[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.

[Duodeno-pancreatic trauma. About 14 cases]. / Les traumatismes duodéno-pancréatiques, à propos de 14 cas.

Through a series of 14 cases brought over a period of 12 years, we realized a retrospective, analytical and descriptive study of these traumatisms. We aimed to release recommendations to improve their management. It was 2 women and 12 men, whom mean age was 24.4 years (extremes: 50 and 60 years), divided into 10 pancreatic injuries, 2 duodenal injuries and 2 duodeno-pancreatic injuries. Etiology was dominated by traffic accidents 7 cases (50%). Trauma was closed in 13 cases (92%). Associated lesions were present among 13 patients (92%). The traumatism appeared by an urgent surgical abdomen among 9 patients, secondarily in 3 cases, tardily in 2 cases: a case of deep suppuration 3 months after a traumatism treated into ambulatory and a case of persistent ascites after a past unperceived traumatism. Abdominal ultrasonography was made among 4 patients. It allowed diagnosing only a case. Scanner was made among 4 patients. It allowed diagnosing all the cases. Only a patient was treated medically, it was a post-traumatic acute pancreatitis. Surgical treatment was made in 13 cases: conservative in 7 cases and radical in 6 cases. Follow-up was complicated in 11 cases (78%) and non-complicated in 3 cases. Mortality rate was 7.1%.

[Intestinal Crohn disease: surgical aspects and predictive factors of risk of relapse. About 26 cases]. / Maladie de Crohn intestinale: aspects chirurgicaux et facteurs prédictifs de risque des récidives. A propos de 26 cas.

Crohn disease is an inflammatory bowel disease of which one cannot declare itself healed. It is a considerably invalidating disease, and surgery is necessary with more than 80% of patients during its long evolution. After a recent review of the literature, we wanted to contribute to the study of the predictive factors of risk of relapse among 26 patients operated for an intestinal Crohn disease during a period of 16 years, from 1986 till 2001. Sex ratio was 0.3 and average age was 33.9 years. Six patients only (23.1%) were known undergoing and treated for Crohn disease. Surgery was indicated urgently in 12 cases (46.2%). The gravity of urgently operated patients burdened the post-operative morbidity in 38.5% of cases of which 2 deaths. Six patients presented a post-operative relapse for an average delay of 40.8 months; among them 3 patients were operated. In our series, we noted that the relapse rate is more frequent with women that with men (42%/21%), and age does not intervene in the relapse contrary to smoking. The rate of relapses was so much more brought up that Crohn disease is former. The relapse was more frequent when the edge of section was sick (5/6). A post-operative medical treatment in the severe forms reduces the rate of relapses until 24%.

[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.