[Dissecting hematomas of the infra-renal abdominal aorta]. / Hématomes disséquants de l'aorte abdominale sous-rénale.

A dissecting haematoma of the infra-renal abdominal aorta is the rarest form of dissection involving this arterial segment. On the basis of seventeen cases published in the literature, together with three personal cases, the authors review the clinical signs (fusiform ectasia, arteriosclerotic form with aortic obliteration, painful form with fissuring) and the radiological characteristics. A successful result was obtained in six patients out of seven undergoing operation with prosthetic replacement, which would thus appear to be the appropriate surgical technique.

[Short common bile duct or high implantation. Apropos of 2 cases]. / Le cholédoque court ou à implantation haute. A propos d'une observation

The authors report a case of so-called short common bile duct or highly implanted common bile duct, associated with double duodenal ulcer, with an unfavourable course in a very young girl. The pathological characteristics and the course suggested it was a congenital case of short bile duct, which is a rare disease, as 37 cases have been reported over a period of 25 years. 32 were associated with duodenal ulcer, which is often resistant to medical treatment, and becomes complicated in 33% of cases. The relationship between the two conditions remains hypothetical. Biliodigestive reflux was the first sign in 66% of cases. Retrograde opacification of the bile ducts under duodenoscopy should permit a diagnosis and precise pre-operative assessment. The abnormality has no special treatment, but the treatment of the associated disease, of the ulcer in particular, should be adapted to the ectopic bile duct to avoid serious injury. At operation, careful examination before dissection will determine the [site] of the papilla and of the opening of the biliary and pancreatic ducts. Vagotomy should be associated with a drainage operation, if possible, or gastrectomy may be performed with gastro-jejunal anastomosis leaving behind the posterior ulcer. Many precautions are necessary including the duodenal stump and details of these are given here.

[Mesenteric-caval anastomosis using an interposed dacron graft. Apropos of 5 cases]. / Les anastomoses mésentérico-caves par prothèse de dacron interposée. A propos de 5 observations

Five meso-caval shunts with the use of dacron prostheses are reported in the adult. Any other type of portocaval decompression was impossible in 2 cases (splenoportal thrombosis) but this procedure was elected in 3 cases (2 Budd Chiari syndromes, 1 cirrhosis with perihepatitis). This operation proved to be technically simple and satisfactory. A cirrhotic patient died 5 days later, because of acute hepatic necrosis, the four others cases being followed by a smooth postoperative course with a favorable effect on hemorrhage and/or ascites. Thrombosis of the graft was not observed (3 angiographic controls, 2 clinically obvious patencies). The follow-up is too short (maximum one year) to extend the indications of this appealing technical procedure.