ABSTRACT
Hydatidosis is a rare parasitic disease that is endemic in many countries of the Mediterranean basin caused by the larval form of Echinococcus Granulosus. Among unusual localizations, renal involvement is rare, especially extension to the pleural cavity. Herein, we report a rare case of 75-year-old woman with giant renal hydatid cyst complicated by pleural extension. The patient was successfully treated with a median phreno-laparotomy.The renal hydatid cyst was completely emptied with resection of the epiploic hydatid cyst.The diaphragmatic breach was closed after resection of the necrotic margins. With 1 month albendazole therapy.
ABSTRACT
Fournier gangrene is a rare and severe necrotizing fasciitis. It is burdened with high morbi-mortality, requiring early and massive medical and surgical management. Initial treatment is based on patient's resuscitation associated with surgical debridement. Subsequently, the main challenge is the healing process and its possible sequelae. Several therapeutic approaches are currently available to improve and accelerate the healing process. We conducted a retrospective study of 20 cases. The median age of our patients was 56 years. The study included 16 men and 7 women. Comorbidity was present in 15 patients. Antibiotic therapy was administered in all cases, with a median duration of 15 days. All patients underwent surgery. Iterative reviews were necessary in all patients, who needed, on average, 3 dressing changes. Colostomy was performed in 6 cases. Hyperbaric oxygen therapy was performed in 4 cases. Vacuum assisted closure was performed in 1 case. Soft tissue coverage was necessary in 2 cases. The mean duration of healing was 15 days with oxygen therapy versus 24 days in the absence of this treatment. The mean duration of hospitalization was 20 days. Four patients died. Healing process without sequelae is a therapeutic challenge. Despite the addition of new therapeutic approaches, outcomes are not satisfactory. However, multidisciplinary approach associated with oxygen therapy and vacuum assisted closure might improve patients outcomes.
Subject(s)
Debridement/methods , Fournier Gangrene/therapy , Perineum/pathology , Wound Healing , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Colostomy/methods , Combined Modality Therapy , Female , Fournier Gangrene/pathology , Hospitalization/statistics & numerical data , Humans , Hyperbaric Oxygenation/methods , Length of Stay , Male , Middle Aged , Retrospective Studies , Treatment OutcomeSubject(s)
Spleen/abnormalities , Splenosis/diagnosis , Diagnosis, Differential , Humans , Liver , Male , Middle Aged , PeritoneumABSTRACT
BACKGROUND AND STUDY AIMS: Hepatic hydatid cyst is a major health problem in endemic areas. Surgery is still the best choice for treatment of the hydatid cyst of the liver. However, it is still associated with high mortality and morbidity. The aim of the study was to evaluate the predictive factors for specific morbidity after conservative surgical treatment of the hydatid cyst of the liver. PATIENTS AND METHODS: A total of 120 patients who underwent conservative surgical treatment between 2001 and 2011 were evaluated retrospectively. RESULTS: Of the 120 patients, 64 were female subjects and 56 male subjects; the median age was 33 years (14-83 years). The mortality rate was 0%. The overall morbidity rate was 26.6%. The specific morbidity rate was 16.6%. The major specific complications were infection of the residual cavity in 10 cases and an external biliary fistula in eight cases. The predictive factors of morbidity in univariate analysis were bilious cyst content, location of the cyst in the hepatic dome, and size >10 cm. After multivariate analysis, only the size of the cyst was an independent predictive factor of morbidity. CONCLUSION: The size of the cyst was the significant predictor of morbidity of conservative surgery for liver hydatid cyst.
Subject(s)
Echinococcosis, Hepatic/surgery , Hepatectomy , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Echinococcosis, Hepatic/mortality , Female , Follow-Up Studies , Humans , Male , Middle Aged , Morbidity/trends , Prognosis , Retrospective Studies , Survival Rate/trends , Tunisia/epidemiology , Young AdultABSTRACT
BACKGROUND: laparoscopic exploration is one of the modalities of treatment of choledocolithiasis. Modalities of biliary decompression after laparoscopic common bile duct exploration are controversial. AIM: to assess the benefits, the efficacity and harms of trancystic biliary drainage following laparoscopic common bile duct stone exploration methods: we report retrospectively twenty patients which were operated in our department by laparoscopy and have done a transcystic biliary drainage. RESULTS: the mean age was 52 years. They were twenty patients (13 women and 7 men). The median operating time was 165 minutes. Post operative course was uneventful in 17 cases. Biliary complications were present in three patients (2 biliary fistulas and one biliary peritonitis. Residual stones were found in two cases. One of the residual stone was treated with endoscopic sphincterotomy.There were no post operative deaths. There were no biliary stricture and no recurrent ductal stones. CONCLUSION: despite of our short experience, the transcystic biliary drainage following laparoscopic management for choledocolithiasis seems to be a safe and an efficient method.
