[Intestinal intussusceptions in adults]. / L'invagination intestinale de l'adulte: à propos de 20 cas.

BACKGROUND: Intestinal intussusception occur when a portion of the gastrointestinal tract invaginates into the part of the tract that precedes into the peristaltic direction. AIMS: To determine clinical presentation, diagnostic methods and outcome of the intestinal intussusception and to compare our results to previous data. METHODS: A retrospective study of 20 patients with mean age of 40 years admitted between 1982 and 1999 and underwent surgery for intestinal intussusceptions. RESULTS: Our patients were 10 males and 10 females. The clinical findings were essentially abdominal pain (90%). Preoperative diagnosis of intestinal intussusceptions was established in 30% of cases. Intussusceptions were ileo-ileal (n=10), ileo-colic (n=7) and colo-colic (n=3). 12 patients had tumors. For all intussusceptions involving the colon, all patients underwent resection while intussusceptions located on the small bowel were treated by reduction then resection or simple reduction then fixation. The mortality rate was 5%. CONCLUSION: Intestinal intussusception in adults is uncommon in comparison with children. Correct diagnosis is often established during surgery. Resection is recommended because of the frequent malignancy.

[Association Budd Chiari syndrome, antiphospholipid syndrome and Grave's disease]. / Association syndrome de Budd Chiari, syndrome des antiphospholipides et maladie de Basedow.

BACKGROUND: Antiphospholipid syndrome is revealed by Budd Chiari syndrome in 5% of the cases. Antiphospholipid syndrome is characterized by venous or arterial thrombosis, foetal loss and positivity of antiphospholipid antibodies, namely lupus anticoagulant, anticardiolipin antibodies and anti-beta2-glycoprotein I. Anticardiolipin antibodies was reported in auto-immune thyroid disorders, particularly in Grave's disease. Antiphospholipid syndrome associated to Grave's disease was reported in only three cases. AIM: To describe a case report of association of Grave's disease and antiphospholipid syndrome. OBSERVATION: We report the first case of Grave's disease associated with antiphospholipid syndrome, revealed by Budd Chiari syndrome. CONCLUSION: Our observation is particular by the fact that it is about a patient presenting a Grave's disease associated with antiphospholipid syndrome revealed by Budd Chiari syndrome. This triple association has never been reported in literature. Although association between antiphospholipid syndrome and Grave's disease was previously described, further studies evaluating the coexistence of these two affections in the same patient would be useful.

[Nutritional and dietary management after extensive intestinal resection]. / Prise en charge nutritionnelle et diététique après résection intestinale étendue.

BACKGROUND: Short bowel syndrome arose after extended intestinal resection over two meters. It was observed in 15% of intestinal resection in adults. Crohn's disease (in UK) and mesenteric ischemia (in France) were the most frequent etiologies. In adults, the incidence was estimated at two adults/million inhabitants/year. AIM: This review aimed to provide answer for these questions: 1. Who are patients interested by short bowel syndrome? 2. Which interventions are responsible? 3. What is evolution before and after nutritional assistance? METHODS: An electronic search was performed between 1990 an 2006 in Medline database with the following keywords: "short bowel disease", "treatment" and "inflammatory bowel disease". Recent literature reviews and meta analysis were retained for analysis. RESULTS: After an extensive intestinal resection, nutritional management should start early during the post operative course. This strategy will prevent in time life threatening complications. NPDA is indicated temporarily for short bowel syndrome until intestinal readaptation or definitively in case of severe short bowel syndrome to improve survival and quality of life.