Two cases of Dieulafoy's lesion in unusual sites: A rare case reports of gastrointestinal bleeding.

INTRODUCTION: Dieulafoy's lesion (DL) is a vascular malformation that can lead to massive gastrointestinal bleeding. It's usually found in the stomach. However, DL's occurrence in atypical sites such as the small bowel and colon is exceptionally rare, posing significant management challenges. CASE PRESENTATION: In this report, we present two cases of DL occurring in uncommon sites, each managed with distinct approaches. Case 1 is a 50-year-old man admitted to the emergency department due to massive GI bleeding and hemodynamic instability. The diagnosis of DL was established through computed tomography angiography and confirmed by histopathological examination after emergency surgery. Case 2 involves a 68-year-old woman presented with melena due to a colonic DL. This case was successfully managed through an endoscopic hemostasis approach. DISCUSSION: Dieulafoy's lesions (DL) were first identified as a large submucosal artery lacking typical gastric ulcer characteristics in three of Paul Georges Dieulafoy's patients. This lesion is responsible for approximately 1-2 % of all cases of gastrointestinal bleeding. Endoscopy is the preferred method for diagnosing and managing DL lesions, especially in cases of active bleeding that is accessible. However, if endoscopic treatment or angiographic embolization fails, a surgical approach may be needed. CONCLUSION: DL presents a diagnostic challenge due to its rarity and is not usually included in the differential diagnosis of gastrointestinal bleeding, particularly when occurring in unusual sites. Endoscopy is the preferred method to identify DL and a possible therapeutic approach in active bleeding. However, if endoscopy hemostasis fails, angiographic embolization or surgical intervention may be required.

Pure squamous cell carcinoma of the pancreas: a rare and challenging diagnosis (case report).

Squamous cell carcinoma (SCC) of the pancreas is a rare exocrine ductal tumour with unknown pathophysiology and poor treatment options. We present a case of SCC in a 59-year-old male patient who presented with epigastric pain, vomiting, anorexia, asthenia, and weight loss. Abdomino-pelvic CT revealed a pancreatic mass with adenopathy satellites. Surgical biopsies were negative, and a trans-duodenal gastric endoscopy showed suspicious lymphadenopathies and a hypoechoic lesion invading the portal vein. An anapathological study confirmed SCC at the site of intense necrotic and inflammatory changes. The patient received radio-chemotherapy, but ultimately developed peritoneal carcinoma.

Gallstone ileus of the sigmoid colon: case report.

Gallstone ileus is an uncommon cause of intestinal obstruction. It is caused when a gallstone migrates through an enterobiliary fistula (most often between the duodenum and the gallbladder) and is impacted in the digestive system, most often in the terminal ileum toward the ileocaecal valve. Case Presentation: Here the authors report the case of a 74-year-old woman who was admitted to Compiegne Hospital in France for a gallstone ileus with the sigmoid colon as the impaction site, which is an even more rare cause of intestinal obstruction. The enterobiliary fistula was between the colon and the gallbladder.The gallstone was removed surgically with a colotomy, without treating the fistula, and after a failed endoscopic attempt to extract the stone. The follow-up was without complications, and a colposcopy showed spontaneous closure of the fistula after 6 weeks. Discussion and Conclusion: The surgical closure of an enterobiliary fistula is an option that should be considered, but it can lead to higher morbidity. That is why the authors opted out of it, especially considering that spontaneous closure of the fistulae can happen, as it did in our case.

Impact of the COVID-19 pandemic on digestive cancer staging, a case series.

Introduction: The COVID-19 pandemic had an undeniable impact on the health system worldwide, this lead to a delay in the diagnosis and treatment of digestive cancers.The purpose of our study was to assess this delay and its impact on patient care. Method: Our work is a retrospective study about 165 patients that were admitted for digestive cancers at Sheik Khalifa hospital, Casablanca morocco during a 3-year period, that we divided into three. We included all the digestive adenocarcinomas (esophagus excluded) whether they were operated on or not. We excluded all other types of cancers (GIST, serous tumors …). We assessed the time between the beginning of the symptoms and the beginning of the treatment and the number of patients that were diagnosed at the complication stage. We also assessed the staging of the tumor at the moment of diagnosis and the complete surgical resection rate. Results: Among the 165 patients admitted for digestive cancer, 54,9% were males with a sex ratio of 1,22 M/F. The average age of our patients was 62,8 years varying between 25 and 86 years old and with a standard deviation of 11,8 years. Digestive cancers were diagnosed in 79 patients during period 1, 43 patients during period2, and 43 during period 3. We found a statistically significant increase in the percentage of patients with advanced cancer by 21,7% (p = 0,045) from 2019 to 2020. The delay in diagnosis (p = 0,275), percentage of cancer discovered at the stage of complication(p = 0,728), and the reduction in complete surgical resection (p = 0,177) were not statistically significant. Conclusion: Our results show an undeniable impact of the COVID-19 pandemic on the staging of digestive cancers but the impact on their care remains to be proven and needs a long-term survival follow-up.

Intraesophageal Migration of a Paraesophageal Hernia Mesh: A Case Report.

Paraesophageal hernias (PEH) have a high recurrence rate, which can justify the use of a mesh during their repair. Mesh use in PEH repair is highly debated as it can lead to many complications like erosion and migration of the mesh, like in our case. Here, we present a case of a 23-year-old woman operated on multiple occasions for a recurring PEH and who presented an intraesophageal migration of the mesh. Partial upper gastrectomy and lower esophagectomy were performed to remove the mesh and the recurrent hernia was repaired using primary sutures of the hiatus. The surgery was without complications and there are no signs of recurrence up to a year later. Reoperation on a recurring PEH can be more difficult in case of mesh use in previous intervention and can lead to other complications like mesh erosion or migration, even so, some surgeons choose this option because it has a lower recurrence rate.

Gallstone ileus: An unusual cause of intestinal obstruction.

Gallstone ileus is an infrequent cause of intestinal obstruction. It is typically the result of cholecystoduodenal fistula, computed tomography scan is the best modality for the diagnosis. Surgical removal of the gallstone is the pillar of treatment to relieve intestinal obstruction. We report the case of a 77-year-old male with features of a small bowel obstruction. Computed tomography scan of the abdomen showed pneumobilia, a cholecystoduodenal fistula, and small bowel obstruction features suspicious for gallstone ileus. The patient had a laparotomy and removal of two gallstones via an enterotomy without postoperative complications.

Acute hemoperitoneum after ruptured hepatocellular carcinoma: First Moroccan SCARE-compliant case report and literature review.

INTRODUCTION: Acute hemoperitoneum with a spontaneously ruptured hepatocellular carcinoma (HCC) is a rare type of internal bleeding that requires a multidisciplinary management approach. PRESENTATION OF CASE: In this case report, we describe a fortuitously ruptured peripheral and discovered HCC in an 81-years-old woman treated effectively using hepatectomy. DISCUSSION: The use of the computed tomography (CT) angiography to diagnose the stability of the patient's condition allows both arterial embolization in case of active bleeding and the evaluation of the underlying hepatopathy. The place of surgery is particularly upon after both the failure of arterial embolization and while facing a severe hemodynamic instability. The surgical strategy varies between perihepatic tamponnade and a surgical resection in one or more stages. The prognosis of a ruptured HCC depends mainly on the underlying liver's function. CONCLUSION: Multidisciplinary management of spontaneously ruptured HCC results in the same survival outcome as non-ruptured HCC at the same stage of hepatopathy.

Numerical analysis of the crack growth path in the cement mantle of the reconstructed acetabulum.

In this study, we use the finite element method to analyze the propagation's path of the crack in the orthopedic cement of the total hip replacement. In fact, a small python statement was incorporated with the Abaqus software to do in loop the following operations: extracting the crack propagation direction from the previous study using the maximal circumferential stresses criterion, drawing the new path, meshing and calculating again (stresses and fracture parameters). The loop is broken when the user's desired crack length is reached (number of propagations) or the value of the mode I stress intensity factor is negative. Results show that the crack propagation's path can be influenced by human body posture. The existing of a cavity in the vicinity of the crack can change its propagation path or can absolutely attract it enough to meet it. Crack can propagate in the outward direction (toward the acetabulum bone) and cannot propagate in the opposite direction, the mode I stress intensity factor increases with the crack length and that of mode II vanishes.