Complicated right-sided Bochdalek hernia in an adult.

Bochdalek hernias on the right side of the diaphragm are very rarely diagnosed in adults. We report a case of a 52-year-old female patient, who presented to the emergency department with acute intestinal obstruction. Plain and cross-sectional imaging identified a large right-sided Bochdalek hernia containing small bowel loops and the right colon. A laparoscopic approach was performed. The herniated intestinal loops and the right colon were reduced into the abdominal cavity. The diaphragmatic defect was closed using clips with reinforcement by a prosthetic polypropylene mesh. A mini median laparotomy was performed to ensure the viability of the bowel and a few stitches were inserted on superficial lesions of the serosa. The recovery was uneventful and the patient was discharged from the hospital 6 days after admission. Nine months later the patient is doing well.

[A huge inguino-scrotal hernia]. / Une volumineuse hernie inguino-scrotale.

We report herein a case of a 76 year-old-man, who presented a huge left inguino-scrotal hernia. Laparoscopic reduction of the hernia contents and hernia repair through an inguinal approach were performed. No recurrence was observed two years and a half postoperatively. Reconstructive surgical approach and important postoperative complications were discussed.

[Malignant solitary fibrous tumor of the abdominal wall in a man]. / Tumeur fibreuse solitaire maligne de la paroi abdominale chez un homme.

We report the first case of malignant solitary fibrous tumor of the abdominal wall in a man. Immunohistochemical staining for CD34 and bcl-2 were positive. Surprisingly, estrogen and progesterone receptors were focally positive. Expression of steroid hormone receptor in solitary fibrous tumor was rarely reported in the literature. In a few series, these receptors were identified as a risk factor of recurrences after surgical excision. Six months after complete surgical resection of the mass, our patient has been quite well without any evidence of recurrence.

Cholecystoduodenal fistula in a porcelain gallbladder.

Calcification of the gallbladder wall (porcelain gallbladder) is rare. Its appearance is quite characteristic on plain films, ultrasonography and computed tomography. Sporadic cases of cholecystitis have been described in porcelain gallbladders. Enterobiliary fistula may complicate acute or chronic cholecystitis in non-calcified gallbladder. We report a unusual case of acute cholecystitis with cholecystoduodenal fistula in a porcelain gallbladder.

[Peroperative localization of insuloma using staged portal vein insulin assay. Apropos of a case]. / Localisation peropératoire de l'insulinome par dosage étagé de l'insuline portale. A propos d'un cas.

The diagnosis of insulinoma is easily done now but, in many cases, it is still difficult to locate it without the use of invasive procedures. With selective angiography and percutaneous transhepatic catheterization of the portal vein however, failure is reduced to about 4%. We report a case of a double localisation of insulinoma, revealed by an intraoperative catheterization of the splenic vein. The advantages of this method are discussed.

Endoscopic resection of an endobronchial hypernephroma metastasis using a polypectomy snare.

A 69 yr old male patient developed an acute respiratory distress. The emergency bronchoscopic examination showed a polypoid tumour obstructing the left main bronchus. A snare used for colorectal polypectomy was introduced through the bronchofibrescope to remove the tumour. The patient then dramatically improved. No side effects were observed. Histopathological examination showed metastasis from a hypernephroma. This simple technique is useful for bronchial deobstruction, when the tumour is accessible with a snare.

[Cystic dilatations of the bile ducts]. / Les dilatations kystiques des voies biliaries.

Clinical manifestations of cystic dilation of biliary tracts, a rare affection usually detected in young patients, are described and 2 recent cases reported. Surgical treatment is outlined as a function of morphology of cysts, with emphasis on the high risk of cancerization of biliary tracts, even after bypass operations.