Primary cystic echinococcosis of the peritoneum: a case report.

BACKGROUND: Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that constitutes a diagnostic and therapeutic challenge. CASE REPORT: A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months. He has a 10 cm hypogastric mass. Biological-tests were normal. A computed tomography Scan showed a cystic mass on the pelvis measuring 13 × 17 cm without echinococcosis cyst in the liver. The patient was operated and we found a cystic mass of 17 cm located on the Douglas cul-de-sac that suggest a pelvic hydatid cyst. We have performed an aspiration of the cyst confirms the diagnosis followed by injection of hypertonic solution, extarction of the germinal layer and a maximal reduction of the pericyst. The postoperative course was uneventful. CONCLUSION: Trough our case, we try to focus on the diagnosis and therapeutic options of this rare entity that we should think of in front of a patient with isolated peritoneal cyst especially in endemic country.

Laparoscopic repair of the broad ligament hernia: A case report.

INTRODUCTION AND IMPORTANCE: Broad ligament hernia is a rare type of internal hernia caused by the protrusion of viscera through an abnormal defect on the broad ligament. The diagnosis is difficult and challenging. Usually, it requires an urgent laparotomy to avoid intestinal necrosis or even the death of the patient. CASE PRESENTATION: A 34-year-old woman, with no medical or surgical history, presented to our educational hospital with acute abdominal pain and recurrent vomiting for the last two days. After clinical and radiological investigations, the diagnosis of an internal hernia through the broad ligament was confirmed. An emergent laparoscopic repair was performed and the postoperative course was uneventful. CLINICAL DISCUSSION: We report a rare case of an internal hernia through the broad ligament and we describe the challenges associated with the preoperative diagnosis and therapeutic approach. The defect in the broad ligament may be unilateral or bilateral and congenital or acquired. There are no specific clinical and radiologic findings. Surgery remains the cornerstone of the treatment. CONCLUSION: Early diagnosis and rapid management of broad ligament hernia are necessary to prevent catastrophic sequelae. It is important to keep in mind that internal hernia like broad ligament hernia can occur in patients with no surgical history.

Spontaneous perforation of the common bile duct in adults presenting as biliary peritonitis: a case report and literature review.

Spontaneous perforation of the common bile duct (SPCBD) is an exceptional disease, especially in adults. The cause is often idiopathic once trauma and choledochal cyst are excluded. Early diagnosis is often difficult because of its often-misleading appearance. Case presentation: The authors report the case of a 54-year-old man, a known case of type 2 diabetes mellitus, who presented to our emergency department for acute abdominal pain that had evolved for 2 days. Clinical findings and investigations: On physical examination, the patient had a fever of up to 38.5°C, and the abdomen was distended and generally tight. The abdominal computerized tomography scan confirms the presence of free fluid. In addition, the thickness of the gallbladder wall had increased in contrast with a resolved gallbladder distention. Because exploration failed to demonstrate the cause of ascites, the authors performed a diagnostic paracentesis, which revealing ascites with a dark yellow-green color, which implied bile leakage.After initial resuscitation, an emergent exploratory laparotomy was performed. The authors found biliary peritonitis secondary to SPCBD. After peritoneal lavage, the perforation was repaired over a T-tube. The postoperative course was uneventful. Histological findings were consistent with ulcerous acalculous cholecystitis. The patient was disease-free after a 3-month follow-up. Discussion: SPCBD is an uncommon condition in adults, and it is rarely reported in the literature. The pathogenesis of this disease is not clear and may be related to single or multiple factors. Usually, this disease is diagnosed in the postmortem. Early diagnosis and optimal surgical treatment are challenging. Conclusion: This present case highlighted the preoperative diagnostic difficulties of the SPCBD. Emergent surgical management should be instituted in the shortest time possible to reduce the high mortality.

Emphysematous cystitis revealed by necrotizing fasciitis: An unusual presentation.

Emphysematous cystitis (EC) is a severe infection of the bladder that usually affects older women with diabetes mellitus. In rare situations, EC can lead to serious complications such as necrotizing fasciitis. We report the case of a 77-year-old woman who developed emphysematous cystitis complicated with rapidly progressive, gas-producing, necrotizing inflammation located on the right lower abdominal wall. The patient had aggressive drainage and debridement in order to control the extensive necrosis. To our knowledge, this is the third case report that describes a possible association between EC and NF requiring aggressive surgical intervention for both diseases.

Primary aortoduodenal fistula presenting as a rare cause of upper gastrointestinal bleeding.

Primary aortoduodenal fistula (ADF) is a serious life-threatening condition. Unlike secondary ADF which occurs in patients who had previous aortic prosthetic reconstruction, primary ADF is uncommon. Its diagnosis is often unsuspected until surgery or postmortem. We report a rare case of primary ADF presenting as massive gastrointestinal bleeding.

A rare case of small intestinal metastasis from lung cancer.

We report the case of a 61-year-old male patient who was admitted with abdominal pain, vomiting and constipation. He had a past medical history of epidermoid lung cancer .computed tomography revealed distended stomach with mural bowel thickening. It was peroperatively two small-bowel metastasis from lung cancer that we resect.

Acute post-traumatic dermoid peritonitis: A rare entity.

Rupture of ovarian dermoid-cyst is rare case. We report the case of a woman admitted for acute post-traumatic abdominal pain due to ruptured ovarian cyst. The patient was operated and we found a very abundant peritoneal effusion with left ovarian cyst which was broken. we performed a left adnexectomy.

Localized stomach cancer: Perioperative or postoperative approach? A meta-analysis of phase III studies.

Background and Aim: Despite the development and standardization of surgical techniques in the treatment of localized gastric adenocarcinoma, the loco-regional and metastatic recurrence rate remains high. A combined radiochemotherapeutic regimen (the MacDonald regimen) as well as perioperative chemotherapy allows a significant improvement in the survival of patients with localized gastric adenocarcinoma with a reduction in the recurrence rate compared to surgery alone. The purpose of this review is to specify the best therapeutic approach in the treatment of localized gastric cancer. Methods: We performed a systemic search of Medline, Embase, and the Cochrane Central Register of Controlled Trials using PubMed, Google Scholar, and Ovid without language restriction. Hazard ratio (HR) with 95% confidence interval (CI) was reported. Results: We pooled 727 patients from two phase III randomized controlled trials. There was a benefit of perioperative chemotherapy versus surgery alone on the overall survival (OS) (HR = 0.72, 95% CI: 0.55-0.95) and on disease free survival (DFS) (HR = 0.65, CI: 0.50-0.85). Adjuvant chemotherapy was superior to surgery alone based on OS and disease free survival (CLASSIC study HR = 0.72, CI: 0.52-1 and HR = 0.56, CI: 0.44-0.72, respectively). Adjuvant radiochemotherapy was superior to surgery alone (HR = 1.35, 95% CI: 1.09-1.66; P = 0.005). Conclusion: A face-to-face comparison of perioperative chemotherapy versus adjuvant chemotherapy versus chemoradiotherapy is necessary.

[Surgical treatment of hydatid cysts with large biliocystic fistula in conservative strategy]. / Prise en charge des larges fistules bilio-kystiques lors de la chirurgie conservatrice du kyste hydatique du foie.

INTRODUCTION: the treatment of large biliocystic fistulas is not unanimous among authors in the absence of consensus or a high level of evidence. There is a controversy over the use of a radical approach which allows the fistula to be sutured in a healthy area or conservative treatment that poses repair issues. The purpose of this study is to compare different conservative techniques to treat large biliocystic fistulas. METHODS: we conducted a retrospective study of 54 patients with large fistulas in the Department of General Surgery at the Habib Bourguiba University Hospital in Sfax over a period of 9 years (2010 - 2018). RESULTS: fourty-four patients were enrolled in the study. Abdominal ultrasound suggested opening of the bile ducts in 18 cases (47.4%) while computed tomography (CT) scan suggested opening in 28 patients (68.3%). The treatment of fistulas was based on DITFO (internal trans-fistulary drainage) in 18 cases (33.3%), cystobiliary disconnection (PERDROMO) in 11 cases (20.4%) and bipolar drainage in 25 cases. Specific surgical morbidity rate was 31.5% and it was dominated by postoperative biliary fistula in 18.5% of cases. DITFO technique was associated with shorter hospital stay (p=0.028) and lower morbidity rates (22.2%) with no statistically significant difference. CONCLUSION: DITFO technique is the gold standard technique in the treatment of biliocystic fistula because it is associated with lower morbidity rates and the shortest hospital stay.

Predictive factors of occult cystobiliary fistula after conservative surgical treatment of the hepatic hydatid cyst A retrospective study of 105 patients.

OBJECTIVES: The objective of our study was to determine the predictive factors of their occurrence during conservative surgical treatment of the hepatic hydatid cyst (HHC). PATIENTS AND METHODS: We carried out a retrospective review of patients who had undergone conservative surgical treatment of the HHC during 6 years. Univariate analyzes were used to determine the predictive factors of an occult cystobiliary fistula (CBF). RESULTS: This current study included 105 patients. Concerning the predictive factors of an CBF regardless of its pattern of evolution, we noted that the presence of fistula was statistically correlated with the a cyst size (bigger than 8.65 cm ; p = 0.003) and with advanced age (p=0.035). Interestingly enough, the correlation to a degenerated cyst (p=0.069) were of little significance. CONCLUSION: The size of the cyst greater than 8.65 cm and the advanced age are the risk factors of CBF according to our study. KEY WORDS: Biliary Fistula, Diagnosis, Echinococcosis, Hepatic, Prevention and control.

[Comparison between endoscopic stenting and colostomy in the management of obstructing cancer of the left colon: Literature review]. / Comparaison entre stent endoscopique et colostomie pour les cancers coliques gauches en occlusion : revue de la littérature.

INTRODUCTION: Colonic occlusion is the mode of discovery of 8 to 29% of colonic neoplasms. Our objective is to compare the placement of stent versus colostomy in the management of obstructing cancer of the left colon. MATERIAL AND METHODS: We have carried out a systematic search of literature from MEDLINE, EMBASE and Cochrane Library database to identify articles related to the comparison of stent versus colostomy published between 2000 and 2016. RESULTS: We have identified 6 studies. Only one study was prospective comparative. Three studies were for curative purposes. The total number of patients was 7205. In the "stent" group, there was a decrease in the average length of hospital stay compared to the "stoma" group and there was a decrease in cost with a statistically significant relationship. There was no difference between the two groups in terms of 4 hospital mortality and early morbidity. CONCLUSION: In case of neoplastic occlusion of the left colon, the choice between colostomy or colonic stent depends on the therapeutic strategy. Indeed, for curative strategy or administration of anti-angiogenics, it is recommended to practice a colostomy. However, for palliative treatment, colonic stenting is the treatment to follow.

Correlation of radiological findings with surgical findings in hepatic hydatid disease. A prospective study of 79 cases.

OBJECTIVES: The liver is the most frequent anatomic location of hydatid disease. Imaging modality nowadays are numerous and increasingly efficient. The objective of our study is to precise the correlation between Ultrasonography, computed tomography and intraoperative findings on the different characteristics of hepatic hydatid cyst. PATIENTS AND METHODS: We conducted a prospective study including all hepatic hydatid cyst operated in 2015. We evaluated statistically, by calculating the coefficient K or the intraclass correlation coefficient, the concordance between Ultrasonography, computed tomography (CT) and intraoperative findings on the different characteristics of hepatic hydatid cyst. RESULTS: In our study, we included 48 patients with 79 hepatic hydatid cysts. It was concluded that Ultrasonography performs better than CT in the study of type of cyst, pericyst, relationships with portal vein and main bile duct. While CT is better than echography in terms of number, localizations of cyst, relationship with the vena cava inferior, other localizations and the remaining liver, both examinations remain limited in the determination of pericyst characteristics and the identification of biliary fistula. CONCLUSION: Ultrasonography and CT cannot provide accurate data for the study of pericyst and biliary fistula, hence requiring prospective studies of the place of MRI and intraoperative echography in this domain. KEY WORDS: Diagnostic, Imaging, Echinococcosis, Hepatic, Intraoperative Care.

An uncommon cause of acute bowel obstruction: the left para-duodenal hernia.

Internal hernias of the abdomen are uncommun. They represent less than 1% of bowel obstruction cases. The left paraduodenal hernia is the most frequent type of internal hernias. We report a case of 77 year-old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal paraduodenal hernia by showing incarcerated jejunal loops in a paraduodenal hernia through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities. KEY WORDS: Computer tomography Internal hernia, Paraduodenal hernia, Small bowel obstruction.

Should we treat white line hernias by laparoscopy? About a prospective study of 42 cases.

UNLABELLED: We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric hernia operated by laparoscopy with a 1 year mean follow-up. The purpose of our study is to investigate the contribution of laparoscopy in the treatment of in terms of results in the short and medium term. Early surgical morbidity was 14.3%. There was no mortality. At 6 months of the intervention, 28.5% of patients have kept umbilical pain. At 1 year of intervention, 2 patients have kept umbilical chronic pain. No case of recurrence was noted. In conclusion, the laparoscopic approach should be reserved for cases of large hernias and for recurrent and incisional hernias. KEY WORDS: Epigastric hernia, Laparoscopy, Mesh, Umbilical hernia.

Post-traumatic Jejunojejunal Intussusception.

Intussusception is a well-known cause of acute abdomen in the pediatric population. Traumatic intussusception is exceedingly rare, with only 22 cases reported in the English language literature. We report a case of jejunojejunal intussusception that happened after blunt trauma to the abdomen in a 10-year-old boy. The patient presented with clinical presentation of small-bowel obstruction. Through this case and brief review of the literature, we try to focus on the etiology of this rare condition, the clinical particularities, and treatment modalities.

[Surgical complications of colostomies]. / Les complications chirurgicales des colostomies.

BACKGROUND: The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. AIM: reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. METHODS: A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. RESULTS: Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. CONCLUSION: Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.