[An unusual etiology of acute pancreatitis]. / Une étiologie inhabituelle de pancréatite aiguë.

A 54-year-old woman consulted the emergency department for abdominal pain, vomiting and fever for 5 days. A biochemical assessment was performed and showed a lipasemia higher than 5 times normal range (264 UI/L). Hyperlipasemia is in favor of acute pancreatitis. On obtaining further history, the patient reported the SARS-CoV-2 infection two weeks ago with a laboratory investigations done the same day as the positive PCR showed a normal lipasemia. The imaging findings were suggestive of early acute pancreatitis. Acute pancreatitis secondary to SARS-CoV-2 infection is suspected.

Gastrointestinal stromal tumor of the ampulla of Vater: A case report and literature review.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) usually develop in the stomach and small intestine and only rarely occur in the ampulla of Vater (AV). CASE PRESENTATION: We report a case of a GIST of the AV. A 21-year-old, previously healthy woman presented with a three-month history of epigastric pain, jaundice and weight loss. The diagnosis of a tumor in the second part of the duodenum was made by the computed tomography. The patient underwent pancreatoduodenectomy, the operative specimen revealed an intermediate risk group of GIST and thus, the patient didn't take adjuvant therapy. DISCUSSION: GIST rarely develops in the duodenal ampulla region and it has no specific symptomatology. Radiological investigations play an important role in the diagnosis of Stromal Tumor of the Ampulla of Vater (STAV) mainly computed tomography because STAV has a large size in the majority of cases contrary to adenocarcinoma. CONCLUSION: The aim of this study is to report a new case of STAV combined with a systematic review of reported cases published in peer-reviewed journals.

Acute pancreatitis secondary to spontaneous intramural duodenal hematoma: A case report and a review of the literature.

INTRODUCTION: Intramural duodenal hematoma is a rare entity, often secondary to traumatic origin, but more rarely spontaneous due to blood flow disorders, especially in the context of anticoagulant therapy. CASE PRESENTATION: We report the case of a 66-year-old woman under anticoagulant treatment for atrial fibrillation, who was diagnosed with acute pancreatitis secondary to a spontaneous duodenal hematoma. The evolution was favorable under medical treatment. DISCUSSION: Intramural duodenal hematoma is frequently associated with abdominal pain and hematemesis, more rarely, it can be responsible for an acute pancreatitis, which is considerate as an unusual complication. We report here a case of duodenal hematoma revealed by acute pancreatitis along with a review of the literature since 2011. CONCLUSION: Monitoring of patients on oral anticoagulants helps prevent the occurrence of IDH and avoid its complications, which can be fatal.

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion.

INTRODUCTION AND IMPORTANCE: A bezoar is an agglutination of ingested materials forming an indigestible and insoluble mass inside the gastrointestinal tract. Trichobezoars formed by ingested hair are rare. The stomach tends to be the typical location. In some cases there is an extension to the duodenum, jejunum or even to the colon and it is called Rapunzel syndrome. CASE PRESENTATION: We present a case of an occlusion due to double trichobezoars in 17 years old woman who underwent an extraction by enterotomy and gastrotomy. CLINICAL DISCUSSION: Trichobezoar is a compact conglomeration of swallowed hair and makes up less than 6% of all bezoars. It appears in young women under 20 years of age who carry psychiatric or chronic metabolic diseases that can alter the behavioral balance. Physical examination is often poor in uncomplicated forms: forms without peritonitis or occlusion or hemorrhage or appendicitis or pancreatitis but it may reveal a well-limited, smooth, firm, and mobile epigastric mass. For uncomplicated forms or forms complicated by hemorrhage, the reference examination requested in the first line remains the esophagogastroduodenoscopy (EGD) which allows a dual role both diagnostic and therapeutic. Computed Tomography (CT) remains the preferred imaging modality requested urgently in case of an occlusion or peritonitis presentation. Endoscopic extraction represents the therapeutic approach for uncomplicated forms but surgical treatment remains the main therapeutic means of trichobezoar. CONCLUSION: Trichobezoars are rare and present both diagnostic and therapeutic challenge. Laparotomy remains the most successful surgical treatment although laparoscopy currently appears to have promising results in expert hands. A post-operative pscychologic management is essential to correct psychobehavioral disorders of patients to prevent recurrence.

Trocar site post incisional hernia: about 19 cases.

It is commonly admitted that laparoscopic surgery has the advantage of abdominal wall preservation. Therefore, having port-site incisional hernia caused by trocars of laparoscopy must be avoided. The aim of this work is to specify predictive factors, therapeutic modalities and to insist on prevention of this avoidable complication. It is a retrospective and descriptive study over a period of 10 years, between January 2006 and December 2015. This series includes 19 consecutive patients who present port-site incisional hernia. Age, initial intervention, site and size of the trocars incisional hernia, diagnostic method, delay and type of the second procedure with the final results were examined and recorded. Our study contains 19 female. The average age was 55 years (29-78). Risk factors were resent in 12 patients. All our patients were operated initially by laparoscopic approach. The average onset time was 6.6 months (3-12). Fourteen patients presented swelling at the trocar site and 5 patients had an emergent surgery due to the strangulation of the port-site incisional hernia. For these five patients a primary suture was made. Hernia content was the great omentum in 11 cases and small bowel in 8 cases. It was umbilical in 16 patients and in the left flank in 3 patients. They occur all where it was placed a 10 mm trocar. The evolution was suitable in all cases. There were two recurrences, one after primary suture and the other after a mesh repair. Port-site incisional hernia is rare. The most incriminated risk factors are essentially trocar size, obesity and open coelioscopy. Vital prognosis can be engaged if port-site incisional hernia is incarcerated or strangulated then prevention is necessary.

Choledochoduodenal fistula due to peptic duodenal ulcer diagnosed by X-barium meal study: interest of medical treatment.

Peptic ulcer complication has decreased over le last years. Spontaneous bilio-digestive fistulas, in the absence of primary biliary disease, remain a very unusual complication of the upper digestive tract. The choledochoduodenal fistula is an extremely rare entity which can be caused by a duodenal peptic ulcer. It appears with the symptoms of peptic ulcer disease. They are diagnosed incidentally on radiological exams. It was suspected after finding pneumobilia on abdominal ultrasound and confirmed by X-barium meals study. The purpose of this observation is to report the case of a patient presenting a choledochoduodenal fistula diagnosed by X-barium meal to underline the importance of this radiological exam to diagnose this disease and to insist on the conservative treatment for choledochoduodenal fistula caused by a duodenal peptic ulcer. The prognosis of patients treated medically is good, although the fistula can remain asymptomatic. Angiocholitis and biliary sequelae remain rare and do not warrant prophylactic surgical treatment.