Hernie de Spieghel compliquee d'une fasciite necrosante de la paroi abdominale. A propos d'un cas

La decouverte d'une hernie de Spieghel compliquee d'une fasciite necrosante de la paroi abdominale est exceptionnelle. Un homme de 36 ans avait presente une tumefaction inflammatoire de la fosse iliaque gauche diagnostiquee comme une fasciite necrosante. Cette tumefaction decouverte quatre mois plus tot avait fait l'objet de plusieurs seances de massage traditionnel. Au cours du traitement chirurgical; une anse grele necrosee et perforee passant a travers une hernie de Spieghel etait retrouvee; a l'origine de la fasciite necrosante. Les difficultes diagnostiques et therapeutiques sont discutees a travers une revue de la litterature

Un cas d'hematome retroperitoneal spontane idiopathique chez une femme enceinte

L'hematome retroperitoneal est habituellement secondaire a un traumatisme. La forme spontanee idiopathique est rare surtout quand il survient chez la femme enceinte. Nous rapportons le cas d'une femme de 29 ans enceinte de 20 semaines d'amenorrhee; qui a presente une douleur abdominale aigue avec instabilite hemodynamique et deglobulisation. La difficulte est d'affirmer le diagnostic de cet hematome afin d'evaluer le retentissement foto-maternel et d'adapter la prise en charge therapeutique

Rupture spontanee de l'oesophage. A propos de quatre observations

La rupture spontanee de l'oesophage (RSO) represente une urgence chirurgicale rare et grave. Nous en rapportons quatre cas observes et traites au Centre Hospitalier de Pau de janvier 1986 a janvier 2007. L'objectif est de montrer les difficultes diagnostiques et therapeutiques. Si le diagnostic est facile dans sa forme classique; il doit etre evoque dans sa forme atypique devant l'association d'une symptomatologie abdominale et pleuro-pulmonaire; d'une douleur basithoracique et de vomissements. La radiographie thoracique; l'oesophagographie et la tomodensitometrie constituent la cle du diagnostic. Quant a la prise en charge chirurgicale; une suture associee a une fistulisation dirigee et une exclusion oesophagienne semblent etre les gestes les mieux adaptes

[Seromuscularis rupture of the oesophagus after vomiting: a rare cause of hemothorax]. / Rupture séro-musculeuse de l'oesophage après vomissement: une cause rare d'hémothorax.

We report a case of seromuscularis rupture of the oesophagus occurring after an episode of vomiting and revealed by a left hemothorax. Diagnosis was established at thoracoscopy and was related to the nosologic setting of post-emetic syndromes. All unusual pleuropulmonary symptoms after vomiting must make evoke this diagnostic hypothesis.

[Metastatic obstruction of the small bowel revealing or complicating squamous-cell lung cancer. Two cases and a review of the literature]. / Occlusion métastatique de l'intestin grêle révélant ou compliquant un carcinome épidermoïde bronchique. Présentation de deux cas et revue de la littérature.

Gastrointestinal metastasis from lung cancer is exceptional and generally asymptomatic. Other secondary localizations are often present. Metastastic dissemination may involve any portion of the gastrointestinal tract. Clinical expression is variable: dysphagia, anemia, bowel obstruction, peritonitis. Surgical treatment may be indicated in selected patients. We describe the cases of two patients who developed obstruction of the small bowel due to metastases from squamous-cell lung cancer. Bowel obstruction was in the inaugural sign in the first patient. Mesenteric metastasis was associated in the second patient.

[Damage control laparotomy for haemorragic abdominal trauma. A retrospective multicentric study about 109 cases]. / La laparotomie écourtée dans les traumatismes abdominaux hémorragiques. Etude multicentrique rétrospective sur 109 cas.

AIM OF THE STUDY: Damage control laparotomy is a new approach to the more severe abdominal traumas. It stems from a better understanding of the physiopathology of the haemorragic shock. PATIENTS AND METHODS: A national retrospective study from 27 centers about 109 trauma patients who underwent a damage control procedure between January 1990 and December 2001, is analysed. Surgical procedures included 97 hepatic packing, 10 abdominal packing, 4 exclusive skin closure, 1 open laparotomy technique and 3 digestive stapplings. RESULTS: The mortality rate is 42%. Eleven abdominal compartment syndromes have occurred with 7 decompressive laparomy (4 deaths). CONCLUSION: This study is based on the largest series of damage control laparotomy published in France. Results in terms of mortality and morbidity are similar to those of published studies from the USA.

Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study.

BACKGROUND: Laparoscopic surgery is thought to promote early recovery and quicker return to bowel function. The objective was to evaluate the rate and predictive factors of success, the causes of failure, the morbidity, and mortality during and after hospitalization, as well as to determine whether laparoscopic treatment of acute small bowel obstruction offers the same benefits as for other laparoscopic procedures. METHODS: The records of 308 patients with acute small bowel obstruction treated laparoscopically in 35 centres between 1 October 1988 and 30 September 1996 were retrospectively reviewed. RESULTS: Treatment was implemented completely by laparoscopy ('success' group) in 168 patients (54.6%). Conversion to laparotomy ('failure' group) was required in 140 patients (45.4%; during the same operation in 126 patients and after a median delay of 4 days (range: 1-12 days) in 14 patients). There were significantly more successes in patients with a history of one or two surgical interventions than in those with more than two (56% vs 37%; P < 0.05). There were significantly more successes in patients who had undergone appendectomy only (67/94; 71%) than in patients who (i) had no antecedent surgery (52%; P < 0.05), or (ii) underwent other surgery (33%; P < 0.001). The rate of success was significantly higher (P < 0.001) in patients operated on early (< 24 h) and in patients with bands (54%), than in those with adhesions (31%) or with other causes of obstruction (15%). The median duration of postoperative ileus was significantly shorter in the 'success' group than in the 'failure' group (2 days vs 4 days; P < 0.001). The median duration of postoperative hospital stay was shorter in the 'success' group than in the 'failure' group (4 days vs 10 days; P < 0.001). Fewer immediate wound complications were sustained in the 'success' group than in the 'failure' group (1.2% vs 10.7%; P < 0.001). The total number of immediate or delayed complications and particularly the number of recurrent obstructions after hospitalization as well as the number of deaths did not differ significantly between the two groups. CONCLUSIONS: Successful laparoscopic treatment of small bowel obstruction can be expected in patients who are seen early, and who have had one or two previous interventions (particularly appendectomy, especially if bands are found).

[Intra-thymic localization of a cystic multi-tissue mature teratoma]. / Localisation intra-thymique d'un tératome mature pluritissulaire kystique.

The authors report a case of mediastinal tumour in a child, corresponding to a teratoma arising in the thymus, an original site for this lesion classically observed in children.

Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research.

OBJECTIVE: We investigated the role of drainage in the prevention of complications after elective rectal or anal anastomosis in the pelvis. Anastomotic leakage after colorectal resection is more prevalent when the anastomosis is in the distal or infraperitoneal pelvis than in the abdomen. The benefit of pelvic drains versus their potential harm has been questioned. Drain-related complications include (1) those possibly benefiting from drainage (leakage, intra-abdominal infection, bleeding) and (2) those possibly caused by drainage (wound infection or hernia, intestinal obstruction, fistula). METHODS: Between September 1990 and June 1995, 494 patients (249 men and 245 women), mean age 66 +/- 15 (range 15 to 101) years, with either carcinoma, benign tumor, colonic Crohn's disease, diverticular disease of the sigmoid colon, or another disorder located anywhere from the right colon to the midrectum undergoing resection followed by rectal or anal anastomosis were randomized to undergo either drainage (n = 248) with 2 multiperforated 14F suction drains or no drainage (n = 246). The primary end point was the number of patients with one or more postoperative drain-related complications. Secondary end points included severity of these complications as assessed by the rate of related repeat operations and associated deaths as well as extra-abdominally related morbidity and mortality. RESULTS: After withdrawal of 2 patients (1 in each group) both groups were comparable with regard to preoperative characteristics and intraoperative findings. The overall leakage rate was 6.3% with no significant difference between those with or without drainage. There were 18 deaths (3.6%), 8 (3.2%) in those with drainage and 10 (4%) in those without drainage. Five patients with anastomotic leakage died (1%), 3 of whom had drainage. There were 32 repeat operations (6.5%) for anastomotic leakage 11 in the group with drainage and 4 in the group with no drainage. The rate of these and the other intra-abdominal and extra-abdominal complications did not differ significantly between the 2 groups. CONCLUSION: Prophylactic drainage of the pelvic space does not improve outcome or influence the severity of complications.

Omentoplasty in the prevention of anastomotic leakage after colonic or rectal resection: a prospective randomized study in 712 patients. French Associations for Surgical Research.

OBJECTIVE: To investigate the role of omentoplasty (OP) in the prevention of anastomotic leakage after colonic or rectal resection. SUMMARY BACKGROUND DATA: It has been proposed that OP--wrapping the omentum around the colonic or rectal anastomosis--reinforces intestinal sutures with the expectation of lowering the rate of anastomotic leakage. However, there are no prospective, randomized trials to date to prove this. METHODS: Between September 1989 and March 1994, a total of 705 patients (347 males and 358 females) with a mean age of 66 +/- 15 years (range, 15-101) originating from 20 centers were randomized to undergo either OP (n = 341) or not (NO, n = 364) to reinforce the colonic anastomosis after colectomy. Patients had carcinoma, benign tumor, colonic Crohn's disease, diverticular disease of the sigmoid colon, or another affliction located anywhere from the right colon to and including the midrectum. Patients undergoing emergency surgery were not included. Random allotment took place once the resection and anastomosis had been performed, the surgeon had tested the anastomosis for airtightness, and the omental flap was deemed feasible. Patients were divided into four strata: ileo- or colocolonic anastomosis, supraperitoneal ileo- or colorectal anastomosis, infraperitoneal ileo- or colorectal anastomosis, and ileo- or coloanal anastomosis. The primary end point was anastomotic leakage. Secondary end points included intra- and extraabdominal related morbidity and mortality. Severity of anastomotic leakage was based on the rate of repeat operations and related deaths. RESULTS: Both groups were comparable in terms of preoperative characteristics. Intraoperative findings were similar, except that there were significantly more septic operations and abdominal drainage performed in the NO group (p < 0.05 and p < 0.01, respectively). Thirty-five patients (4.9%) had postoperative anastomotic leakage, 16 in the OP group (4.7%) and 19 in the NO group (5.2%). There were 32 deaths (4.5%), 17 (4.9%) in the OP group and 15 (4.2%) in the NO group. Five patients with anastomotic leakage died (0.8%), 2 of whom had OP. There were 37 repeat operations (30%), 12 (6 in each group) for anastomotic leakage. Repeat operation was associated with fatal outcome in 14% of cases. The rate of these and the other intra- and extraabdominal complications did not differ significantly between the two groups. CONCLUSION: OP to reinforce colorectal anastomosis decreases neither the rate nor the severity of anastomotic failure.

Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research.

BACKGROUND: Only 4 controlled trials have investigated whether prophylactic abdominal drainage was of value after colonic resection. None have been able to find any statistically significant difference, but the number of patients was small and the beta error risk was high. OBJECTIVES: To compare patients who underwent abdominal drainage with those who did not for the rate and severity of complications after elective colonic resection followed immediately by anastomosis of the suprapromontory colon and to compare suction drains with nonsuction drains. PATIENTS: Between September 1990 and June 1995, 319 patients (135 men and 184 women), whose mean age was 67 years (range, 22-95 years), with carcinoma, benign tumors, or colitis, located anywhere between the ascending and sigmoid colons, were included in the study. Patients were comparable for demographic characteristics, except that there were more patients with ascites in the group that did not undergo abdominal drainage (P<.02). INTERVENTIONS: After 2 protocol violations, 156 patients were randomized to the abdominal drainage group and 161 to the no abdominal drainage group. All 317 anastomoses were tested for airtightness intraoperatively and repaired if leakage was found (n=71), and all patients with anastomoses received a routine diatrizoate sodium enema to detect infraclinical leakage. MAIN OUTCOME MEASURES: The postoperative complications possibly influenced by drainage included (1) deep complications for which drainage can lead to early diagnosis, such as generalized or localized peritonitis, intraabdominal hemorrhage, or hematoma; (2) complications believed to be enhanced by drainage, such as an operative wound (an abscess, disruption, or incisional hernia) or pulmonary (microatelectasis) and intestinal obstructions; and (3) complications directly due to the drains, such as ulcerations leading to fistulae, hemorrhages, drainage tract infections, difficulty in removal, intra-abdominal retention, and incisional disruptions. Subsidiary end points were the severity of these complications as assessed by the number of related subsequent operations and deaths. RESULTS: Twenty-six patients overall (8%) had postoperative complications possibly influenced by drainage (9% in the group that underwent abdominal drainage and 8% in the group that did not). This difference was not statistically significant (P<.90). One patient had a fistula directly imputable to drainage. There was no difference between suction and nonsuction drainage (P<.90). CONCLUSIONS: Routine abdominal drainage after colonic resection and immediate anastomosis decreases neither the rate nor the severity of anastomotic leakage. It can, occasionally, be detrimental.

[Bilateral newborn testicular torsions]. / Les torsions testiculaires néonatales bilatérales.

A case of bilateral spermatic cord tension in a neonate is reported. Clinical findings are compared with those in 22 previously published cases. Obstetrical history is usually unremarkable. Torsion occurs prior to birth or immediately after birth. The two cords are involved simultaneously or successively. Edema of the scrotum is found in recent spermatic cord tension, whereas subsequently the tests are extremely hard and occasionally severely atrophied. Prognosis is poor since castration or poor testicular viability was the outcome in most cases.

[Mesenteric fibromatosis in infants. A case]. / Fibromatose mésentérique du nourrisson. Une observation.

The authors report on a case of mesenteric fibromatosis in a 5 month-old infant. Surgical excision was available and the clinical course was good, without recurrence after 30 months. Clinical and histological features of mesenteric desmoïd tumor in children are discussed and diagnostic difficulties are examined in depth.

[Transpyloric gastrojejunostomy]. / Gastro-jéjunostomie "transpylorique".

Gastric decompression and feeding by jejunostomy are usually performed in patients undergoing major abdominal surgery. In the technique described here, the gastrostomy and jejunostomy tubes are introduced through the same orifice created in the gastric wall, and a double Witzel canal is performed around the two tubes, together with fixation of the gastric wall to the parietal peritoneum. This techniques was used in 9 consecutive patients with no mortality or morbidity directly ascribable to the procedure.