Prostatic cystadenoma presenting as a large multilocular pelvic male mass.

Multilocular cystadenoma are benign lesions located most commonly between the rectum and the bladder. Their presence manifests as obstructive or/and irritative lower urinary tract symptoms or transit disorders. Computed tomography scan and magnetic resonance imaging may help to establish the diagnosis. Surgery is the established treatment standard, with a high risk of recurrence in case of incomplete excision of the lesions. Here we report a case of 59-year-old man presenting with an acute urinary retention due to a giant multilocular prostatic cystadenoma treated by complete excision. The diagnosis has never been suspected before surgery and has been confirmed histologically after complete excision.

Vaginal cuff dehiscence and evisceration 11 years after a radical hysterectomy: A case report.

INTRODUCTION: Vaginal cuff dehiscence (VCD) and evisceration (VCDE) are rare but rather serious complications of hysterectomy procedures. We aimed to report a case of VCDE happening eleven years after the initial surgery and review a treatment protocol of this rare complication. CASE: A 68 years old Tunisian female patient In 2004, the patient underwent concomitant chemoradiation followed by total abdominal radical hysterectomy for a squamous cell carcinoma of the cervix. Eleven years later, after an abdominal thrust due to a strong cough the patient had a protrusion of the two small bowels. Patient was surgically treated following a combined approach. The follow-up did not show any sign of relapse. CONCLUSION: VCDE is a rare complication of hysterectomy that carries a lot of mobimortality if not treated on time. Surgery without delay is usually a guarantee for a god outcome.

Laparoscopic assisted foreign body extraction from the small bowel: A case report.

BACKGROUND AND AIM: Foreign body ingestion is a commonly seen accident in emergencies, only 1% of them will finally need surgery. Historically, exploratory laparotomy has been the mainstay of treatment for patients requiring surgery. However surgeons are more and more tempted to use laparoscopy in emergency setting.Through this case report we wanted to show in some selected cases the feasibility of laparoscopic assisted foreign body extraction from the small bowel leaving the patient with smaller scar, less morbidity and faster recovery. CASE PRESENTATION: A 30 year old male Inmate, ingested 40 days prior to his visit a bottom part of plastic bottle.Physical examination found an afebrile patient with a whole abdominal tenderness but no signs of peritonitis.The Abdominal Computed Tomography found a small bowel obstruction caused by a foreign body. No Radiological sign of perforation or peritonitis was found.First therapeutic strategy was to wait and see, for 24 h with no sign of improvement and the patient was taken to surgery. We opted for a laparoscopic approach y. The patient had bowel and gas movement the day after surgery. In the third day, the patient had developed a parietal abscess Treated medically. In the 10th day, after surgery the patient was discharged.Fourteenth month after the surgery, the patients is doing well with no late complication. CONCLUSION: Laparoscopic assisted foreign body extraction from the small bowel is a good therapeutic option however Large scale randomized controlled trials are needed before this can be used as a standard of care.

Multiple bile duct stones: Comparison of two surgical techniques done at laparotomy.

BACKGROUND: Biliary lithiasis is the most common surgical disease in Tunisia. Multiple bile duct stones are one of his most rare complications.It poses real problems with the best therapeutic approach. AIMS: To analyze the results of conventional surgery for multiple bile duct stones by comparing two techniques: The choledochotomy for stoneextraction followed by external biliary drainage and biliary-enteric anastomosis, to identify and to analyze the factors influencing the therapeuticchoice. METHODS: During study period spanning 16 years, 137 choledochotomy were made for multiple bile duct stones. These patients had either acholedochotomy with stone extraction and then drained through a T-tube or a biliary-enteric anastomosis. RESULTS: Preoperative diagnosis of multiple bile duct stones has been made in 32.1 % of patients. Cholangiography was found in all casesmultiple bile duct stones and had demonstrated an association with intrahepatic stones in 18.2 %. External drainage by a Kehr drain wasperformed in 39.4 % and biliary-enteric anastomosis in 60.6 %. Univariate and multivariate analysis had identified three factors significantlyassociated with external drainage: age ≤ 65 years, bile duct diameter < 15 mm and the existence of a pronounced inflammatory reaction of thecholedochal wall. No factors had influenced the choice between different bilio-enteric anastomosis techniques. These three techniques did notdiffer from the post operative morbidity (p = 0.84) or mortality (p = 58). CONCLUSION: Basing on the analysis of our series and the comparison with other series reported in the literature, we recommend biliary drainagewith a T-tube in young people under 65 years who have a little dilated bile duct, not exceeding 15mm. In patients aged over 65 years or thosewith a CBD dilated more than 15 mm, even with intrahepatic stones, in cases of distal bile duct stricture or periampullary diverticulum, biliaryentericanastomosis seems to be the safest technique.

Primary anorectal melanoma: a case report.

BACKGROUND: Anorectal melanoma is a rare but highly lethal malignancy. Clinical symptoms are non-specific and treatment is still debated. AIM: The aim of this study was to report a case concerning diagnostic and management of Anorectal melanoma. CASE: A 66-year-old man was admitted in our surgical unit with a 3- month history of pain and rectal bleeding. Rectal examination revealed a tender mass arising from the 5 o'clock position of the anal canal that bled on touch. A provisional diagnosis of rectal polyp was made and it was removed by local excision under general anaesthesia. Histopathologic examination reported it as an anorectal malignant melanoma. The postoperative course was uneventful. Extension staging showed a 15 mm nodule on the left lung. The patient underwent a metastasectomy of the left lung. No adjuvant therapy was given. He died one year later. CONCLUSION: With this case we want to illustrate that malignant melanoma can be difficult to diagnose, as patients have non-specific symptoms and histology may be misleading. Surgery remains the mainstay of treatment. Wide local excision combined with adjuvant oco-regional radiotherapy should be preferred when technically feasible. Abdominoperineal resection has to be done only in the case of large tumors or when the anal sphincter is involved. Overall 5-year survival is less than 20%. It's correlated to extension of disease regardless of initial surgical therapy.

[Perineal gangrene: clinical and therapeutic features and prognostic analysis of 35 cases]. / Etude clinique et thérapeutique et analyse pronostique des gangrènes du périnée: a propos de 35 cas.

STUDY OBJECTIVE: The objective of this retrospective study of 35 cases of perineal gangrene was to describe their clinical and therapeutic features and to analyze the prognostic factors of mortality. METHODS: From 1997 to 2004, 35 cases (25 men and 10 women, mean age=50.3 years) with perineal gangrene were treated in the "A" surgical department of Charles Nicole Hospital (Tunisia) with a combination of intensive care, antibiotic therapy, extensive excision and drainage, repeated if necessary and colostomy. RESULTS: The mortality rate was 17.1%. The mean duration of hospitalization was 15.3 (range: 2-64) days. One patient had anal incontinence as sequelae. The colostomy in two patients was closed at the 9(th) and the 13(th) month. Statistical analysis showed that the extent of cellulitis, presence of myonecrosis, occurrence of septic shock need for postoperative mechanical ventilation, and IGSII and FGSIS severity scores differed significantly between patients who survived and those who died. CONCLUSION: Perineal gangrene is still a very severe disease. The initial anatomic lesions, the IGSII and FGSIS severity scores and postoperative complications are the main prognostic factors of mortality.

[Evaluation of the activity of the emergency department Nefza district hospital]. / Evaluation de l'activite du service des urgences de l'hopital de circonscription de Nefza.

BACKGROUND: Permanent reception at the level of hospital emergencies should be a sanitary priority. AIM: In order to set up a data base that allows identifying failures, to bring forward a certain number of solutions and to elaborate a strategy for promoting first-line emergency services METHODS: We carried out a retrospective descriptive survey of 20853 consultants in the first-line emergency ward of the district hospital of Nefza over a one-year period (2001). RESULTS: At the end of our analysis, we found the following main results: the profile of the emergency consultant is a young person (average age 31.76), of female sex in 52% of cases and benefiting from social security (CNSS or CNRPS) in 40.5% of cases. The average number of consultations is of 57 consultations per 24 hours: essentially during August, October and March. The reason for having recourse to emergency services is dominated by the medico-surgical pathology in 78% of cases and 15.5%. In our survey 3% of the patients were referred to second-line emergencies; the referring motives are essentially dominated by traumatisms (39%). CONCLUSION: one patient out of two is consulting for a false emergency case, probably for reasons of easy access to the emergency services and because of the absence of a day consultation in the basic health care units. On the other hand, the non-availability of diagnostic means in the afternoon and evening increases the number of 2nd line emergency recourse.