Internal supravesical hernia: an unusual cause of small bowel obstruction.

Internal hernia of the supravesical fossa is an unusual cause of small bowel obstruction. We report the case of a patient without previous abdominal surgery with an acute abdominal obstruction in which laparoscopic exploration revealed a strangulated internal supravesical hernia. To help clinicians with their pre-operative diagnosis and to better understand the clinical management of this unusual internal hernia, a description of the anatomy of the supravesical fossa is included in this case report.

Efficacy of double gloving with a coloured inner pair for immediate detection of operative glove perforations.

OBJECTIVE: To compare the efficacy of double gloving with an inner coloured pair of gloves and double gloving with classic gloves, for prompt detection of perforation during a single standard operation. DESIGN: Prospective, randomised study. SETTING: Teaching hospital, France. SUBJECTS: 100 Consecutive patients with haematological malignancy or AIDS, who were referred for implantation of a vascular access port. INTERVENTIONS: Insertion of a central line with an implantable chamber under local anaesthesia. The use of double gloving with an inner coloured pair or with classic gloves was decided preoperatively by random allocation. MAIN OUTCOME MEASURES: Visual detection of one or more perforations on one or more gloves during operation, localisation of the perforation(s), and post-operative evaluation of the water tightness of the gloves. RESULTS: There were a total of 14 perforations of the outer gloves, 9 were detected during operation in the coloured inner pair group compared with none in the standard gloves group. Postoperative testing showed that there were no undetected perforations in the coloured inner pair group compared with 5 in the standard gloves group. CONCLUSIONS: Double gloving with a coloured inner pair is effective in the peroperative detection of accidental perforations in surgical gloves.

[Peroperative contamination of the peritoneal cavity with micro-foreign bodies]. / Contamination per-opératoire de la cavité péritonéale par des microcorps étrangers.

This prospective study examined the presence of foreign bodies in postoperative adhesion specimens and parietal peritoneum removed in a given patient at the same operative site. Fifty-two consecutive patients were enrolled. A significantly larger number of foreign bodies were observed in adhesion specimens than in peritoneum specimens. Inflammatory processes were also found to develop preferentially on the perioneum. In man, foreign bodies participate in the mechanism of development of postoperative intraperitoneal adhesions.

Giant cavernous hepatic hemangiomas in adults: enucleation under selective blood inflow control.

Among hepatic hemangiomas (the most common solid hepatic tumor in adults), "giant hemangiomas" are those defined by a diameter greater than 4 cm. The natural history of such lesions is unclear, and many surgical procedures have been described. In five women and one man (mean age 49), we successfully used enucleation of the tumor under blood inflow control. This technique was made possible by a cleavage plane between the hepatic parenchyma and the hemangioma. This straightforward and safe procedure required a low rate of transfusion (mean 200 mL/patient) and spared a maximum amount of hepatic tissue.

[Gastric MALT lymphoma of low-grade malignancy. Apropos of 4 surgically treated cases]. / Les lymphomes gastriques du M.A.L.T. de faible degré de malignité. A propos de 4 cas opérés.

From 1990 to 1993, programmed surgery was performed in four patients with histologically low grade malignant gastric lymphomas of mucosa-associated lymphoid tissue (MALT) (partial gastrectomy = 1, total gastrectomy = 3). These small cell lymphomas have the B phenotype and are uncommon. The clinical course is usually slow and classically limited to the stomach. As for other gastric lymphomas, there is still a certain amount of discussion as to the best therapeutic choice between surgery, chemotherapy and radiotherapy. Certain elements in the literature can help in managing these low grade gastric lymphomas. Recent publications report on a prospective study on primary lymphomas of the digestive tract, a clinical trial on single drug chemotherapy alone and the relationships between Helicobacter pylori and MALT lymphoma.

[Extensive ulceronecrotizing anorectitis caused by abuse of analgesic suppositories]. / Ano-rectite ulcéronécrosante extensive par utilisation abusive de suppositoires contenant des produits antalgiques.

Usually considered as totally unoffensive, antalgic suppositories can, under certain conditions, lead to extensive anorectal injury with anatomic, functional and legal implications which we evaluated on the basis of two cases and a review of the literature. Clinicians, surgeons, pathologists and pharmaceutical firms should be aware of these pathophysiological events. Consumer information is required to reduce the risk of self-medication. There are characteristic psychologic situations and "dose-dependent" toxic effects which, as the saying goes "errare humanum est, perseverare diabolicum". Careful use of scientific knowledge and wise decisions by both experts and judges are required to avoid misinterpreting the pathogenesis of this particular anatomoclinical entity.

[Catheters with implantable chamber, technique of implantation. 168 consecutive patients in a single year]. / Cathéters à chambre implantable, technique d'implantation. 168 patients consécutifs en un an.

Our experience with 168 consecutive implantable chamber catheters over a one year period led us to establish the criteria for this implantation technique. Implantation should be carried out under local anaesthesia and be well tolerated and comfortable for the patient who is often weak. It should be a first indication technique in order to save the venous capital. Based on our experience, subclavian implantation corresponds best to these criteria.

[Natural history of postoperative intraperitoneal adhesions. Surely, a question of the day]. / Histoire naturelle des adhérences intra-péritonéales post-opératoires. Une question vraiment à l'ordre du jour.

Postoperative intraperitoneal adhesions are known to occur after conventional surgery. The prospective study that we have performed in 1992 shows that the frequency of postoperative intraperitoneal adhesions is very high (93% of patients). It is higher than was stated 20 years ago, while so-called "spontaneous" adhesions seem to be decreasing. The histological study of postoperative intraperitoneal adhesions shows a specific evolution in time and a very high frequency of foreign bodies (starch, variably decayed textile fibers) (92%). The very great frequency of such foreign bodies in postoperative intraperitoneal adhesions, logically involving them in the genesis of this condition, may be an argument in favor of the new surgical techniques, especially of celioscopy.

[Lymphangioma of the mesentery. A rare cause of acute abdominal pain syndrome in adults]. / Lymphangiome du mésentère. Une cause rare de syndrome douloureux abdominal aigu chez l'adulte.

We report about one case of cystic lymphangioma of the jejunum in a 27-year-old woman admitted to hospital for abdominal pain. The study of this case and the review of the literature enabled us to bring out the main characteristics of the lesion: rarity in adults, benignancy, mode of occurrence--most often painful--, radiological--and particularly CT--features, diagnosis based on histological findings only, and lastly, treatment with surgical exeresis that must be complete to prevent recurrence.

[Reconstruction of the intestinal tract by intracolonic ileal sleeve. An experimental study and 1st clinical cases]. / Rétablissement du circuit intestinal par trompe iléale intracolique. Etude expérimentale et premiers cas cliniques.

An experimental study on 15 piglets allowed defining the technical procedure and controlling the anatomical and functional results of various modes of restoration of the ileocolic tract after resection with a terminolateral tubing including and intracolic ileal sleeve. Coloileal fixation was ensured only by a few seromuscular sutures and adhesion with "Tissucol". The clinical application of this procedure was very satisfactory for 9 recent right colectomies, thus confirming the results previously observed for 33 ileal perforations in Africa. The ileocolic tubing technique is easy, reliable, morbidity-free, and causes no leakage of intestinal fluid, no intestinal ischemia and no stenosis. As it prevents coloileal reflux, this assembly may prevent ileitis after right colectomy. Its valvular effect also contributes in the mechanical regulation of transit. The assembly produces a system that can be compared to the ileocecal valve.