Surgical treatment of hydatidothorax. Series of 79 cases.

OBJECTIVE: A retrospective review of 79 cases of ruptured intrapleural pulmonary hydatid cysts. We analyse and evaluate our experience in the surgical treatment of this complication. MATERIALS AND METHODS: In a ten-year period, from 1990 to 1999, 79 patients were operated on in our service for intrapleural rupture of a pulmonary hydatid cyst. There were 51 males and 28 females with a mean age of 35.4 years. The diagnosis was established on the basis of different clinical signs and imaging studies. Surgical approach consisted of a posterolateral thoracotomy in all cases. After decortication, different procedures were performed on the pulmonary lesions according to the importance of lung destruction. RESULTS: Radical resections were done in 48 cases, including lobectomies (15), segmentectomies (33) and conservative treatment: simple capitonnage and bronchial fistula closure (31). Postoperative complications occurred in 8 cases (10.1%), including one pyothorax, one haemothorax, one prolonged air leak, two pneumonias and two wound infections. There was one postoperative death, by respiratory failure. Ninety-five percent (95%) of patients were free of recurrence of thoracic hydatid disease in a follow-up ranging from 1 to 10 years (mean: 5.4 years). CONCLUSION: Hydatid cysts of the lung should be treated before complications occur, particularly intrapleural rupture because it considerably increases morbidity.

[Mature teratoma of the posterior mediastinum]. / Tératome mature du médiastin postérieur. A propos d'un cas.

Mature teratoma is the most frequent primary germ-cell occurring in the anterior mediastinum. We report a case of a 67-year-old man with mature teratoma of the posterior mediastinum. Computed tomography was helpful in suggesting a diagnosis of mature teratoma by demonstrating the presence of fat and calcification.

[Surgery for intra-bronchial foreign bodies]. / Chirurgie des corps étrangers intrabronchiques.

OBJECTIVE: The aim of this study was to evaluate the results of surgical treatment of intra-bronchic foreign bodies after unsuccessful endoscopic extraction. MATERIALS AND METHODS: Fifteen patients underwent surgical treatment of intra-bronchic foreign bodies in our department during a period of 10 years. There was 9 males and 6 females, the mean age was 20.27 years (range between 5 and 39 years), there were 8 right localizations and 7 left. The recurrent pulmonary infections were most frequent complaint of patients. RESULTS: Twelve pulmonary resections (including one pneumonectomy) were necessary because of the importance of pulmonary parenchyma destruction. There was one post-operative complication (one empyema) and the peri-operative mortality was nul. CONCLUSION: Surgical treatment of intra-bronchic foreign bodies must be used only after unsuccessful endoscopic extraction. The preventive measures are the best treatment.

Desmoid tumors of the chest wall.

OBJECTIVE: Desmoid tumors of the chest wall are uncommon fibromatous tumors characterized by their local invasion and frequent recurrences. They are considered low-grade malignant sarcomas. We analyze our results and evaluate our experience in their surgical treatment. PATIENTS AND METHODS: From 1980 and 1999, eight patients were operated in our service for desmoid tumors of the chest wall. There were five males and three females with a mean age of 32 years old (17-52 years). The diagnosis was established on the basis of clinical signs and imaging studies (Chest X-ray and computed tomography). Surgery was done by direct approach of the tumors. RESULTS: None of the patients had Gardner's syndrome. Complete resection was done in seven of the eight cases. Histology confirmed all cases. The follow-up ranged from 24 and 180 months, for a mean of 82 months. There was one death from cardiac and renal failure 3 months after a fifth resection associated with adjuvant radiation therapy. No other post-operative complications were observed. Recurrences occurred in 50% of cases, all treated by surgery, associated to radiotherapy in one case. CONCLUSION: Surgical treatment of primary desmoid tumors of the chest wall requires wide local resection. In cases of recurrences, multimodality therapies should be considered.

[Diaphragmatic hydatidosis: Report of a series of 27 cases]. / L'hydatidose diaphragmatique: A propos d'une série de 27 cas.

OBJECTIVES: To analyze the clinical, radiological and treatment of this rare disease and assess the results of surgical treatment by thoracotomy. PATIENTS AND METHODS: In the period of 10 years (1990-1999), 27 patients (15 males and 12 females, mean age: 32,4) underwent surgical treatment for hydatid cyst of the diaphragm with or without other location. Clinical signs were chest pain and dyspnea. Diagnosis was by abdominal echography and thoracic CT in 82% of cases. Surgical treatment was given alone in 25 cases, completed by medical care in 2. RESULTS: Diaphragmatic cyst was simple in 17 cases and complicated in 10: intrapleural rupture (4 cases), pulmonary hydatid cyst association (3 cases), hepatic cyst (2 cases) and disseminated form (1 case). Resection of the dome and pericystectomy were the used surgical procedures. Pneumothorax was the only post-operative complication (3.7%). The mortality was nil. CONCLUSION: Diaphragmatic hydatidosis requires a careful topographic diagnosis between the lung, diaphragm, liver or abdominal localizations. Ultrasound and computed tomography are highly contributive. Surgery is the best treatment, thoracotomy being an excellent approach.

[Intrathoracic textiloma caused by transdiaphragmatic migration after biliary surgery. Report of a case]. / Textilome intrathoracique par migration transdiaphragmatique après chirurgie biliaire. A propos d'un cas.

Intrathoracic textiloma is very rare and the transdiaphragmatic migration after abdominal surgery is exceptional. The diagnosis was suspected by history of surgery and radiology (CT), the treatment is only surgical. We report a case of intrathoracic textiloma after biliary surgery 30 years before and we describe the clinical, radiological features and treatment of this severe complication including clinical and medico-legal consequences.

Thoracic rupture of hepatic hydatidosis (123 cases).

BACKGROUND: Hydatid disease is frequently endemic in countries with poor environmental sanitation and in geographic areas where interaction between humans and animals is common. Pulmonary complications result from the proximity of hydatid cysts in the liver and the diaphragm. METHODS: The medical records of 123 patients, with established hydatid disease manifesting abnormal chest roentgenograms, were retrospectively analyzed for the period January 1990 to December 1999. RESULTS: Chest roentgenogram and abdominal ultrasound provided a correct preoperative diagnosis in 108 patients (87.8%). Expectoration of bile, demonstration of fistula by ultrasound, expectoration of cyst contents, and additional ultrasound or imaging findings were the criteria used to establish the preoperative diagnosis. The remaining 15 cases were confirmed at operation. Men outnumbered women nearly 3:1. Mean age was 36.2 years. Pulmonary resection was performed in 67 cases. Sixty-eight patients presented with a bronchobiliary fistula (55.3%). Morbidity rate was 14.6% and mortality rate was 8.9%. CONCLUSIONS: Thoracotomy offers adequate simultaneous access to both the chest and hepatic lesions with acceptable morbidity and mortality. Endoscopic sphincterotomy undertaken preoperatively is useful in reducing biliary complications.

Hydatid cyst: an unusual disease of the mediastinum.

BACKGROUND: Hydatid cystic disease is still a significant clinical problem in endemic countries, particularly in Morocco. Mediastinal localization is very rare. We report our surgical experience with this particular lesion. PATIENTS AND METHODS: In a retrospective review of the last ten years (1990-1999), we had seven cases of mediastinal localization out of total of 2332 (0.3%) intrathoracic hydatid cysts treated in our service. Imaging investigation consisted of chest x-ray and computed tomography. All diagnoses were confirmed peroperatively macroscopically and for some lesions, histologically. RESULTS: Complete resection of the cyst was performed in six cases. In one case, a small part of the wall intimately adherent to the superior vena cava was left in place. There were no complications, mortality or recurrence. CONCLUSION: Hydatid cysts can be found in many different sites in the body. Whenever possible, surgical management is the best treatment but extensive resection should be avoided. Medical treatment as an adjunct to surgery is indicated when there is a risk of dissemination.

[Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas by thoracotomy]. / Traitement des fistules biliobronchiques et bilio-pleuro-bronchiques d'origine hydatique par thoracotomie.

STUDY AIM: The aim of this study was to report the results of surgical treatment of hydatid bilio-bronchial et bilio-pleuro-bronchial fistulas via thoracotomy. MATERIAL AND METHODS: From 1990 to 1998, 63 cases were observed in the same center. Biliptysis was the main symptom in 72% of cases. The diagnosis was based on chest radiography and abdominal ultrasonography; both examinations visualised the cyst, intrathoracic collections, a diaphragmatic breach and biliary lesions. All patients were treated by one-stage thoracotomy. The procedures consisted of lung resection (lobectomy and/or segmentectomy) (n = 47) and decortication (n = 16) in the chest, cyst dome resection (n = 61) or partial pericystectomy (n = 12) in the abdomen and suture of the diaphragmatic defect in all cases after hepato-diaphragmatic disconnection. An additional laparotomy was necessary in 4 cases. RESULTS: There were 8 deaths (12.7%): one intraoperative death due to haemorrhage and seven postoperative deaths, mostly related to pulmonary complications. Postoperative complications (14.3%) were mainly respiratory. Clinical and radiological results were good with a one-year follow-up. CONCLUSION: Bilio-bronchial and bilio-pleurobronchial fistulas due to hydatid cyst are rare, but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragmatic and thoracic. A high perioperative mortality rate was observed. Thoracotomy is the best approach for surgical treatment at all three levels.