[Hyperbaric oxygen in the treatment of perineal Crohn's disease era of infliximab: a renewal interest?]. / L'oxygénothérapie hyperbare dans le traitement de la maladie de Crohn perineale a l'ère de l'Infliximab : un regain d'intérêt ?

BACKGROUND: Despite the growing number of therapeutic methods and the recent introduction of new drugs more active in the therapeutic arsenal, lesions of the ano-perineal Crohn's disease remains difficult to support. Hyperbaric oxygen (HBO) was made before the era of infliximab, an interesting therapeutic approach in which the current position remains unclear. AIM: To assess HBO efficacy in the treatment of anal fistulas refractory Crohn's disease. METHODS: Literature review. RESULTS: Hyperbaric oxygen therapy was used in the 90's when the biotherapy was not part of the armamentarium for Crohn's disease. Research conducted has identified only nine publications evaluating the efficacy of hyperbaric oxygen therapy in the treatment of anal fistulas refractory Crohn's disease. Among the nine publications, we have retained only four: two clinical trials and two clinical cases. The total number of patients was 22: 12 women and 10 men. The average age of patients was 37 years. The average number of session was 42 sessions. Remission was observed in 15 patients (68.18%) whereas with Infliximab rate is 66%. Adverse events were observed in 2 patients (16.6%). Indeed, instead of considering them as two different alternatives, it should be combined to obtain a synergy to increase response rates, shorten the healing and especially to decrease the recurrence rate. CONCLUSION: Only a prospective randomized controlled trial (with two arms: biotherapy versus biotherapy associated with hyperbaric oxygen therapy) could accommodate this technique in the armamentarium of perineal lesions of Crohn's disease.

[Malignant intraductal papillary mucinous tumours of the pancreas. A three cases report]. / Tumeurs intracanalaires papillaires et mucineuses dégénérées du pancréas: à propos de trois cas.

BACKGROUND: Intra ductal papillary mucinous tumors of pancreas are rare and are characterized by a risk of malignant transformation. AIM: To clarify their clinical presentation and the performance of different imaging examinations to determine their benign or malignant and achieve their staging. CASES: We report three cases of degenerate intra ductal papillary mucinous tumors of pancreas. The combination of CT, the pancreato- MRI and duodenoscopy has led to the diagnosis in all cases. A pancreaticoduodenectomy were performed in two cases. CONCLUSION: The various imaging techniques allow better detection and analysis of the tumor including the evaluation criteria of degeneration. The treatment of these lesions is still surgery.

Acinar cell carcinoma of the pancreas: a rare tumor with a particular clinical and paraclinical presentation.

Acinar cell carcinoma (ACC) of the pancreas is a rare tumor with an extremely low incidence rate. While the number of reported patients with ACC is relatively small, a long-term survival rate has been noted in patients with neuroendocrine differentiation. A 39-year-old woman visited our emergency department for upper gastrointestinal bleeding. Endoscopy indicated extrinsic compression of the posterior body of the stomach, together with a large, 10-cm, central ulcer covered with necrotic tissue. Abdominal computed tomography (CT) indicated a lesion that involved the whole of the pancreas, with a fistula in the stomach, which was suspected of being a degenerative intraductal papillary mucinous tumor of the pancreas. Magnetic resonance imaging (MRI) of the pancreas was performed, and the results further strengthened our suspicions by demonstrating the presence of cystic lesions and tumor buds. A total duodenopancreatectomy, including total splenectomy and gastrectomy, was performed, along with two independent Roux-en-Y anastomoses (one esojejunal and one hepaticojejunal). The tumor also had a wide opening in the stomach. The patient's postoperative course was marked by partial thrombosis of the portal vein, which was treated medically. Histopathological examination provided evidence of pancreatic ACC. The diagnosis of ACC should be considered in the presence of cutaneous lesions, which were absent in the case of our patient, and colonoscopy is also highly desirable because of the various forms associated with familial adenomatous polyposis. The prognosis, which includes a 5-year survival rate of 45%, in the population with an R0 resection is better than that for ductular adenocarcinoma, thus prompting the more aggressive management of this type of tumor.

[Mesenteric panniculitis simulating malignancy]. / La panniculite mésentérique simulant un processus tumoral.

BACKGROUND: Panniculitis mesenteritis is a rare, benign, and chronic fibrosing inflammation disease with unknown aetiology that affects the mesentery of small bowel and colon. AIM: To report a new case of this entity and to highlight its diagnostic difficulties especially when it affects the mesocolon. CASE REPORT: A 37 years-old women presented with chronic abdominal pain; physical examination found mass of left ilaca fossa. Closcopy and abdominal CT scan showed a thickness of bowel wall with negative biopsies. The patient underwent a colectomy. Histologic examination concluded to the diagnosis of Mesenteric panniculitis without malignant lesion. CONCLUSION: Mesenteric panniculitis is a rare pathology which diagnosis is difficult to establish. It can simulate malignancy. A better knowledge of its clinical and radiological features could ovoid unnecessary digestive resection.

[A case of an acute pancreatitis after endoscopic band ligation of esophageal varices: a strong association or an unusual complication?]. / Pancréatite aiguë au décours d'une séance de ligature elastique de varices oesophagiennes: une association fortuite ou une complication inhabituelle?

BACKGROUND: Endoscopic band ligation is considered as the gold standard of treatment for oesophageal varices. Fewer and often mild complications can occur. AIM: To report and to discuss an association between oesophageal variceal endoscopic band ligation and actue pancreatitis. CASE REPORT: We report the original case of a patient with cirrhosis and who had presented an acute pancreatitis 3 days after oesophageal variceal endoscopic band ligation. Common aetiologies of acute pancreatitis was eliminated. The evolution was favourable without specific treatment. CONCLUSION: In the absence of similar case reports, the association between oesophageal variceal endoscopic band ligation and acute pancreatitis observed in our patient remains rather fortuitous even though experimental studies can explain these association.

[Early gastric adenocarcinoma]. / Adénocarcinome superficiel de l'estomac.

AIM: the purpose of this study was to determine the epidemiological and clinical behaviour of the superficial adenocarcinoma of the stomach, to clarify its pathological characteristics, its therapy and prognosis. METHODS: Over a period of 14 years (1990-2004), 16 patients were operated for a superficial gastric adenocarcinoma among 155 gastric cancers treated during the same period in the service of general surgery "A" La Rabta. RESULTS: The superficial gastric adenocarcinoma represented 10.3% of our series. The mean age was 59 years, 8 men and 8 women. Two patients were followed for a chronic stomach ulcer, a patient is followed for Biermer anaemia and another one for Menetrier disease. Among these cancers, 12 were intra mucosal and 4 invaded the submucousa. Lymph node involvement was present only in one case. The cancer was located in the antrum in 8 cases and was multifocal in 3 cases. One patient died in postoperative case because of a medical cause. The 5-year-overall survival was 65,6%. The recurrence had interested only one patient. CONCLUSION: the superficial gastric adenocarcinoma is rare. The follow up of precancerous states allows its diagnosis. The treatment is based on the gastric resection associated to the D1-type lymph node clearance. The multifocal character imposes a surveillance of the remaining gastric stump.

Percutaneous drainage of suppurative pylephlebitis complicating acute pancreatitis.

Suppurative pylephlebitis is a rare condition with a significant mortality rate, ranging from 50% to 80%. We report a case of suppurative pylephlebitis complicating acute pancreatitis treated by percutaneous drainage in a 40-year-old woman. The patient had an uneventful recovery.

[Rupture of hydatid cyst of the liver into the duodenum. A case report]. / Kyste hydatique du foie rompu dans le duodénum. A propos d'un cas.

BACKGROUND: Rupture of hydatid cyst in the digestive tract is a rare complication even in endemic areas. AIM: Authors report a case of a hydatid cyst of the left hepatic lobe ruptured in the duodenum CASE: was discovered at the occasion of epigastric pain and vomiting. Ct-scan revealed presence of air in a calcified hydatid cyst of the left liver lobe and a fistulous tract between the cyst and the duodenum. Endoscopy confirmed the diagnosis by the visualisation of a fistulous orifice of the anterior aspect of the first duodenum with a protrusion of hydatid membrane. Patient was treated surgically and had a partial cysto-pericystectomy and suture of duodenum.

[Solitary fibrous tumor of the pancreas. A case report]. / Tumeur fibreuse solitaire du pancréas. A propos d'un cas.

Solitary fibrous tumour (SFT), a rare mesenchymal neoplasm usually arising from the pleura, may also occur in many other extra pleural sites. It has exceptionally been described in the pancreas. This report describes the case of a benign SFT of the pancreas occurring in a 41-year-old man who presented with a solid epigastric mass. Pathological and immunohistochemical findings are presented. Imaging features on ultrasonography, CT, MRI, and arteriography are widely detailed. Surgical resection of the tumour was performed, and the patient died from postoperative complications.