[A late post-traumatic diaphragmatic hernia revealed by a tension fecopneumothorax (a case report)]. / Hernie diaphragmatique post-traumatique révélée par une pleurésie stercorale (à propos d'un cas).

INTRODUCTION: Post-traumatic diaphragmatic hernia is a particular lesion in traumatology that may be neglected. Thus, the diagnosis may be delayed for a few days to several months and only be made following a complication. The left diaphragmatic cupola is the most touched. Tension fecopneumothorax following diaphragmatic hernia perforation in the pleural cavity is a rare but particularly severe complication of traumatic diaphragmatic hernia. CASE REPORT: A 68-year-old man was admitted for acute intestinal occlusion with respiratory distress. A history of a violent blunt thoraco-abdominal traumatism resulting from a traffic accident eight years before was noted. The chest x-ray revealed an abundant hydropneumothorax and the thoracic scan revealed abundant effusion with heterogeneous density in the left pleural cavity, associated with an intrapleural hernia of the large intestine. An emergency thoracolaparotomy discovered tension fecopneumothorax secondary to intrathoracic perforation of the transverse colon through a left hemidiaphragm defect. The surgical treatment consisted of hernia reduction, pleural drainage, colostomy and repair of the diaphragmatic defect. CONCLUSION: The possibility of diaphragmatic hernia should be kept in mind in case of violent blunt thoraco-abdominal traumatism or basithoracic wound. In this way, complications such as tension fecopneumothorax that could threaten the functional and vital prognosis may be prevented.

[Intra-uterine fetal death by knife: case report]. / Mort foetale intra-utérine par arme blanche (à propos d'un cas).

INTRODUCTION: Opened injuries by knife are rare in pregnant women and are responsible of foetal death in most cases. OBSERVATION AND COMMENTARY: We report a case of a 27-years woman, in her 8th months of pregnancy, victim of three knife punchs in her right iliac fossa. An emmergent laparotomy revealed deep wounds in the uterus and its right vascular pedicles, and a right external iliac artery lesion. Hysterectomy was performed and the extracted fetus was dead. He had two wounds in skull and back. Foetal death is common in opened knife injuries especially at the end of pregnancy. On one hand, the fetus has an abdominal situation that expose him to penetrating lesions. On the other hand, the uterus is richly vascularized during this period of pregnancy, thus any uterine or pedicular wound could result in a maternal hemorrhagic shock and hence a poor foetal and maternal prognosis. CONCLUSION: Knife injuries in pregnant women could compromise the foetal prognosis. Managmanent should be early and requires a close collaboration between resuscitators, obstetricians and vascular surgeons.

[Non operative management of blunt splenic trauma in adults]. / Traitement non-opératoire des traumatismes fermés de la rate chez l'adulte.

Nonoperative management of blunt splenic injury allows preservation of the immune function of the spleen while avoiding unnecessary laparotomy. The aim of our study was to evaluate the feasibility and the results of conservative management of adult blunt splenic trauma in the context of a developing country. Nonoperative management was proposed for 52 out of 62 patients with blunt splenic trauma treated at the Casablanca University Hospital, Morocco. Motor vehicle-road accidents (88%) were the most common etiology. Multiple trauma was present in 79% of the cases. 15% of the cases had hemodynamic instability. Ultrasonography was performed in 52 patients; it showed splenic contusion in 45 patients and subcapsular hematoma in 7 patients. CT scan showed splenic contusion in 11 patients. Four cases ultimately required operative management with one death. Of the remaining 48 patients, 45 had an uneventful course with observation, but there were two deaths in the observation group.

[Cushing's syndrome due to a pulmonary carcinoid]. / Syndrome de Cushing révélateur d'un carcinoïde pulmonaire.

Cushing paraneoplasic syndrome is a rare cause of hypercorticism. We report a case of 35 year-old man presenting with Cushing's syndrome characterized by severe signs of hypercorticism and hypokalemia. Endocrine investigations were suggestive of an hypercortisolism linked to an ectopic adrenocorticotropic (ACTH) secretion, both at baseline (mean ACTH levels=275 pg/ml, urinary free cortisol excretion=3.898 mmol/24 h) and after pharmacodynamic testing (lack of inhibition of ACTH by dexamethasone). Thoracic tomodensitometric examination revealed a 15 mm tumor corresponding to a neuroendocrine pulmonary carcinoid with positive immunostaining for chromogranin A. Postoperative ACTH measurement was undetectable, plasma cortisol and free urinary cortisol were also decreased after tumor resection suggesting complete tumor removal. This case report illustrates the characteristics of paraneoplasic Cushing syndrome due to ACTH secreting pulmonary neuroendocrine carcinoid.

[Long-term prognosis of hydatid lung cyst treated by video-assisted thoracic surgery]. / Pronostic à long terme du kyste hydatique du poumon traité par vidéo-chirurgie thoracique.

With the advent of mini-invasive surgery, video-assisted thoracic surgery (VATS) is a good means of diagnosis and therapeutic in thoracic surgery. We report 14 cases of hydatid cyst of the lung treated by VATS. Outcome as uneventful.

[Hypoglycemic coma revealing a solitary fibrous tumor of the pleura]. / Coma hypoglycémique révélant une tumeur fibreuse solitaire de la plèvre.

INTRODUCTION: Solitary fibrous tumor of the pleura (TFSP) is rare. When associated with hypoglycemia it is commonly referred to as Doege-Potter syndrome. CASE: A 51-year-old man was hospitalized for recurrent near-syncope associated with hypoglycemia. Clinical examination and then thoracic imaging clearly showed anomalies that corresponded to a mass occupying the entire left hemithorax. After resection, histological analysis diagnosed a fibrous tumor of the pleura. DISCUSSION: Solitary fibrous tumors of the pleura are observed most often in patients aged 50 and 70 years. Hypoglycemia is rare, occurring in approximately 4% of cases. It is explained by the abnormal secretion of a type-II insulin-like growth factor. This tumor is treated by complete surgical excision.

[Colonic actinomycosis: report of a case and review of the literature]. / Actinomycose colique: à propos d'un cas et revue de la littérature.

Actinomycosis is a chronic granulomatosis infection caused by a Gram positive anaerobic bacteria, Actinomyces. Abdominal localizations are rare and simulated a malignant process. The difficulties of diagnosis are usually leading to surgical resection. We report a colonic actinomycosis case of a 62-year-old woman with a abdominal tumor and diagnosed after surgical resection.

[Desmoid tumors of the shoulder-girdle (report of three cases)]. / Les tumeurs desmoïdes du creux sus-claviculaire (a propos de trois cas).

The authors report three cases of desmoid tumors of the shoulder-girdle. Through these observations and a review of the literature, they underline the specific characteristics of the desmoid tumors: the frequency and the seriousness of the localisations at the member roots and the great difficulties of the exeresis.

[Primary retroperitoneal tumors in adults: report of 11 cases]. / Les tumeurs rétropéritonéales primitives de l'adulte: à propos de 11 cas.

The primitive retroperitoneal tumors are tumors which diagnosis isolate and thus the prognosis is poor. The authors assess the resectability of these tumors and the therapeutic results. We performed a retrospective study during 5 years, 11 patients were reviewed, in the unit of visceral surgical emergency of UHC Ibn-Rochd in Casablanca. The median age was 44 years old. The revealing signs were pains (67%), abdominal mass (54%), and compressive signs in 78%. The diagnosis was based on the computerized tomography in 10 cases (90%), the ultrasound sonography in 3 cases, and the IVU in 3 cases when it was necessary. The treatment was surgical in all cases. The resection was curative in 58%, 1 patient received chemotherapy. Histologically, the mesenchymatous variety was the most frequent (68%) and almost malignant (80%), the ectodermic origin was noted in 3 cases, and the vestigial in 1 case. The long-term follow-up was characterized by recurrence in 4 cases and 3 patients were lost to follow-up. The prognosis of the primitive retroperitoneal tumors is poor, because of a late diagnosis, and the malignant, and recurrent potential of these tumors.

[Leiomyosarcoma of the inferior vena cava: a new case report]. / Léiomyosarcome de la veine cave inférieure: à propos d'une nouvelle observation.

We report on a new case of leiomyosarcoma of the inferior vena cava presenting as an abdominal mass. With the help of review of the literature, the value of modern imaging techniques is recalled. The treatment is exclusively surgical. The prognosis is poor due almost to the diagnosis delay.

[Abdominal stab wound injury with omentum evisceration]. / Plaies abdominales avec épiplocèle.

INTRODUCTION: The abdominal stab wound with omentum evisceration, represent 4 to 20% of abdominal injuries. It causes a problem of therapeutic indication between selective and mandatory laparotomy. The goal of this work is to give some answers to this dilemma. MATERIAL AND METHODS: A retrospective study from 1992 to 2000, concerning 75 patients presenting an omentum evisceration. Where there were 71 men et four women, the mean age was 25 years old. All the abdominal injuries are exclusively by the stab wound. These 75 patients were divided into three groups: group I: 24 patients (32) were immediately operated ahead of the existence of severity elements; group II: 18 (24%) patients had an isolated omentum evisceration without any elements of severity were operated immediately; group III: 33 (44%) were placed under clinical, radiological and ultrasound control. RESULTS: We have found four cases of negative laparotomy (16,7%) in group I, and 14 (77,8%) in group II. Five secondary laparotomies (15%) were performed in group III. Among the 51 patients (Group II and Group III) nine (17%) had visceral injuries... In all of the three groups, there was a high frequency of intestinal organs injuries, there was no mortality and 12% of morbidity. CONCLUSION: The isolated omentum evisceration is a penetrating injury of the abdominal wall but not synonym with visceral injuries, the interventionists authors had a high rate of negative laparotomy. However the selective authors in the asymptomatic patients under clinic examination appears logical: we believe that the laparoscopic diagnostic and therapeutic in doubtful cases can resolve this problem.

[Hydatid cyst of thoracic soft tissues]. / Kyste hydatique des parties molles thoraciques.

Hydatid cysts are uncommon in thoracic soft tissue. We report a case of hydatid cyst which had developed within the lattissimus dorsi presenting as a left parietal scapular mass diagnosed by ultrasound and CT scan, which remains the preferred primary examination for the investigation of masses of this type. We discuss the various possible clinical and paraclinical contexts and recommend total pericystectomy of a closed cyst as the best treatment for this kind of cyst.

[Larrey or Morgagni hernias treated by laparoscopy]. / Hernies de la fente de Larrey, ou hernies de Morgagni, traitées par laparoscopie.

INTRODUCTION: Diaphragmatic hernia or Morgagni-Larrey hernia is a rare entity. Its treatment is surgical and hence raises the question of the surgical approach. OBSERVATIONS: Two patients underwent laparoscopic surgery for Morgagni-Larrey hernia. The first, aged 17 exhibited a chromosomic abnormality (trisomie 21). The second was 18 years old. Both patients underwent surgery by laparoscopy. In both cases, the surgical act performed was resection of the hernia and closure of the orifice with separate sutures. Their post-surgical courses were uneventful, even two years later. COMMENTS: In the age of mini-invasive surgery, laparoscopy is an excellent alternative to laparotomy in this benign pathology.

[Primary lymphoma of the thyroid gland]. / Lymphome malin primitif de la thyroïde.

Malignant primary lymphoma of the thyroid gland is a rare disease generally occurring women in the 6(th) or 7(th) decade of life. The principal clinical sign is giant goiter rapidly leading to sings of compression, raising the question of differential diagnosis with anaplastic cancer. The radiological findings in our patient were suggestive of malignancy due to the locoregional invasion. Immunohistochemistry study of the surgical specimen was required to reach the definitive diagnosis of thyroid gland primary lymphoma. Diagnosis of malignant primary lymphoma of the thyroid gland made at the stage of extensive locoregional extension compromises prognosis. Our patient died after one session of chemotherapy.

[Perineo-scrotal gangrene: apropos of 31 cases]. / La gangrène périnéo-scrotale: à propos de 31 cas.

Fournier's gangrene is a fascitis of the perineum and of the external genitalia. It is a serious infection with rapid evolution and a severe prognosis. It is also unpredictable towards the necrosis. It concerns a series of 31 cases of the perineal scrotal gangrene supervised in the department of surgical visceral emergency of the Ibn Rochd University hospital of Casablanca between 1992 and 2000. In this investigation, the male predominance is important and the mean age is 49 years. The diagnostic delay is 12 days. The symptomatology was dominated by edema and erythema signs, fever and pain. The skin necrosis was seated in the perineum and the scrotum. A septic shock was noticed in six patients and a condition of deep coma in two other patients. Etiology of gangrene was of coloproctologic origin in 15 cases and of urogenital origin in five patients. The bacteriological parietal swabs was positive in 11 cases. The therapeutic take-in-charge consisted of urgent measures of reanimation for six patients. The likely wide spectrum antibiotic therapy consisting of a triple association (beta lactam antibiotic, nitrite-imidazole compound and aminoglycoside) with a secondary adaptation that was recommended for all patients. All the patient underwent surgical debridement of the necrotic tissue with incisions and drainage of the involved areas of the of all the operated-on patients, 26 had colostomy, five among them had both colostomy and cystostomy. The overall evolution was favorable except in eight cases of death. In all, the authors insist on the positive diagnosis as well as the early take-in-charge of the disease to avoid complications of local or general order and recommended the preventive treatment with the precocious treatment of the causing infection.

[Perforated duodenal ulcer: laparoscopic treatment of perforation and ulcerous disease]. / Ulcère duodénal perforé: traitement coelioscopique de la perforation et de la maladie ulcéreuse.

STUDY AIM: The aim of this retrospective study was to report a continuous series of 44 perforated duodenal peptic ulcers operated on through laparoscopic approach with curative treatment of the peptic ulcer disease for socioeconomic purpose. PATIENTS AND METHOD: From February 1995 to May 1996, 44 patients were operated on laparoscopically. There were 42 men and two women (mean age: 36 years). All patients had peritonitis with pneumoperitoneum in 68%. Duodenal peptic ulcer was known in 12 patients and antecedent of episodic epigastric pain were present in 27. Four trocads were used. The diagnosis was confirmed by abdominal exploration and peritoneal lavage was performed with physiological serum. RESULTS: The procedures were: suture of perforated ulcer associated with posterior vagotomy and anterior seromyotomy (n = 6), with troncular vagotomy and pyloroplasty (n = 24) and single suture (n = 1). A conversion into laparotomy was necessary in 13 patients (29.5%). There was no mediastinitis, no postoperative death. Peritonitis by leakage occurred in two patients who were reoperated by laparotomy; mean duration of hospital stay was 5.5 days. With a one-year follow-up, all patients were in good condition, free of pain. CONCLUSION: With laparoscopic surgery, diagnosis of peptic ulcer perforation was confirmed, peritoneal lavage was perfectly done, duodenal perforation was sutured and surgical treatment of the peptic ulcer disease was performed, which is important in poor countries.

[Penetrating injuries of the abdomen. Results of two classical and selective attitudes in the management of 249 wounds]. / Les plaies pénétrantes de l'abdomen. Résultats des 2 attitudes classique et sélective dans la prise en charge de 249 plaies.

The systematic surgical exploration of each abdominal penetrating wound allows an exact out-come of lesions and an adequate treatment without delay. But these advantages are made upon a possibly 30% negative laparotomy. The selective attitude in the management of these abdominal's wounds has permitted to decrease this rate to 5% with a risk of secondary operation for non primary detected lesions in 5%. Our attitude toward 249 penetrative abdominal's wounds was classic and selectable respectively from 86 to 89 and 90 to 93. The results has confirmed the literature's date and especially has shown no significant difference between the two attitude concerning the morbidity and the mortality.