[Urachal remnant infection: keep it in mind during atypical abdominal pain in children]. / Infection d'un résidu ouraquien: cause de douleur abdominale atypique.

Etiological diagnosis of abdominal pain is delicate due to its many possible causes. Those that are less frequent are consequently less known and can lead to a trickier diagnosis. We report on a rare case of a 2.5-year-old female patient presenting with abdominal pain in association with secondary dysuria due to an urachal remnant infection. Knowledge of the anatomical pathway of the urachal channel can discriminate its role during an atypical clinical case. The diagnosis is then based on ultrasound scans, which localize and characterize its contents.

[Ruptured hepatocarcinoma. Report of 20 cases and review of the literature]. / Les hépatocarcinomes rompus. Rapport de 20 observations et revue de la littérature.

Hepatocellular carcinomas may rupture in rare cases (5 to 15%) creating a serious short-term and mid-term situation. Over a period of 10 years, 20 patients (19 males, 1 female, mean age 68 years, range 38-82) were treated for ruptured hepatocellular carcinoma involving a cirrhotic (ethylic) liver in 12 cases, haemochromatosis in 2 and a normal liver in 6. Twelve patients underwent emergency surgery for acute haemoperitonium operation was delayed until after exploratory investigations (CT scan and arteriography +/- embolization) for pain in the right hypochondria associated with partitioned effusion and anaemia. The diagnosis of cancer had been known in 5 patients and rupture was the first manifestation in 15 others. Emergency procedures, 7 excisions, 3 sutures, were performed but 2 patients died during vascular clamping. Four deaths occurred within 8 days due to liver failure. There were no postoperative deaths after programmed procedures, 6 excisions, 1 ligature. One patient underwent embolization peroperatively and died 6 days later due to digestive haemorrhage and liver failure. Lesions were localized in the left liver (9), right liver (6) and in both with multiple nodules (5). Among the 13 survivors, 7 died within a delay of 2 to 30 months, 1 due to recurrent rupture (5%). Six patients are still living with a follow-up of 3 to 36 months (including 2 hepatocellular carcinomas on a healthy liver and 1 with haemochromatosis). A review of the literature confirms the severity of such events whatever the initial management. Acute rupture of hepatocellular carcinoma usually requires emergency procedures with a high risk of mortality (50%). Fissuration authorizes explorations and possibly peroperative embolization with better immediate results.

[Use of silicon-impregnated compresses for echographic detection of section planes during hepatectomies]. / Utilisation de compresses siliconées pour le repérage échographique des plans de section au cours des hépatectomies.

It is essential to detect section planes during hepatectomy, notably for limited resections in cirrhotic patients. The authors describe a technical artifice, the use silicon-impregnated compresses, to help in the peroperative ultrasonographic detection of these section planes.

[Surgical strategy for hepatocellular carcinoma of the caudate lobe]. / Stratégie chirurgicale pour les carcinomes hépatocellulaires du lobe caudé.

Liver-cell carcinomas generally occur in cirrhotic livers; their surgery is difficult when they are located in the caudate lobe. After an anatomical summary, the authors propose a topographic classification of these tumors and describe the surgical strategy to be implemented.

[Segmentectomy under echographic control on cirrhotic liver]. / Segmentectomies échoguidées sur foie cirrhotique.

Hepatectomy for liver cell carcinoma in cirrhosis patients requires peroperative echographic control. Basel on their experience at the National Cancer Center Hospital in Tokyo (more than 500 hepatectomies of cirrhosis livers), the authors describe the advantages of peroperative echography and surgical techniques of various segmentectomy procedures.

[Role of emergency subtotal colectomy in neoplastic obstructions of the left colon]. / Place de la colectomie subtotale en urgence dans les occlusions néoplasiques du côlon gauche.

From 1984 to 1990, 60 patients underwent emergent surgery for a neoplastic obstruction of the left colon. We performed 19 colostomies without initial exeresis and 41 immediate tumoral resections. In the latter group, five subtotal colectomies (S.T.C.) were performed, including four with immediate mechanical anastomosis. Two patients had synchronous cancers and three had pre-perforating cecal lesions. Three patients had an associated general peritonitis. Three of the patients treated with STC died. These were these patients with general peritonitis, two of whom also had hepatic metastases. The data found in the literature on neoplastic obstructions of the left colon treated with STC with immediate anastomosis (227 cases are published) show an overall mortality rate of 8.4% with 24% morbidity, a complication of the anastomosis occurring in 4.5% of all cases.

[Antropyloric lithiasic obstruction. A variant of Bouveret's syndrome]. / Obstruction lithiasique antro-pylorique. Une variante du syndrome de Bouveret.

We report about one case of cholecystoduodenal fistula complicated by antropyloric lithiasic obstruction, which was treated surgically with gastrotomy and extraction of the calculus, in an 82-year-old woman. This case represents an anatomic variant of Bouveret's syndrome, which is classically defined as a duodenal lithiasic obstruction. On the basis of this case, the authors discuss the diagnostic and possibly therapeutic merits of digestive endoscopy and define the main clinical, anatomical and evolutive characteristics of this unfrequent complication of biliary lithiasis.

[Neonatal Pepper's syndrome. Apropos of a series of 22 cases]. / Syndrome de Pepper néonatal. A propos d'une série de 22 cas.

From 1960 to 1987, 22 neonates were treated at the Institut Gustave-Roussy for a Pepper' syndrome. During this period of time, 83 children were treated for the same syndrome, the neonatal type representing 26% of cases. Twelve of the 22 neonates presented with the rapidly evolving type, requiring an immediate aggressive treatment. In 4 of them death occurred early despite treatment. The 10 other neonates presented with a slowly progressive disease. In 5 of them treatment of the metastatic disease was not necessary to obtain remission. The survival rate of disease without relapses in 77%, with a median follow-up of 8 years. So, despite the high incidence of rapidly progressive forms, the prognosis of this disease remains favorable in neonates, provided an accurate treatment initiated early.

[Surgical treatment of perforated diverticular sigmoiditis. A retrospective study apropos of 45 cases]. / Traitement chirurgical des sigmoïdites diverticulaires perforées. Etude rétrospective à propos de 45 cas.

The authors report their experience with 45 cases of perforated diverticular sigmoiditis (10 cases of mesocolic abscesses, 13 cases of localised peritonitis and 22 cases of generalised peritonitis). The mean age of the patients was 69 years and a previous history of diverticulosis was found in 26.6% of patients. 18% were taking steroids or anti-inflammatories. The often atypical symptomatology only suggested sigmoid perforation in 50% of cases. Surgical procedures consisted of 33 immediate resections (group 1) and 12 conservative procedures (group 2). Overall mortality was 17.8%, and was 13% at the abscess and localised peritonitis stage, and 22.7% at the generalised peritonitis stage (difference not significant). 12% of patients died after resection in comparison with 33.3% after conservative surgery (difference not significant). Mortality was significantly higher when there was evidence of shock, pre-operative leucopenia and pyostercoral peritonitis. In group 1, the surgical morbidity was 24% with 9% reinterventions, while in group 2, there was a 50% complication rate and 25% reintervention rate. Intestinal continuity was reestablished in 67.5% of surviving patients with zero mortality. In view of the results obtained and after review of the literature, immediate resection would appear to give better results than conservative treatment.

[Obstructive left colonic cancer. Retrospective analysis of the therapeutic attitude in a series of 40 recent cases]. / Cancers du côlon gauche en occlusion. Analyse retrospective de l'attitude thérapeutique adoptée dans une série de quarante observations récentes.

In a series of 40 cancers involving the descending and sigmoid colon and producing true acute obstruction, the following were performed: 16 colostomies of first intention (including 11 palliative); 14 resections with colostomy (Hartmann type); 9 resection-anastomoses (including 3 protected); 1 attempt at laser treatment for non consent to surgery. Only 22 patients were theoretically suitable for anastomosis (18 contraindications due to invasive cancer or peritonitis); this was in fact carried out in 9 cases. Thus, if single stage surgery represents the ideal, it cannot be systematically applied; on the other hand, tumor resection can often be performed. It would seem that the use of per-operative colonic lavage can increase the percentage of single stage surgery, though there will always be a place for Hartmann or Bouilly-Volkmann type procedures, future reestablishment of continuity being facilitated by the use of surgical staples (EEA type).

[Extracorporeal lithotripsy in the treatment of biliary calculi]. / La lithotritie extra-corporelle comme traitement de la lithiase vésiculaire.

The authors present their experience from February 1988 with biliary lithotripsy in 125 patients. They review the protocol inclusion criteria and the various forms of complementary medical treatment. From this group, 30% of the patients underwent cholecystectomy, 45% received medical treatment and only 25% did not eventually require complementary medical therapy.