Diaphragmatic eventration associated with megacolon: A case report.

INTRODUCTION: Diaphragmatic eventration (DE) associated with gastrointestinal anomalies is rarely reported, and its treatment is not well defined. CASE PRESENTATION: We present a 24-years-old male admitted for cough, dyspnea, and chest pain, all of gradual onset. Chest computerized tomography (CT) and chest x-ray diagnosed diaphragmatic eventration and colonic distension. He underwent surgery via a posterolateral thoracotomy. We found colonic distension which pushed the left hemidiaphragm under intense pressure further into the chest, making immediate diaphragmatic plication via the chest difficult. We managed this by colonic needle decompression followed by resection and plication of the diaphragm. The patient had a satisfactory postoperative recovery with a good respiratory profile and no constipation. At a follow up visit, barium enema showed megacolon with no apparent etiology. He is to have a long-term outpatient follow up. DISCUSSION: Diaphragmatic eventration coexisting with megacolon is rare. Data available suggests supplementary abdominal workup is necessary to better plan the surgery. Surgical correction via an abdominal route tends to be more appropriate in these scenarios. CONCLUSION: In cases of gastrointestinal anomaly associated with diaphragmatic eventration, more careful abdominal consideration is needed to better plan the surgery.

[Therapeutic approach to massive thymic hyperplasia associated with respiratory distress syndrome in a newborn infant living in a developing country: a case report]. / Stratégie thérapeutique devant une hyperplasie thymique massive associée à un syndrome de détresse respiratoire chez un nouveau-né dans un pays en voie de développement: à propos d'un cas.

Thymic hyperplasia is an anterior mediastinal mass with a variable clinical presentation. It causes differential diagnostic problems in the pediatric age group and there is no consensus on the therapeutic approach. We here report the case of a 1-month-old infant treated for respiratory distress syndrome. Chest CT scan revealed anterior mediastinal mass, which was excised through median sternotomy. Anatomopathological examination showed thymic hyperplasia. Clinical outcome was satisfactory. This encouraging result suggests that, contrary to what some authors propose, it would be more appropriate to opt for an aggressive therapeutic strategy when managing symptomatic thymic hyperplasia. This is even more justified in a socio-economic context characterised by difficult access to care and follow-up measures limited by patients' means.

[Indications and results of surgical resection of bubbles arising from pulmonary emphysema]. / Indications et résultats de la chirurgie de résection des bulles d'emphysème pulmonaire.

Surgical resection of bubbles or bullectomy is the gold standard in the treatment of bubbles arising from pulmonary emphysema. It is usually indicated for patients with complicated bubbles or when they are the underlying cause of disabling dyspnea. This study aims to determine the indications for bullectomy and to evaluate surgical outcomes in our Department. We conducted a retrospective, descriptive study of 24 patients (23 men and 1 woman) whose average age was 49 years and who had undergone bullectomy between 2004 and 2013. Collected data were: factors favoring the occurrence of bullous emphysema, the circumstances in which bubble was detected, data from the radiological examinations, data from pulmonary and cardiovascular function testing, data from bullectomy, data from postoperative clinical and functional examination. Morbidity rate was 37.5 %. The main complication was persistent air leak (7 cases). One patient died two days after surgery due to acute respiratory failure. The average follow-up period was 26 months during which we observed improvement of dyspnea in all patients and no complications. Bullectomy is an effective, reliable and safe surgical technique that may improve patients' quality of life for a few years.

Penetrating chest injuries caused by swordfish sword used as a weapon.

We report 5 cases of penetrating chest wounds caused by weapons made from swordfish swords, involving breakage of the sword that later appeared as a thoracic foreign body. The patients had been assaulted 2 days to 17 years earlier. Three of them had a chronic infected wound, one had a penetrating thoracic wound with hemopneumothorax, and one had a foreign body. Computed tomography showed a foreign body in the lung in 4 cases, with aortic penetration in one. The foreign body was removed via thoracotomy in all 4 patients, with aorta repair in one who presented later with a pseudoaneurysm.

[Anatomical bases of external pudendal artery injuries during surgical treatment of pelvic limb varices]. / Bases anatomiques des lésions de l'artère pudendale externe lors de la chirurgie des varices du membre pelvien.

INTRODUCTION: External pudendal artery is a collateral branch of the common femoral artery which is the primary blood supply to the penis or the clitoris. Its relationship with the venous arch of the great saphenous vein and its afferents in femoral triangle, are very narrow. This often entails injuries during crossectomy and great saphenous vein stripping. These lesions can cause sexual dysfunction. METHODS: This study reports the case of a dissection of 22 inguinal regions in 13 men and 9 women who underwent surgical treatment of the femoral triangle. The distribution and the relationship between the external pudendal artery and the venous arch of the great saphenous vein are studied. RESULTS: Single external pudendal artery is the most common. All external pudendal arteries originate from the common femoral artery. The most common type of relationship is between the sub-crossing of the venous arch of the great saphenous vein and a single external pudendal artery. Moreover, we recorded a pre-crossing, an alternate crossing and some relationship with the common femoral vein and the afferences of the venous arch of the great saphenous vein. Some surgical techniques expose more or less to external pudendal artery injury. CONCLUSION: This study confirms previous data but shows some peculiarities about the relationship between the venous arch of the great saphenous vein and external pudendal artery.

A case of pericardial tuberculoma presenting as a left anterior chest wall mass.

INTRODUCTION: Tuberculosis (TB) can present both in its pulmonary or extra-pulmonary forms. Cardiac tuberculoma previously described only after autopsy is continuously seen with the advent of more advanced imaging modalities. CASE REPORT: A 23-year-old male with a four month history of a progressively increasing left anterior thoracic wall mass of 5 cm in diameter was referred from oncology for clinical re-evaluation and for echocardiography. Systemic examination was essentially normal. Transthoracic and trans-oesophageal echocardiography showed the presence of a pericardial mass around the right atrioventricular junction. Thoracic CT scan showed an anterior mass in left chest wall extending to the pericardium and also the presence of mediastinal lymphadenopathy. Mantoux test was positive and histological examination of tissue biopsy confirmed the presence of TB. However, blood tests and culture of aspirated purulent fluid were unyielding. A diagnosis of pericardial tuberculoma with mediastinal and parietal extension was made and patient was successfully treated with standard anti-TB chemotherapy. DISCUSSION: The possible differential diagnoses for chest wall tumors are varied and a high degree of suspicion is needed to diagnose cardiac tuberculoma especially in endemic regions. Imaging though helpful in morphological description cannot make precise diagnosis. The diagnosis depends on histological and culture studies. There is usually a good evolution with anti-TB treatment. CONCLUSION: In an era of an increasing number of acquired immune-compromised patients, and with increasing number of diagnoses of tuberculosis, a diagnosis of cardiac tuberculoma should be considered in patients presenting with a thoracic wall mass.