Adult small bowel obstruction due to congenital peritoneal belt: A case report.

INTRODUCTION: Peritoneal bands on the virgin abdomen are an extremely rare etiology of occlusive syndrome. Congenital bridles can be in 0.7 to 2% a cause of small bowel obstruction. PRESENTATION OF CASE: We report a case of a 21-year-old woman who was admitted with symptoms of bowel obstruction. The patient had no surgical or traumatic history. Laparotomy was done and the findings showed a congenital belt extending from the antimesenteric wall of the ileum to the vesical dome, causing bowel strangulation. Band's ligation proceeded smoothly after the operation. DISCUSSION: Congenital flanges present an uncommon situation. These bands are usually difficult to classify and define. They are usually observed in childhood. Therefore, this situation represents an unusual surgical problem in diagnosing clinically unexpected elderly patients. CONCLUSION: Congenital or spontaneous flanges are an uncommon cause of occlusion, which presents a challenging diagnosis. Exploratory laparotomy or laparoscopy is mandatory.

Evaluation of a new supraglottic airway device in ambulatory surgery: the I-gel.

BACKGROUND: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Its tube is profiled to facilitate and stabilize its insertion. aim : The aim of our study is to state the efficiency and the place of I-gel® in airway management in adult anaesthetic practice. methods: One hundred patients, ASA I-II, scheduled for shortduration elective surgery under general anaesthesia were included in this prospective study. Patients with neck pathology, previous or anticipated airway problems, increased risk of regurgitation or aspiration, ASA III and above and undergoing emergency surgery were not included in the study. We collected the following data: adequacy of the size recommended to the patient, ease in inserting the I-gel®, leak fraction, gastric leak, complications during insertion and removal, ease in inserting the gastric tube, haemodynamic and ventilatory parameters, stability during patient movement and satisfaction of the anaesthetists. results: The success rate of insertion and the use of the I-gel was respectively 99% and 96%. The device was inserted at the first attempt in 92% of cases. The introduction of the I-gel® was rated easy in 99% of cases taking a median of 13 seconds. Complications of insertion were restricted to coughing in 5 patients and hiccups in 7 patients. There were no significant increase in heart rate and mean arterial blood pressure compared to pre-insertion values. An audible leak was recorded in 14.6% of cases. The need for additional manoeuvres was less than or equal to 2 in 96.9 % of patients. The mean of the recorded peak airway pressure values was 18 cmH2O. After a fibreoptic exam via the airway tube, the glottis was completely seen in 74% of cases and partially seen in 14.6%. Two cases of gastric inflation were recorded. There was no case of regurgitation or hypoxemic episode during this trial. Post-operatively sore-throat was reported by one patient in recovery. After I-gel withdrawal, trace of blood was observed in 5 devices. One case of dental trauma was noted. 95% of the anaesthetists were satisfied with the use of the I-gel in their pratice. CONCLUSION: This study showed that I-gel® can be used safely and effectively in patients undergoing short-duration elective surgery because the I-gel® has a very good insertion success rate and few complications. The fibreoptic position of the device was correct and the ventilation was highly effective. These elements must be corroborated in larger series.

[Predictive factors of esophagojejunal fistula after total gastrectomy in gastric cancer patients]. / Facteurs prédictifs du lâchage de l'anastomose oeso-jéjunale après gastrectomie totale pour cancer.

BACKGROUND: The main complication observed after total gastrectomy is the oesophagojejunal anastomosic fistla. Its incidence varies between 7.4% and 11.5%. The mortality after anastomic leafage is high at around 20%, representing 30% and 54% of global mortality after total gastrectomy. AIM: This study aimed to evaluate mortality and morbidity after total gastrectomy and to determine their predictive factor METHODS: this is retrospective study about 80 cases of total gastrectomy for gastric cancer, collected in the departmentof General Surgery of the University Hospital Habib Thameur Tunis during the period 1 January 1995 to 31 December 2010. Reconstruction of the alimentary tract was achieved by Roux-en-Y-jejunal-loop. RESULTS: Esophagojejunal anastomotic leeakage developed in 14 patients (17%). In 8 patients treatment of anastomotic leakage consisted of re-operation with surgical drainage and confection of jejunostomy. in one patient treatment required resutre of the anastomosis and drainage of an abscess. In one patient treatment required resuture of the anastomosis and drainage of an abscess. in 5 of the 14 patients with a proven leak of oesophagojejunal anastomosis, conservative treatment with parental alimentation, placement of an irrigation-aspiration system and systemic antibiotics was performed. This treatment was successful in all cases. The presence of anastomic fistula extends the median lenght of post operative stay in the hospital of 20 days compared for the payents withiut fistula.Global mortalilty was 8/80 (10%). After esophagojejunal anastomotic leakage, the mortality was 3/8 (21%). CONCLUSION: Leakage of the oesophago-intestinal anastomosis may occur after total gastrectomy for gastric cancer. it's serious complication contributes to mortality after total gastrectomy. Knowledge of the predective factors of esophagojejunal fistula after total gastrectomy in gastric cancer can decrease its incidence .

[Pseudo-tumoral osteomyelitis. Immunologic study and etiopathogenic approach. Apropos of 2 cases]. / L'ostéomyélite pseudo-tumorale. Etude immunologique et approche étiopathogénique. A propos de 2 cas.

Two cases of pseudo-tumoral osteomyelitis are reported. The first concerns a 12 year-old boy who presented with pain of the left knee during 8 months and, later on, with swelling of the upper extremity of the left leg, without fever or local inflammatory signs. The radiological aspect of condensation with a filling defect and "chimney" crossing the cartilage led to osteotomy. Local bacteriological samplings were normal. The second case concerns a 11 year-old boy who, after having complained from pain of the right wrist during 2 weeks, presented with swelling and on X-ray films a picture of metaphyso-epiphyseal lysis and an aspect of sequestrum in its center. There was no biological sign of inflammation. Evolution was favorable after antibiotic treatment and immobilization. In both cases, an immunological study showed an activation syndrome of the immune system with increased serum IL-1, IL-2 receptors and class II antigen receptors on the surface of T cells, suggesting a previous immunization of both children towards staphylococcus and, thereby, the subacute nature of evolution.