Perforated degenerated immature teratoma of the ovary: Rare cause of acute peritonitis, case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Malignant transformation of ovarian teratomas is rare, provoking peritonitis and death are exceedingly rare. CASE PRESENTATION: We present the case of a 75-year-old woman who was admitted to the emergency department for severe abdominal pain with septic shock due to acute peritonitis caused by perforation of the ovarian mass. CLINICAL DISCUSSION: Teratomas are germ cell tumors usually composed of multiple cell types derived from one or more of the three germ layers. Pathologically, malignant transformation of ovarian dermoid cysts is rare due to the thickness of the capsule, spontaneous rupture is a very rare complication, acute peritonitis presents with features of acute abdomen or shock, treatment is essentially surgical and includes at least unilateral adnexectomy, complete exploration of the pelvis and abdominal cavity, peritoneal washing and/or sampling of any ascites. CONCLUSION: In conclusion, although ovarian teratoma with granulomatous peritonitis is rare, rupture leading to generalised acute peritonitis further worsens the prognosis. Which will ensure correct management that will provide a good outcome with less complications.

Malignant transformation of hepatocellular adenoma: report of a case.

Hepatocellular adenomas are benign liver tumours that occur mainly but not exclusively in young women taking contraceptives. Their malignant transformation into hepatocellular carcinoma is a rare complication that has been rarely reported in women taking contraceptives. The purpose of our work is to remind the epidemiological and diagnostic features of malignant transformation of hepatic adenomas by reporting the case of a hepatocellular carcinoma developed from a hepatocellular adenoma diagnosed within the Pathology Department of the Mohammed VI university hospital of Oujda.

Acute hemoperitoneum after ruptured hepatocellular carcinoma: First Moroccan SCARE-compliant case report and literature review.

INTRODUCTION: Acute hemoperitoneum with a spontaneously ruptured hepatocellular carcinoma (HCC) is a rare type of internal bleeding that requires a multidisciplinary management approach. PRESENTATION OF CASE: In this case report, we describe a fortuitously ruptured peripheral and discovered HCC in an 81-years-old woman treated effectively using hepatectomy. DISCUSSION: The use of the computed tomography (CT) angiography to diagnose the stability of the patient's condition allows both arterial embolization in case of active bleeding and the evaluation of the underlying hepatopathy. The place of surgery is particularly upon after both the failure of arterial embolization and while facing a severe hemodynamic instability. The surgical strategy varies between perihepatic tamponnade and a surgical resection in one or more stages. The prognosis of a ruptured HCC depends mainly on the underlying liver's function. CONCLUSION: Multidisciplinary management of spontaneously ruptured HCC results in the same survival outcome as non-ruptured HCC at the same stage of hepatopathy.

Leiomyosarcoma of scrotum: case report.

Scrotal leiomyosarcoma is rare tumor. It presents as a painless, slow-growing cutaneous lesion. It's often mistaken for a benign condition. It is best treated by wide local excision. A case of scrotum leiomyosarcoma is presented in a 63 year old patient who was treated for the first time as having a benign lesion.

[Breast tuberculosis: about a case]. / Tuberculose mammaire: à propos d'un cas.

Breast tuberculosis is rare. It poses a problem of differential diagnosis because it may be mistaken for breast cancer as clinical examination and diagnostic imaging are not specific. Breast tuberculosis should be suspected especially in endemic countries or in immunosuppressed individuals. We report the case of a menopausal woman with breast tuberculosis in order to raise concern for diagnosis.

Primary tuberculoma of the liver: a case report and literature review.

We report the case of an immunocompetent patient with an isolated tuberculoma of the liver, which was diagnosed by percutaneous US-guided liver biopsy. The patient received an antitubercular therapy, and there has been no relapse to date.

Graves' disease allied with multiple pheochromocytoma.

Pheochromocytoma is an uncommon cause of high blood pressure touching adults. The combination of severe hypertension in the triad of headache, sweating, and tachycardia should suggest this diagnosis; this clinical picture is similar to that of hyperthyroidism. We report the case of a 22-year-old patient with multiple pheochromocytoma associated with Graves' disease revealed by malignant hypertension and discussed the difficulties of the diagnosis and the treatment approach.

Right diaphragmatic iatrogenic hernia after laparoscopic fenestration of a liver cyst: report of a case and review of the literature.

Iatrogenic right diaphragmatic hernia is very rare. We report the first case of a patient who had a diaphragmatic hernia after laparoscopic fenestration of liver cyst. A herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Diaphragmatic hernias are not as common as the traumatic type. Surgeons can easily miss diaphragmatic injuries during the operation especially after laparoscopy. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. Ct scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients. The incidence of iatrogenic diaphragmatic hernia after surgery may be reduced if the surgeon checks for the integrity of the diaphragm before the end of the operation. A review of the literature is also performed regarding this rare complication.

Pancreatic GIST with pancreas divisum: A new entity.

INTRODUCTION: Gastrointestinal stromal tumours (GISTs) are uncommon intra-abdominal tumours. These tumours tend to arise with a higher frequency in the stomach and the small bowel. In fewer than 5% of cases, they originate primarily from extra-gastrointestinal tumours (EGISTs). Gastrointestinal stromal tumour of the pancreas is very rare. Only few cases have been published. We report the first case of stromal tumour of the pancreas with concomitant pancreas divisum. PRESENTATION OF CASE: A 39-year-old male who presented with constipation and abdominal pain. A computerized tomography demonstrated a 9cm pancreatic mass, without liver lesions. A Whipple procedure with segmental colectomy was performed with success. After 24months follow up, the patient is doing well and disease-free. DISCUSSION: Mesenchymal tumours of the pancreas are extremely rare, accounting for less than 1% of all pancreatic tumours. The endoscopic ultrasound is helpful for diagnosis. Surgical resection with negative pathologic margins remains the treatment of choice. CONCLUSION: in our knowledge, this is the first case of pancreatic GIST with pancreas divisum. Although pancreatic GISTs are uncommon tumours, they must be considered in the differential diagnosis of solid pancreatic lesions. Even though the tumour can be evaluated as high risk, treatment must be aggressive in order to improve survival rate.

Giant malignant cystic pheochromocytoma: a case report.

Cystic malignant pheochromocytomas are uncommon. Differing from solid pheochromocytomas, which produce catecholamines and present adrenergic syndrome, cystic pheochromocytomas, may not produce these. Preoperative diagnosis may be difficult. Ct scan is useful for preoperative management. In this report, we describe a case of a giant malignant cystic pheochromocytoma in a young woman (17 years old) which presented as giant abdominal mass. The malignancy was confirmed by the presence of liver metastasis. Two years after curative resection, the patient is in good health with no recurrence.

Giant liposarcoma of the omentum mimicking an ovarian tumor. A case report.

Liposarcomas are common soft tissue of the retroperitoneum and the limbs. They are rarely found in the greater omentum. Once in the peritoneum, these can become enormous and can be mistaken for ovarian mass. The authors report a case of giant omental liposarcoma revealed by an abdominal mass and genital prolapse due to the compression syndrome. A complete macroscopic resection of the omental tumour was performed. A post operative chemotherapy was also prescribed. A description of this clinical presentation in the preoperative assessment, the characteristics of this tumour, together with the use of adjuvant chemotherapy are discussed in this report.

Giant trichobezoar of duodenojejunal flexure: a rare entity.

UNLABELLED: Bezoars are concretions of undigested material in the gastrointestinal tract, most commonly in the stomach. Duodenojejunal localization of bezoars is exceptional. We report a case of a 27-year-old woman who experienced nausea, vomiting and severe abdominal pain for one week. By palpation a mobile and sensitive mass, 15 Chi 15 cm, was detected, which filled the upper quadrant. Results of gastric endoscopy were normal. X-ray and ultrasonography suggested a bezoar. A laparotomy revealed that the jejunum was fissured by the trichobezoar ball. This trichobezoar mass was totally excised by intestinal resection. CONCLUSION: To our knowledge, this is the first reported case of duodenojejunal fissuration caused by trichobezoar in an adult. Among patients with high subocclusif syndrome, duodenojejunal bezoar should remain a possibility in differential diagnosis.

Patient satisfaction in an acute medicine department in Morocco.

BACKGROUND: Patients' satisfaction is an important indicator for quality of care. Measuring healthcare quality and improving patient satisfaction have become increasingly prevalent, especially among healthcare providers and purchasers of healthcare. This is mainly due to the fact that consumers are becoming increasingly more knowledgeable about healthcare. No studies of inpatients' satisfaction with hospital care have been conducted in Morocco. The first objective of the present study was to confirm the reliability and validity of the Arabic version of the EQS-H (Echelle de Qualité des Soins en Hospitalisation). The second objective was to evaluate patient satisfaction in an acute medicine department in Morocco by using the EQS-H questionnaire; and also to assess the influence of certain demographics, socioeconomics, and health characteristics in patient satisfaction. METHODS: it was a patient survey conducted in an acute medicine department of a Moroccan University Hospital. We surveyed their socio demographic status, and health characteristics at admission. We performed structured face to face interviews with patients who were discharged from hospital. The core of the EQS-H questionnaire was translated to Arabic, adapted to the present setting, and then used to measure patient satisfaction with quality of care. The internal consistency of the EQS-H scale was assessed by Chronbach's coefficient alpha. Validity was assessed by factor analysis. Factors influencing inpatients' satisfaction were identified using multiple linear regression. RESULTS: The Arabic version of EQS-H demonstrated an excellent internal consistency for the two dimensions studied (0.889 for 'quality of medical information' (MI) and 0.906 for 'Relationship with staff and daily routine' (RS)). The principal component analysis confirmed the bidimensional structure of the questionnaire and explained 60% of the total variance. In the univariate analysis, urban residence, higher income, better perceived health status compared to admission, better perceived health status compared to people of the same age, and satisfaction with life in general were related to MI dimension; Otherwise, mal gender, urban residence, higher income, staying in double room, better perceived health status compared to admission, and satisfaction with life in general were related to RS dimension. The multiple linear regression showed that four independent variables were associated with higher satisfaction in MI: More than 2 prior hospitalizations, a longer length of stay (10-14 days) (P = 0.002), staying in double room (P = 0.022), and better perceived health status compared to admission (P = 0.036). Three independent variables were associated with higher satisfaction in RS: a longer length of stay (10-14 days) (P = 0.017), better perceived health status compared to admission day (P = 0.013), and satisfaction with life in general (P = 0.006). CONCLUSIONS: Our current data assessing patient satisfaction with acute health care by the Arabic version of the EQS-H showed that the satisfaction rate was average on MI dimension; and good on RS dimension of the questionnaire. The majority of participants were satisfied with the overall care. Demographic, socioeconomic, and health characteristics may influence in-patients satisfaction in Morocco, a low/middle income country. An appreciation and understanding of these factors is essential to develop socio culturally appropriate interventions in order to improve satisfaction of patients.

Stromal duodenal tumor revealed by an acute pancreatitis: report of a case.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are one of the most common mesenchymal neoplasms of the human gastrointestinal tract. Duodenal GISTs are very rare and constitute less than 5% of all kind of GISTs. CASE REPORT: This is a report of a rare gastrointestinal stromal tumor of the duodenum in a 25-year-old female who was presented as an acute pancreatitis. DISCUSSION: The computed tomography evoked a pancreatic tumor. The patient underwent successful Whipple's procedure. The histological and immunohistochemical exams of the specimen resection confirmed the diagnosis of duodenal stromal tumor.