[Volvulus of the transverse colon. Apropos of three cases]. / Volvulus du côlon transverse. A propos de trois cas.

Volvulus of the transverse colon is a very rare entity, representing 1 to 3.4% of all volvuli of the colon. We report three cases illustrating the problems of this pathology. The presentation is usually acute, leading to prompt surgery. Multiple etiologies may be combined: congenital malrotations of the gut, chronic constipation in the elderly enhanced by psychiatric medications, and mechanical by adhesion bands which help to create anomalous rotation axes for the volvulus. The best treatment must be surgical, and we recommend an aggressive approach: an extended right colectomy, which gave good results in our patients.

[Abscess of the abdominal wall: a rare presentation of xanthogranulomatous pyelonephritis]. / Abcès de la paroi abdominale: une présentation rare d'une pyélonéphrite xanthogranulomateuse.

A young psychiatric patient presented with a purulent collection in the lower abdominal wall. Simple drainage failed to heal the abdominal wall abscess, and the presence of a primary septic focus was suspected. Full investigation showed a right renal pelvis calculus with xanthogranulomatous pyelonephritis complicated by a retroperitoneal abscess. Recovery was complete after a nephrectomy. A review of the published literature demonstrated the rarity of this presentation, although even more curious cases have been described, including a urinobronchial fistula, as well as catastrophic cases presenting with a massive haemorrhage. Authors are unanimous that ultrasonography should be the first examination, the scanner being also of primordial value for the diagnosis and demonstration of the retroperitoneal spaces ans fascia. Treatment requires both rapid and radical surgical intervention.

[Is enterolithiasis a disease occurring more frequently in desert climate? Apropos of 8 cases]. / Entérolithiase, une pathologie plus fréquente en région désertique? A propos de huit cas.

This work is a report about 8 cases of enterolithiasis treated in our University Hospital between 1980 and 1990. We emphasize the rarity of this condition. We also note its relative frequency (5 of 8 cases) in the Bedouin population of our mostly desertic area, and question the possible impact of a diet rich in goat's milk and/or of tuberculosis, which is still endemic in some tribes. We then discuss the difficulties of diagnosis and the essential contribution of small bowel radiographs. The etiologies of enterolithiasis are reviewed, as well as the various modalities of treatment.

[Hydrothorax of hepatic origin. Description of a clinical case, pathophysiology]. / Hydrothorax d'origine hépatique. Description d'un cas clinique, pathophysiologie.

We admitted a 60 year old patient with severe right hydrothorax. He was known to suffer from decompensated non-alcoholic cirrhosis. His invaliding dyspnea was only temporarily improved by repeated thoracocentesis, due to the very rapid refilling of the thorax from the ascites; until the development of a "tension hydrothorax" with dangerous mediastinal deviation. By insertion a peritoneo-venous shunt described by LeVeen the clinical picture was improved, and the patient no longe required further pleural aspiration. Six per cent of cases of ascites complicating hepatic cirrhosis may be associated with hydrothorax of the same origin. The diaphragm is normally perforated by a multitude of tiny virtual holes, closed by the peritoneum and the thoracic pleura. The high intra-abdominal pressure in ascites tears these fragile membranes, and allows the peritoneal fluid to overflow into the pleural cavity. Usually treated by fluid restriction and diuretics, when this condition becomes intractable or when a tension hydrothorax appears, interfering with respiratory function a LeVeen peritoneo-venous shunt should be inserted.

[Cystadenocarcinoma with peritoneal involvement (pseudomyxoma peritonei). Is surgical resection alone sufficient?]. / Cystadénocarcinome avec atteinte péritonéale (pseudomyxome péritonéal). L'exérèse chirurgicale seule est-elle suffisante?

We present our experience of 10 cases of pseudomyxoma peritonei treated in our regional hospital between 1978 and 1992. We note the rarity of this disease; the catastrophic macroscopic appearance may mislead the in experienced surgeon. Preoperative diagnosis is usually easy when confronted with a mass in an ascitic abdomen, with the help of ultrasonography and CT-scan, and above all after abdominal puncture which produces pathognomonic gelatinous fluid. Most cases are derived from the ovary and appendix. Treatment is surgical and aggressive; we adopt the protocol proposed by Sugarbaker which combines repeated surgery and local and systemic chemotherapy. The relatively good survival, even in the malignant cases, seems to be improved by this treatment.