODS: It was a prospective study carried out at Habib Thameur hospital in Tunis (Tunisia), between April 2016 and August 2016. The study involved residents from different surgical specialties in the departments of general surgery and paediatric surgery of the hospital during 2015 and 2016. This study assessed the reliability of a modified MISTELS system (Only three tasks were performed out of the five tasks used in the original MISTELS system). Evaluation was based on Cronbach's alpha and intraclass correlation coefficients (ICC). A low-cost trainer box was designed and constructed. The residents included in the study performed three series of three tasks using this trainer box. The first series was scored by two trained raters to evaluate inter-rater reliability. The two-other series were successively performed to evaluate test-retest reliability. RESULTS: The internal consistency, assessed by Cronbach's alpha, was at 0.929 which is an acceptable score. As for inter-rater and test-retest reliabilities that were assessed by ICCs, they yielded excellent scores that were at 1 and 0.95 (95% CI, 0.891-0.978) respectively. CONCLUSIONS: The reliability of a modified MISTELS is not altered by the use of a low-cost trainer box. The score of the modified MISTELS is a reliable score for evaluating technical skills of surgical residents using a low-cost trainer box.

Gastric leiomyosarcoma and diagnostic pitfalls: a case report.

BACKGROUND: Since the advent of immunohistochemistry for the diagnosis of stromal tumours, the incidence of leiomyosarcomas has significantly decreased. Nowadays, gastric leiomyosarcoma is an exceptionally rare tumour. We report the second case in the English literature of gastric leiomyosarcoma revealed with massive bleeding and hemodynamic instability and diagnostic pitfalls that we encountered. CASE PRESENTATION: A 63-year-old woman, with 2 years' history of dizziness and weakness probably related to an anaemic syndrome, presented to the emergency room with hematemesis, melena and hemodynamic instability. On examination, she had conjunctival pallor with reduced general condition, blood pressure of 90/45 mmHg and a pulse between 110 and 120 beats per minute. On digital rectal examination, she had melena. Laboratory blood tests revealed a haemoglobin level at 38 g/L. The patient was admitted to the intensive care department. After initial resuscitation, transfusion and intravenous Omeprazole continuous infusion, her condition was stabilized. She underwent upper gastrointestinal endoscopy showing a tumour of the cardia, protruding in the lumen with mucosal ulceration and clots in the stomach. Biopsies were taken. Histological examination showed interlacing bundles of spindle cells, ill-defined cell borders, elongated hyperchromatic nuclei with marked pleomorphism and paranuclear vacuolization. Immunohistochemistry showed positivity for Vimentine, a strong and diffuse immunoreactivity for smooth muscle actin (SMA). Immunoreactivities for KIT and DOG1 were doubtful. Computed tomography scan revealed a seven-cm tumour of the cardia, without adenopathy or liver metastasis. The patient underwent laparotomy. A total gastrectomy was performed without lymphadenectomy. Post-operative course was uneventful. Histological examination of the tumour specimen found the same features as preoperative biopsies with negative margins. We solicited a second opinion of an expert in a reference centre for sarcomas in France, who confirmed the diagnosis of a high grade gastric leiomyosarcoma. CONCLUSION: Gastric leiomyosarcoma is a rare tumour. Diagnosis is based on histological examination with immunohistochemistry, which could be sometimes confusing like in our case. The validation of a pathological expert is recommended.

Ascending Cholangitis secondary to migrated embolization coil of gastroduodenal artery pseudo-aneurysm a case report.

BACKGROUND: Gastroduodenalartery (GDA) pseudo-aneurysms are very rare. Their clinical importance lies in the eventuality of rupture, causing bleeding and ultimately exsanguination. CASE PRESENTATION: We report the case of a man, with prior history of biliary surgery, presenting with haemobilia secondary to a rupture of GDA pseudo-aneurysm eroding the main bile duct. The patient was treated with coil embolization. This technique is considered to be safe. However, on the long term, some complications may occur. In our case, the patient presented with cholangitis subsequent to coil migration in the lower bile duct. This situation was managed using endoscopic retrograde cholangiopancreatography (ERCP) allowing coil extraction with favorable evolution. CONCLUSIONS: GDA pseudo-aneurysms are very rare. Bleeding, secondary to the rupture of these lesions, is a serious complication that could lead to death. Diagnosis and treatment of ruptured GDA pseudo-aneurysms rely on angiography. This method is considered to be safe. Cholangitis secondary to coil migration in the main bile duct is exceedingly rare,but remains an eventuality that physicians should be cognizant of.