[Retro-peritoneal liposarcoma. About 5 cases and revue of literature]. / Le liposarcome rétro-péritonéal. A propos de 5 cas et revue de littérature.

Liposarcomas are malignant mesenchymatous tumors developed from elements constituting the greasy tissue in various stages of differentiation. It is one of the most frequent mesenchymatous sarcomas. Retro-peritoneum is a privileged site of development in 12 to 15% of cases. During 9 years, from 1994 till 2002, we have colligated and operated 5 cases of retro-peritoneal liposarcomas. Average age was 50 years (extremes 34 to 79 years) with a sex-ratio of 1.5. Diagnosis was late beyond 6 months. Abdominal pain and the appearance of an enormous mass (20 cm) were the revealing signs. No imagery method allowed to evoke the diagnosis. The cyto-puncture realized once, was not able to determine with precision the histological type. Immunohistochimy occupies nowadays an important place to classify a sarcoma. Large surgical resection realized in 5 cases did not allowed the complete ablation of the tumour in 3 cases considering the advanced loco-regional extension, which was at the origin of 3 recurrences. Well differentiated histological type was noted in 3 cases, myxoid type in a case and not differentiated type in a case.

[Tumors of the vaterian region indications, findings and prognosis : about 49 cases]. / Les tumeurs de la region vaterienne: indications, resultats et pronostic: a propos de 49 cas.

This retrospective study is about 49 cases of tumors of the vaterian region collected between 1976 and 2001. Tumors of the vaterian region represented 7% of the bilio-pancreatic tumors. The study was about 18 women and 31 men, with sex-ratio of 1.7. The mean age was 61 years. Treatment was surgical : cephalic duodeno-pancreatectomy (28 patients) or ampullectomy (5 patients). Rate of tumor resectability was 69.4%. Bilio-digestive derivation was practiced on 13 patients and therapeutic abstention was decided for 3 patients. Age over 65 years, rate of bilirubine superior to 120 mmol/l and surgery done in emergency were elements of bad prognosis that increased post-operative mortality of following cephalic duodeno-pancreatectomy. Global mortality and morbidity were respectively 16% and 24%. Factors of poor prognosis were essentially: Tumor of large size, infiltration of the surrounding structures and tumor with metastases. The survival after bilio-digestive derivation didn't pass the 8 months. Five year survivals cephalic duodeno-pancréatectomy represented 20%. It depended on the degree of the local invasion. This 5 years survival rate to was 85% for stage I (classification of Martin) and 10% for stage IV.

[Late post-operative adhesive small bowel occlusions. About 258 cases]. / Les occlusions du grele par brides post-operatoires tardives. A propos de 258 cas.

This retrospective study reports a series of 258 patients operated on for late developing post-operative adhesive occlusions. The impact of anterior interventions on these occlusions. The impact of anterior interventions on the occllusions as well as he clinical and paraclinical patterns are discussed before any approach to the different therapeutic aspects of this complication. Previous surgery had an impact not by number of the operations performed (80% of patient had undergone only one intervention on the pelvis or abdomen) but essentially by the nature of the opertions since most of the adhesions occured following surgery on the appendix. The diagnosis should be made urgently ont basis of findings yielded by physical examination and plain abdominal x-rays (ct-scan of the abdomen is hardly indicated for the absence of hydroaeric levels on the plain abdominal film does not defintely exclude the strangulation). Laparoscopic adhesiolys is an adegnate treatment in case of a single adhesion. This laparoscopic is an adegnate treatment in case of a single adhesion. This laparoscopic procedure practised on 11 patients had to be transformed in 3 cases in to an open laparoctomy. Resection rate was 11.6%. Mortality and morbidity rates were 2% and 17% respectively.

[Anastomotic ulcer after vagotomy for duodenal ulcer]. / Les ulcères anastomotiques après vagotomie pour ulcère duodénal.

Between January 1981 and December 2000, 2609 patient underwent surgery for duodenal ulcer. 2274 underwent isolated vagotomy; 1590 had vagotomy associated with GI anastomosis. Only relapses of anostomic ulcers after vagotomy associated with gastrojejunal anastomosis were included in this study. 22 patients (20 males, 2 females) aged between 26 and 79 years had anastomic ulcer relapses (1.38%) after vagotomy and GI anastomosis. Incomplete vagotomy was diagnosed in 14 cases (93%) associated with a defect in setting in 2 cases. Despite the ongoing controversy about the role of Helicobacter in the pathogenesis of anastomotic ulcers, medical treatment remains the primary therapy, and a partial gastrectomy alone or with vagotomy is necessary only in unresponsive cases.

[Mucus secreting tumors of the appendix. Report of 22 cases]. / Les tumeurs mucosécrétantes de l'appendice. A propos de 22 cas.

The retrospective study presented in this article was realized on a series of 22 cases of mucus secreting tumor of the appendix compiled among 8373 appendicectomies. The clinical picture was dominated by an appendiceal syndrome (73%). The diagnosis was made pre or peroperatively in 10 cases and it was only with to the systematic anatomopathologic exam that 12 other cases were discovered. The histological study of the appendectomy piece showed a retention mucocele (12 cases), a mucosal hyperplasia (8 cases) and a cystadenoma (2 cases). For 5 patients, the diagnosis of peritoneal pseudomyxoma (4 cases) or extraperitoneal (1 case) was retained. All the patients underwent an appendicectomy, associated to an evacuation of the peritoneal gelatinous ascites for 5 patients among whom two underwent in more an omentectomie. Two cases of recurrence were recorded 5 months later.

[Psoas abscess in Crohn's disease. Report of a new case]. / Abcès du psoas revelant une maladie de Crohn. A propos d'une nouvelle observation.

Psoas abscess complicating Crohn's disease is a rare condition. The clinical diagnosis is confirmed by ultrasonography and/or computerized axial tomography. Etiology of the abscess is confirmed by digestive opacifications. We present one case of recurrence psoas abscess, revealing Crohn's disease in young girl of 18 years. Therapy is consisting in a pathologic bowel resection after urgency drainage. After literature review we, try to propose diagnostic and therapeutic walk of this affection.

[Congenital diaphragmatic hernias in the adult: report of six cases]. / Les hernies diaphragmatiques congenitales de l'adulte: a propos de six cas.

The anterior hernia or the fissure of Larrey and Bochdalek hernia are exceptional in adult. We present 6 cases of congenital diaphragmatic hernia revealed in adult. Three hernia of the fissure of Larrey and three Bochdalek hernia. We discuss the different clinical, radiological, and therapeutic aspects of these hernia. We insist on the gravity of strangulated hernia and their surgical treatment.