Acute cholecystitis in pregnant women: A therapeutic challenge in a developing country center.

Backgrounds/Aims: Acute cholecystitis is a rare condition in pregnant women, potentially affecting the maternal and fetal prognosis. Our aim was to report the main clinical and paraclinical features of acute cholecystitis during pregnancy and therapeutic modalities. Methods: We conducted a case series analysis recording pregnant patients with acute cholecystitis admitted to our surgery department over a period of 11 years. We collected clinical data, paraclinical features, and management modalities related to cholecystitis. Results: There were 47 patients. Twenty-eight percent was in the first trimester of pregnancy, 40% in the second, and 32% in the third trimester. Abdominal pain was located in the right hypochondrium in 75% of cases. Fever was noted in 21% of cases. C-reactive protein was elevated in 39% of patients. Cholestasis markers were high in four patients. Abdominal ultrasound showed a distended gallbladder in 39 patients, with thickened wall in 34 patients, and gallbladder lithiasis in all cases. No patient had a dilated main bile duct. All patients received intravenous antibiotic therapy. Tocolysis was indicated in 32 patients. Laparoscopic cholecystectomy was performed in 32 cases (68%), and open cholecystectomy in 15 cases (32%). Postoperative course was uneventful in 42 patients, and complicated in 5 patients. Rate of complications was statistically higher after open cholecystectomy (p = 0.003). Morbidity rate was higher in the third trimester (p = 0.003). Conclusions: Delay in the diagnosis of acute cholecystitis during pregnancy can lead to serious complications. Management is based on antibiotic therapy and cholecystectomy. Laparoscopic cholecystectomy appears to be less morbid than open cholecystectomy.

RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER.

BACKGROUND: Surgical treatment for pilonidal abscess is the gold standard, but not yet well codified. Different techniques proposed can be conservative or radical. AIMS: The aim of our study was to compare postoperative outcomes of both methods in one-stage treatment strategy. METHODS: This is a comparative study including patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up, over a period of 4 years. We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients. RESULTS: We analyzed 57 patients: 33 males and 24 females. The mean age was 26.9±10 years. The type of operation was excision in 46 (81%) cases and incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case. There was no statistically significant relationship between the type of surgery and the occurrence of postoperative surgical complications (p=1) and hospital stay (p=0.4). Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04). Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02). CONCLUSIONS: Excision of pilonidal abscess was the common technique in our series, with a significantly lower rate of recurrence of the disease than after incision. However, the long convalescence following excision and the longer operating time, particularly in an emergency context, may sometimes lead to choosing conservative surgery.

When a polyester mesh causes an enterocutaneous fistula, 30 years after its implantation.

Digestive fistula on mesh is an exceptional and late complication of hernioplasty. The type of mesh and its position are often implicated in its occurrence. Clinical presentation is multiform. Morphological examinations are essential to confirm the diagnosis, and the curative treatment remains surgical.

Spontaneous gas gangrene of the lower limb in a patient with rectal cancer: A fatal diagnostic pitfall.

Spontaneous gas gangrene of lower limb is rare. It may complicate digestive cancer or neutropenia. We report a case of spontaneous gas gangrene of the lower limb complicating a rectal cancer, initially diagnosed as deep vein thrombosis. The diagnostic delay was fatal.

[Abdominal wall edometriosis: about two cases]. / Endométriose de la paroi abdominale: à propos de deux cas.

Abdominal wall endometriosis is a rare disease that usually develops in association with a cesarean section scar. Although frequently identified in the skin and subcutaneous adipose tissue adjacent to the cesarean scar, intramuscular localization is possible but rare. Treatment is based on surgical excision of the lesion associated with or without hormone therapy. Wide surgical excision is the treatment of choice, but it exposes to the risk of abdominal wall hernia. We here report two cases of parietal endometriosis occurring after Pfannstiel scar for cesarean section whose data were collected at the Department of surgery in the Zaghouan Regional Hospital.

Acute lithiasis cholangitis in pregnant women: About three cases.

Acute lithiasis cholangitis is a rare non-obstetric emergency during pregnancy, which may threaten fetus and mother's life. It requires a codified management in order to avoid complications. In this current study, we aimed to report our center experience in the management of acute lithiasis cholangitis occurring in three pregnant women.

Radical versus conservative methods in one-stage pilonidal abscess surgery: the experience of a tunisian center / Métodos radicais versus métodos conservadores em uma etapa da cirurgia de abscesso pilonidal: a experiência de um centro tunisiano

ABSTRACT BACKGROUND: Surgical treatment for pilonidal abscess is the gold standard, but not yet well codified. Different techniques proposed can be conservative or radical. AIMS: The aim of our study was to compare postoperative outcomes of both methods in one-stage treatment strategy. METHODS: This is a comparative study including patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up, over a period of 4 years. We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients. RESULTS: We analyzed 57 patients: 33 males and 24 females. The mean age was 26.9±10 years. The type of operation was excision in 46 (81%) cases and incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case. There was no statistically significant relationship between the type of surgery and the occurrence of postoperative surgical complications (p=1) and hospital stay (p=0.4). Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04). Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02). CONCLUSIONS: Excision of pilonidal abscess was the common technique in our series, with a significantly lower rate of recurrence of the disease than after incision. However, the long convalescence following excision and the longer operating time, particularly in an emergency context, may sometimes lead to choosing conservative surgery.

RESUMO RACIONAL: O tratamento cirúrgico do abscesso pilonidal é a indicação habitual, mas ainda não está bem codificado. Diferentes técnicas propostas podem ser conservadoras ou radicais. OBJETIVOS: Comparar os resultados pós-operatórios de ambos os métodos, em uma única etapa da estratégia de tratamento. MÉTODOS: Estudo comparativo incluindo todos os pacientes operados por abscesso pilonidal, com um seguimento pós-operatório satisfatório, durante um período de 4 anos. Foi avaliada a ocorrência de recidiva pós-operatória nos prontuários médicos ou entrevistando pacientes. RESULTADOS: Foram incluídos no estudo 57 pacientes: 33 homens e 24 mulheres. A média de idade foi de 26,9±10 anos. O tipo de operação foi a excisão em 46 casos (81%) e a incisão em 11 casos (19%) associada à curetagem em três casos e a drenagem em um caso. A excisão do abscesso pilonidal foi significativamente associada a um tempo maior para retornar à atividade (p=0,04). A cirurgia conservadora foi significativamente associada a uma cicatrização mais rápida da ferida cirúrgica (p<0,001). A taxa de recidiva foi de 19% em cirurgia radical e de 54% em cirurgia conservadora. A cirurgia radical foi significativamente associada a uma taxa de recidiva menor do que o procedimento de incisão (p=0,02). CONCLUSÕES: A excisão do abscesso pilonidal foi a técnica comum nesta casuística, com taxa de recidiva da doença significativamente menor do que após a incisão. No entanto, a longa convalescença após a excisão e o maior tempo de operação, pode às vezes levar à escolha de uma cirurgia conservadora.