[Pudendal hernia of the labia]. / Hernie de la grande lèvre.

A case of hernia is reported with a brief review of perineal hernia.

[Acute severe colitis with recto-vaginal fistula during treatment with non-steroidal anti-inflammatory agents]. / Colite aiguë grave avec fistule recto-vaginale sous anti-inflammatoires non stéroïdiens.

INTRODUCTION: We report the case of severe colitis occurring during treatment with non-steroid anti-inflammatories (NSAI). OBSERVATION: A 57 year-old woman was hospitalized for lumbar pain that had not been relieved by AINS, tramadol and then morphine. The patient presented with septic shock and peritonitis by rectal perforation, followed by acute rectorrhagia. The endoscopic aspect evoked Crohn's disease with a recto-vaginal fistula. Progression was further complicated by two episodes of collapse because of acute rectorrhagia, requiring hemostasis colectomy and abdominal-perineal amputation. CONCLUSION: The diagnosis retained was AINS-induced colitis complicated by acute colectasia on a fecaloma with recto-vaginal fistula.

Motility of the Roux-en-Y hepaticojejunostomy in asymptomatic patients.

OBJECTIVE: The aim of our study was to describe the motility in the limb, the duodenum, and the jejunum distal to the limb after Roux-en-Y hepaticojejunostomy in patients who remained asymptomatic postoperatively. Our objective was to obtain reference manometric recordings for interpretion of recordings in symptomatic patients. METHODS: Manometric recordings were obtained in the Roux-en-Y limb in 13 patients 15.6 +/- 1.1 days postoperatively, using a probe inserted into the limb during surgery and coming out through the abdominal wall. The recording openings were positioned in the limb itself in eight patients, and also in the jejunum immediately distal to the limb in five patients. In four of eight patients, limb manometry was combined with duodenal manometry using a second probe introduced nasally. RESULTS: Phase IIIs were recorded in all 13 patients, either spontaneously or after trimebutine stimulation (100 mg i.v.). Phase IIIs occurred spontaneously in 12 patients. They always migrated throughout the Roux-en-Y limb, and were also most often observed in the distal jejunum; migration stopped in the distal jejunum in three of five patients. Phase IIIs in the limb occurred independently from duodenal phase IIIs. In the limbs, the duration of phase IIIs was longer (p < 0.02), and the migration slower than in the duodenum (p < 0.001) and in controls (p < 0.02). In nine of 13 patients, injection of trimebutine (100 mg i.v.) initiated phase III in the Roux limb or in the distal jejunum within 2 min. During the combined recordings, trimebutine initiated phase III simultaneously in the duodenum and in the limb. The response to meals in the limb was poorer than in controls. Interruption of phase IIIs was shorter, and the area under the postprandial curve was smaller (p < 0.01) for each postprandial half-h. Postprandial motility was poorer in the limb than in the distal small bowel (p < 0.01). CONCLUSIONS: In asymptomatic patients, interdigestive motility is present in the hepaticojejunostomy Roux-en-Y limb, but it is abnormal because of slow migration of phase IIIs. The second abnormality observed in the limb is a response to meals that is both short and of low amplitude.

Ileoanal anastomosis for ulcerative colitis: results of an evolutionary surgical procedure.

BACKGROUND/AIMS: Proctocolectomy with ileoanal anastomosis (IAA) has proved to be the most suitable surgical treatment for ulcerative colitis. The aim of this study was to compare the results of IAA according to the evolution of surgical procedures and particularly to compare the results of stapled versus hand-sewn anastomosis. METHODOLOGY: From 1984 to 1996, 37 men and 31 women were operated on in our centre for ulcerative colitis. The anastomosis between the J pouch and the dentate line was handsewn in 35 patients (group 1) and stapled in 33 patients (group 2). RESULTS: The mean operative time was significantly shorter in group 2 as compared with group 1 (265+/-59 vs. 323+/-53, p<0.01, respectively), whereas morbidity and functional results were comparable in both groups. In 10 patients with stapled IAA, a diverting ileostomy was not performed and the morbidity in this group did not increase. CONCLUSIONS: These results suggest that stapled IAA anastomosis is a safe procedure. The stapling technique of IAA simplifies total excision of the rectum and could mean that a diverting ileostomy is not necessary.

Eversion of the rectum. A simplified technical approach to ileoanal anastomosis.

Eversion of the rectum allows complete excision of the rectum. Here, we describe a modification of the stapling technique of ileoanal anastomosis, which leads to a safer anastomosis.

Should the vagus nerves be isolated from the fundoplication wrap? A prospective study.

OBJECTIVE: To assess whether careful dissection and isolation of vagus nerves from the three-quarter Nissen fundoplication wrap (a periesophageal posterior gastric wrap 270 degrees in circumference) could modify the postoperative outcome and reduce postoperative gastric emptying disturbances. DESIGN: Open randomized control trial. SETTING: University hospital. PATIENTS: Forty-two patients with proved esophageal reflux and indication for surgery, after informed consent. INTERVENTIONS: A three-quarter Nissen fundoplication with (21 cases) or without (21 cases) dissection and exclusion of vagus nerves from the wrap. MAIN OUTCOME MEASURES: Standard questionnaire, acid reflux test, and gastric emptying study before and 3 months after surgery. RESULTS: No difference was found between the groups. There was a correlation between preoperative and post-operative gastric emptying. CONCLUSION: Exclusion of the vagus nerves from the three-quarter Nissen fundoplication wrap provides no advantage on postoperative gastric emptying and does not affect outcome of reflux surgery.

[Practical approach to tumoral perforations of cancers of the colon. Apropos of 7 cases]. / Attitude pratique devant les perforations tumorales des cancers du colon. A propos de 7 cas.

In 4 to 5% of cases, the cancer of large bowel is presented with a perforation in situ. The mortality rate in these conditions is high, and it is evaluated in the literature between 40 to 50% of cases. The authors present their experience with 7 consecutive patients, operated for this complication. In all cases, the tumour is excised: in 6 patients, terminal colostomy is realised while one patient only had a direct resection anastomosis. No per-operative mortality, was noted, and in four patients retauration of intestinal tract is realised, within 3 to 6 months latter. In our experience, the perforated tumour does not appear as a factor of immediate gravity.

[Appendiceal mucoceles. Pathophysiology and therapeutic indications]. / Les mucocèles appendiculaires. Physiopathologie et implications thérapeutiques.

Appendiceal mucoceles (AM) are rare lesions of the appendix, characterized by an accumulation of mucus. Two main pathogenic mechanisms may be invoked to explain their development. Firstly, AM are secondary to an obstruction of the appendiceal lumen for a wide variety of reasons. Secondly, they may be due to tumours of the appendix, whether malignant (cystadenocarcinomas) or benign (cystadenomas), responsible for a hypersecretion of mucus. Intraperitoneal mucinous effusion (IME) develops when appendiceal perforation occurs, especially with malignant AM. We found 13 retention AM and in most a definite obstructive lesion was present. There were 3 malignant AM, all associated with a neoplastic IME. While they are frequently described in the literature, no cystadenoma was observed in these series. Clinical symptoms are often confusing, but paraclinical investigations may lead to preoperative diagnosis. Appendectomy is the treatment of retention AM and cystadenoma. Their prognosis is related to other associated diseases, namely ovarian and colorectal tumours, but is otherwise good. Cystadenocarcinomas require a right hemicolectomy with evacuation of IME but their prognosis is poor.

[Superficial gastric cancer. A review of 30 cases]. / Le cancer gastrique superficiel. Revue de 30 cas.

Thirty cases of superficial cancer of the stomach were treated over a ten-year period from 1984 to 1993. Actuarial survival rate at 5 years was 73%. The depth of cancer invasion has a predominant effect on two prognosis factors: mucosal and submucosal involvement. Invasion of the lymph nodes is more frequent in cases with submucosal invasion. Treatment is based on gastric surgery. Nevertheless, if the diagnosis of superficial cancer is certain before operation and deep extension is clearly identified by histology and especially by echoendoscopy, more selective surgery could be justified: R1 type exeresis for cancers involving the mucosa only and R2 type exeresis for submucosal involvement.

[Cysts of the parathyroid glands. Apropos of 6 cases]. / Les kystes des parathyroïdes. A propos de six cas.

Parathyroid cysts are rare lesions. Pathological examination distinguishes the "true" parathyroid cysts (non functional) most often present and cystic degeneration of a parathyroid adenoma (rare) with clinical or biochemical evidence of hyperparathyroidism. With the increased use of ultrasound and fine needle aspiration biopsies, the diagnosis of these cysts can be confirmed by an elevated parathyroid hormone (PTH) assay. The non-functioning parathyroid cysts can be successfully treated by total aspiration of the cyst fluid. Surgical exploration of all parathyroid glands is the treatment of choice for hyperparathyroidism. The different proposed etiologies for parathyroid cysts are discussed.