Rupture of mesenteric artery branch aneurysm.

We describe a case of ruptured mesenteric artery branch aneurysm. Since it is characterized by nonspecific clinical manifestations, aneurysm in this uncommon location is usually diagnosed following complications. Definitive diagnosis requires Doppler ultrasound followed by arteriography. The purpose of this report is to describe the pitfalls of diagnosis and define an appropriate management strategy. Unlike abdominal aortic aneurysm, isolated aneurysms of the superior mesenteric artery (SMA) branches are rare. Most cases are diagnosed after the occurrence of complications. Early diagnosis would be useful, since the natural course can be tragic without timely treatment. In this report, we describe one case of ruptured mesenteric artery branch aneurysm and review the literature for relevant data on the circumstances of discovery, methods of investigation, and appropriate management of these lesions.

[Heterotopic pancreas. Three cases]. / Hétérotopie pancréatique. A propos de trois observations.

The authors report three cases of heterotopic pancreas discovered surgically in three young men. The heterotopy was located in the biliary tract in one case revealed by choledochal stenosis (case 1), in the stomach discovered at laparotomy for abdominal trauma (case 2) and in the first part of the duodenum discovered during hepatic resection for adenoma (case 3). Management consisted of Whipple's operation in the first case, tumor resection in the second and antroduodenectomy in the last case. Histological examination revealed no malignant transformation. Results were excellent with follow-up 2-years to 4 years. The authors recommend resection with histological examination for all case of heterotopic pancreas discovered at surgery.

Major liver resections without vascular clamping: retrospective study of 84 cases.

BACKGROUND/AIMS: The question as to whether vascular clamping aggravates mortality and morbidity of major liver resection was investigated in this study. Major liver resection with vascular clamping for parenchyma transection has mortality between 0 and 5%, and higher morbidity reaching 47% with healthy liver in recent report. METHODOLOGY: Eighty-four major liver resection without vascular clamping were carried out between January 1986 to December 1996 were reviewed. There were 57 men and 27 women with average age of 58.2 (12.2) years old. Indications of resection were adenoma (4.8%) angioma (11.9%) focal nodular hyperplasia (1.2%) hematoma (1.2%) metastases (60.7%) hepatocellular carcinoma (14.3%) and cholangiocarcinoma (5.9%). Resections used ultrasonic dissector (Sonoca) with intraoperative ultrasonography were right hepatectomy in 56 cases extended right hepatectomy in 10 cases left hepatectomy in 17 cases and middle hepatectomy in 1 case. Remnant liver was cirrhotic in 3 cases. RESULTS: Three patients died (3.5%) and the rate of major complications were 11.2%. 46 patients (54.8%) had no blood transfusion. The mean of blood transfusion was 1.5 (2.7) units. The mean of operative length was 286.23 (63.3) minutes and the mean hospital stay was 15.8 (8.1) days. Liver function tests are same with the others authors at day 1, 4 and 7 after operation with return to normal value after 1 week. CONCLUSION: In major liver resection, vascular clamping is not always necessary.

[Primary adenocarcinoma of the duodenum. Study of three cases and review of the literature]. / Adénocarcinome primitif du duodénum. Etude de trois observations et revue de la littérature.

The authors report three cases of primary adenocarcinoma, two concerning the duodenum and the third concerning the duodenojejunal junction. These rare tumours are characterized by polymorphic and non specific clinical signs. Diagnosis is suspected by upper gastrointestinal fibroscopy and barium swallow, and confirmed by biopsies. Prognosis varies according to histological differentiation and lymph node extension. Whipples operation is the sole curative procedure in the absence of local lymph node involvement. Cases of extensive invasion are managed by bilio-digestive by-pass.

[Total gastrectomy and viscerosynthesis]. / Gastrectomies totales et viscérosynthèse.

A retrospective study of 134 total gastrectomies performed between 1982 and 1992 was conducted with regular follow-up. There were 96 males and 38 women (mean age 66.66 years, range 27-82). The indication for total gastrectomy was malignant tumour (n = 115), mostly adenocarcinoma (79.1%, 91/115) with 7 cases of stump degeneration after partial gastrectomy (5.2%) and benign lesions (n = 19), mostly gastric ulcers. Gastrectomy was associated with node dissection in 53 cancer cases (47.8% 53/115) and dissection of neighbouring organs in 16 patients. Y anastomosis with circular mechanical suture was performed in 78 cases (62.9%) with pre-stapling in 30 (38.5%). Operative mortality was 8.2% (11/134). The oesophagealjejunal disunion occurred in 7/133 patients (5.3%) including two fatal cases. Early reoperation was necessary in 10.5%. Long-term follow-up for 2 to 12 years in 119 patients gave the following data. For malignant tumours: 5-year survival rate 10.1% (n = 8), recurrence an anastomosis 6.3% (n = 5), distant recurrence 28.2% (n = 21). For all patients sequellae were: reflux oesophagitis 8.1% (n = 10), stenosis of the anastomosis 7.3% (n = 9) requiring late reoperation in 2. The quality of life was considered satisfactory by 28.57% (n = 8) and good in 39.29% (n = 11). These results were compared with those reported in the literature and led to the conclusion that the general view as to the gravity of gastrectomy should be reconsidered in light of the progress in viscerostapling.

[Intestinal obstruction caused by postoperative adhesion. 79 cases]. / Les occlusions intestinales par brides post-opératoires. 79 observations.

The intestinal post-operative bridle represents the third most important etiology of obstructions at the clinic of the University Hospital of Dakar, behind hernia strangulations and the volvulus of the digestive tube. Between 1970 and 1989, a retrospective study has led to a sample of 79 patients with post-operative bridle obstructions. The group was made of 47 women and 32 men between 17 and 84 years of age. Stomach ache was by far the most common functional symptomatology, followed by the stoppage of the transit and vomiting. In most cases palpation revealed the presence of tympanism. For almost all the patients, the abdomen without preparation revealed either a hydroaeric level or a diffuse grey area. The initial intervention concerned mainly gynecological affections or pathologies of appendicular type. The resection of the bridles was carried out in most cases. There were 10 deaths. The intestinal obstructions by post-operative bridles continue to be a surgical emergency still characterized by a high mortality rate. The late consultation of the patients, often received when presenting considerable visceral deficiency, is one of the main causes of the high rate of fatalities.

[Genital prolapse in Dakar]. / Les prolapsus génitaux à Dakar.

Genital prolapses are the result of musculo-ligamentary alterations often caused or complicated by traumatic delivery and senible atrophy of the tissues. From 1969 to 1988, we gathered 104 files of patients with genital prolapses. The age of the patients ranged from 20 to 70 years with an average age of 30. The subject between the ages of 20 and 39 were the most affected (64%). The average number of children per woman was 4. 60 patients had 5 children. No case of prolapses was found among virgin or mulliparous women. In 48 cases delivery was dystocic. The clinical symptomatology was a feeling of intravaginal globus, pelvic algia and discomfort (57 cases). Straingul urinary incontinence wax manifest in 15 patients. Colpocystocele (88 cases), rectocele (66 cases) and hysterocele (50 cases) were among the most frequently evidence lesions. On the therapeutic matter, the low passage was used 58 times and the high passage 32 times. An urinary gesture was made 33 times. There was no operatory fatality. Urinary troubles related to infection, acute retention of urine and strainful urinary incontinence were observed. Later 10 cases of recurrence were observed within an average time interval of 2 years. This work is characterized by the young age of the patients. It denotes the noticeable role played by obstétrical traumatisms in the genesis of genital prolapses in the African context. The senescence and atrophy of the tissues seem to have a less important role in contrast with the developed countries. Finally, the surgical treatment of these patients must take into account, among other things, the child bearing desire of the patients, given the social and psychological weight of maternity in our society.

[Pancreatic pseudocyst: diagnosis, treatment. Apropos of 7 cases]. / Le pseudokyste du pancréas: diagnostic, traitement. A propos de 7 observations.

A pseudocyst of the pancreas (PCP) is a rare affliction in Africa despite widespread malnutrition and abdominal disorders. The authors cover 7 PCP observations on 3 men and 2 women between 18 and 32 years, and 2 boys of 5 and 6 years, in the clinical context of abdominal pain (7/7), an abdominal tumour (7/7) and as a sequence to abdominal contusion (4/7). In 5 cases, echotomography led the etiological investigation of the liquid mass to seek a pancreatic origin. Surgical treatment consisted of 2 termino-lateral cystojejunostomies on a shaped flexure++ and 3 latero-lateral cystojejunostomies (of which one had to be drained externally two times); and a corporeo-caudal pancreatectomy. Supervision of between 1 1/2 and 5 years (1 1/2 years: 3 patients; 2 1/2 years: 2 patients; 5 years: 1 patient; 1 patient lost track of) revealed only one recurrence after internal latero-lateral drainage, and that without clinical repercussions. The authors use this short experiment to study the clinical and paraclinical symptomatology, the etiology and the treatment of PCPs. They stress the role of medical pictures in diagnosis, and of interventional radiology in treatment, but above all the primacy of surgery to treat pseudocysts of the pancreas in Africa.

[Complications of Meckel's diverticulum in Dakar (apropos of 2 cases)]. / Complications du diverticule de Meckel à Dakar (a propos de 2 observations).

Meckel's diverticula is the most common lesion among the abnormalities resulting from the persistence of the vitelline canal and its vessels. Studying it is interesting, on the one hand, because of the difficulty of detecting it, and, on the other, because of the possibility of accidents dominated by intestinal occlusions and digestive haemorrhages. Two observations on complications in Meckel's diverticula discovered in young men in the casualty unit are covered, and literature on the rare pathology is reviewed.