[Sacral rectopexy-sigmoidectomy in the treatment of rectal prolapse syndrome. Anatomical and functional results]. / Rectopexie sacrée-sigmoïdectomie dans le traitement du syndrome du prolapsus rectal. Résultats anatomiques et fonctionnels.

UNLABELLED: Various options have been suggested to improve the functional results of abdominal rectopexy for rectal prolapse and to limit the risk of post-operative constipation. OBJECTIVES: In this prospective study, we evaluated the results of posterior abdominal rectopexy-sigmoidectomy to treat rectal prolapse syndrome in terms of morbidity, anatomic correction and bowel function. Patient benefits after surgery were assessed according to their pre-operative functional status. PATIENTS AND METHODS: Twenty patients (14 females, mean age: 42 years) were treated for rectal prolapse with sutured abdominal rectopexy and sigmoidectomy. RESULTS: (a) Thirteen patients had normal post-operative course. No anastomotic leak occurred. Mean hospital stay was 9.7 days. (b) Anatomical control was obtained in all cases for a mean follow-up of 31.2 months without recurrence. (c) Functional results: bowel movements per week remained unchanged pre- and post-operatively (18.6 +/- 33 vs 18.1 +/- 17). Constipation appeared or worsened in 2 patients (10%). Anal incontinence (n = 6-30%) never worsened post-operatively and improved in 3. CONCLUSIONS: This prospective clinical study confirmed the important functional disorders occurring in rectal prolapse syndrome. Rectopexy-sigmoidectomy is a valid option with stable mid-term results. Constipation was observed in 10% with no worsening of anal incontinence.

[Surgically treated severe acute inflammatory colitis. Immediate results and long-term outcome]. / Colites inflammatoires aiguës graves traitées chirurgicalement. Résultats immédiats et devenir à long terme.

UNLABELLED: The goal of this study was to analyse the management and the long-term evolution of 40 patients surgically treated for acute colitis (AC) during a 10 year period. PATIENTS AND METHODS: From June 1985 to June 1995, 40 patients (22 males and 18 females, mean age: 33,5 y.o.) have been consecutively operated on for AC. Assessment of severity was based on clinico-biological, endoscopic and radiological criterias: AC was complicated in 3, failing to respond to medical therapy in 9, resisting to medical therapy in 28. Sub-total colectomy (STC) with ileostomy and sigmoidostomy was the most frequently performed procedure (27 cases-68%). RESULTS: 1) The preoperative diagnosis of colitis was modified 6 times (15%) after histological assessment of the specimen: the final diagnosis was ulcerative colitis, indeterminate colitis and Crohn colitis respectively in 36 (90%), 2, and 2 cases. The established diagnosis had to be modified 4 times during follow-up. 2) Postoperative complications occurred in 5 after STC (18%) and in 4 in the other procedures (31%), without mortality. 3) After a mean follow-up of 55 +/- 10 months of the all series, 7 patients (17,5%) had a stoma: 2 had ileo-anal anastomosis taken down and 2 returned to ileostomy for Crohn disease, 1 patient with protected ileo-rectal anastomosis stayed with an ileostomy, 1 patient refused ileo-anal anastomosis, and 1 with imperforate anus had terminal ileostomy. Respectively 25, 6 and 2 patients had a functional ileo-anal, ileo-rectal, and colo-rectal anastomosis and experienced good to excellent digestive comfort in 85% of the cases.

[Cystic dystrophy of the duodenal wall on aberrant pancreas. Apropos of 2 cases]. / Dystrophie kystique de la paroi duodénale sur pancréas aberrant (DKPA). A propos de deux observations.

Cystic dystrophy in heterotopic pancreas is characterized by the presence in the duodenal thickened muscularis of cysts corresponding to dilated ducts lined with exocrine epithelium. The pancreas proper is normal. Cystic dystrophy in heterotopic pancreas occurs mostly in men, in the periampullary region. Two cases, revealed by duodenal stenosis, are reported here. Symptoms and morphologic investigations favoured a diagnosis of malignancy: in one case, partial portal thrombosis was observed; this complication has not been previously described in association with cystic dystrophy in heterotopic pancreas. Endosonography was non-contributory in these 2 cases because of duodenal stenosis. A pancreaticoduodenectomy was performed associated in one case with portal thrombectomy. Pathologic findings allowed diagnosis of cystic dystrophy in heterotopic pancreas.

[Intestinal endosalpingiosis. Apropos of 2 cases]. / L'endosalpingiose intestinale. A propos de 2 observations.

Intestinal endosalpingiosis (ES) involving colon or small bowel is a rare, misleading disease. Two different aspects must be distinguished:--serosal involvement, more or less disseminated: this form is asymptomatic or associated with ascites leading to the diagnosis of peritoneal pseudo-carcinomatosis; in this form of typical or atypical endosalpingiosis of florid type, no malignancy is found on histology;--parietal involvement, leading to stenosis or intestinal perforation with enterocutaneous fistula: this malignant form of endosalpingiosis is similar to primary papillary peritoneal carcinoma or stage III ovarian carcinoma. These two forms of ES are studied on 2 cases illustrating the overlap between typical benign ES, proliferating ES and malignant ES.

[Pre- and retro-anal myorrhaphy in the treatment of severe anal incontinence. Clinical and manometric results]. / Myorraphie pré- et rétro-anale dans le traitement de l'incontinence anale sévère. Résultats cliniques et manométriques.

Optimal surgical treatment for neuropathic severe anal incontinence is still controversial: the combination of pre-anal levator plication and post-anal repair (Parks) has been recently described. This non-randomized prospective study evaluated the results of pre- and post-anal repair for medically non-corrected neuropathic and traumatic anal incontinence. Ten female patients (mean age: 59) were operated by pre- and post-anal levatorplasty (total pelvic floor repair). Incontinence was scored clinically according to the Jorge and Wexner score (normal: 0, max.: 20) and with no rectal manometry, before and after surgery. Fourteen months after surgery (range: 9-18 months), anal continence for stools was achieved in 7 out of 10 patients: the patients clinical scores decreased from 15 (12-19) pre-operatively to 6 (1-18) post-operatively (p < 0.01) (4 for good results, 17 for the 3 failures). No manometric parameter was able to predict or explain postoperative functional results. Only anal canal length and maximal amplitude of anal contractions were significantly improved from 3.0 cm (2.0-4.0) to 3.5 cm (2.2-4.5), p < 0.05) for the former and from 54 to 69 cm H2O for the latter (p < 0.05). In this small series, pre- and post-anal levatorplasty effectively corrected severe neuropathic anal incontinence in the short-term, in 70% of cases. In our experience, this technique appears to be superior to post-anal repair, without increasing technical problems or morbidity.

[Quality of life and ileo-anal anastomosis with pouch. Results of a prospective series of 35 surgically treated cases of hemorrhagic rectocolitis. Proposal for a score of quality of life]. / Qualité de vie et anastomose iléo-anale avec réservoir. Résulats d'une série prospective de 35 rectocolites hémorragiques opérée. Proposition d'un score de qualité de vie.

Ileal-pouch anal anastomosis (IPAA) following coloproctectomy avoids permanent ileostomy, and allows complete excision of diseased mucosa in ulcerative colitis (UC) and adenomatous polyposis. Preserving normal intestinal pattern, the goal of IPAA is to improve quality of life for patients. This study was designed to measure the impact of IPAA on quality of life in a series of 35 surgically treated UC. Four fields of quality of life were explored: diet, professional activity, sport practice, sexual activity. Interview with independent observer and prospective follow-up allowed to establish a score from 0 (excellent quality of life) to 19 (bad quality of life). In the same time, functional score evaluating pouch evacuation and continence was established (0 = excellent function, 30 = bad function) to be compared to quality of life. The series included 35 IPAA in function for more than 6 months (mean follow-up = 46 +/- 31 months), performed for UC (14 females and 21 males, mean age: 34 y-a). Respectively 30 (86%) and 5 (14%) of the patients had an excellent and fair quality of life, according to the scoring system: 25 had no diet, all but one had a normal professional activity and all were satisfied of sport practice; 33 had no sexual disturbances related to IPAA, but 3 female patients complained of infertility. Functional results were excellent, fair and bad respectively in 25 (72%), 9 (26%) and 1 patients: stool frequency was 4.6 +/- 2 per day, 60% of patients having no nocturnal emission, and 90% being able to delay for more than 1 hour.(ABSTRACT TRUNCATED AT 250 WORDS)

[Complications of biliary cysts. Apropos of 10 cases]. / Complications des kystes biliaires. A propos de 10 observations.

Ten cases of complications of simple biliary cysts were reported: 4 intracystic haemorrhages including 1 intraperitoneal rupture, 3 bacterial infections including 1 case with invalidating pain. Complications of biliary cysts raises the problem of the differential diagnosis with cysts caused parasites, neoplastic processes (cystadenomas and pseudocysts of the liver) and with intrahepatic collections of pancreatic or traumatic origin. Imaging and echo-guided puncture are the most appropriate exploration techniques. MRI has been particularly helpful to evaluate bleeding in an intrahepatic cyst. A pathology examination of the cyst wall and its contents should always be performed. Theoretically, partial cystectomy (performed here in 8 cases) is the indicated treatment. Total cystectomy (1 case) is justified when the diagnosis of cystadenoma cannot be excluded. The role of liver resection is very limited. Preventive resection of a simple biliary cyst greater than 8 cm can be indicated, particularly with videolaparoscopy.

[Hepatic and renal angiomyolipoma]. / Angiomyolipome hépatique et rénal.

Angiomyolipoma is a benign mixed mesenchymal tumor. It is a well known entity in the kidney, but very rare in the liver. A case of renal and hepatic angiomyolipoma without no evidence of tuberous sclerosis is presented. This association has been previously described only once before. Radiologic and ultrasonographic findings may be suggestive of the lesion, showing both fatty and hypervascular components. The definitive diagnosis requires histologic and immunohistochemical confirmation by fine needle aspiration biopsy. Surgical excision is unnecessary unless abdominal discomfort is present or malignant tumor is not completely ruled out.

[Leiomyoma of the rectum]. / Les léïomyomes du rectum.

Most of the 150 leiomyomas of the rectum reported since 1872 were no larger than 5 cm. The authors report 3 new observations of leiomyomas of the rectum measuring more than 5 cm. The diagnosis of leiomyoma is difficult. The physical examination and rectoscopy suggest a submucal tumour of the rectum and endoendoscopy helps, describe the relations with the urogenital tract and the sphincters. Due to the lack of distinctive pathology features of malignancy, a leiomyosarcoma cannot be totally eliminated. The prognosis is uncertain due to the rate of relapse and the short follow-up (less than one year) in the previously reported cases. A slow spontaneous clinical course is however possible. The treatment goal is complete surgical removal. While local exeresis is indicated in tumours less than 5 cm in size, echo-guided endorectal protectomy with or without amputation of the sphincter should be discussed for larger tumours.

[Muir-Torre syndrome. Apropos of a case associated with a familial form of cancer]. / Syndrome de Torre et Muir. Rapport d'un cas associé à un syndrome de cancer familial.

We report the case of 41 year-old male patient, in whom multiple and recurrent infrequent cutaneous lesions (sebaceous adenomas) led to suspect the diagnosis of Muir-Torre syndrome. This diagnosis was confirmed when 2 colo-rectal adenocarcinomas were discovered and curatively excised (trans-anal excision, followed by total colectomy). The Muir-Torre syndrome was part of a familial cancer syndrome in this case, as the patient's mother and brother died from colonic cancer before the age of 45. The case-report underlines the diagnostic role of cutaneous lesions in this syndrome, allowing early detection of internal malignancy.

["Cholethorax" revealing injury to the common bile duct after celioscopic cholecystectomy]. / "Choléthorax" révélateur d'une plaie de la voie biliaire principale après cholécystectomie per-coelioscopique.

The case-report describes the unusual formation of a bilious pleural effusion or "cholethorax" revealing a common bile duct injury secondary to laparoscopic cholecystectomy. Pleural drainage led to a diagnostic ERCP. Subsequently a Roux en Y hepatico-jejunostomy allowed a satisfactory outcome.

[Problems posed by the association of streptococcus D infectious endocarditis and colorectal tumor]. / Problèmes posés par l'association d'une endocardite infectieuse à streptocoques D et d'une tumeur colo-rectale.

The problems arising from the discovery of a colorectal tumor during an infectious endocarditis caused by Streptococci D have rarely been mentioned in the surgical literature. The frequency of association of an asymptomatic colorectal tumor and of a Streptococcus bovi endocarditis is now undisputed. This notion implies the systematic search for an intestinal lesion (adenoma or carcinoma) in case of endocarditis or septicemia without involvement of the valves, caused by a streptococcus of group D. The authors report about 3 cases of enterococcal (1 case) and S. bovis (2 cases) infectious endocarditis revealing a colic adenocarcinoma (2 cases) and a villous adenoma (1 case), all being perfectly latent. The specific therapeutic problems arising from this association are outlined, including the antibiotic therapy, the role of the anticoagulant treatment and the priority given to valve surgery in case of hemodynamic instability.

[Disabling rectocele: rectal plication by perineal approach. Apropos of 20 cases]. / Rectocèles invalidantes: plicature rectale par voie périnéale. A propos de 20 cas.

Rectocele is a frequent rectal static disorder. Its usual clinical manifestation is a distressing outlet obstruction. Surgical treatments actually proposed are based on a trans-anal approach. Perineal approach has specific interests as shown on a consecutive series of 20 patients operated on between January 90 and January 92. The surgical modalities were, after mobilization of the recto-vaginal wall, careful concentric folding of the rectocele followed by suturing the rectal fascia and pre-anal levatorplasty without associated colpectomy. Results (mean follow-up: 15 months) showed: 1) anatomic correction obtained in 18 cases, without local complications, but one dyspareunia, 2) restoration of normal rectal evacuation in 16 cases. The 4 functional failures were observed in patients with associated anorectal disorders (anismus, colon inertia).

[Post-stress acute hemorrhagic ulcers of the cecum. Apropos of 3 cases]. / Ulcères aigus hémorragiques post-agressifs du caecum. A propos de trois cas.

Three cases of acute ulcers of the cecum causing massive bleeding with hemodynamic impact are reported. These three cases involve young subjects (28, 31 and 51 years old). Bleeding occurs after an aggression (post-traumatic context in 2 cases, postoperative in 1 case). For these three patients, the angiographic location of arterial bleeding allows elective colic exeresis without rebleeding. From a pathogenetic point of view, the most likely hypothesis seems to be that of ischemic lesions following an aggression.