Tuberculosis or Gallbladder carcinoma? A confusing presentation in an endemic region.

INTRODUCTION AND IMPORTANCE: Gallbladder tuberculosis (GT) is an extremely rare clinical entity that represents only 1 % of abdominal tuberculosis cases. Preoperatively, most patients are misdiagnosed as chronic cholecystitis or gallbladder malignancy. CASE PRESENTATION: We report the case of a 43-year-old patient, whose clinic, imaging and biology were in favor of Gallbladder carcinoma. DISCUSSION: The clinical presentation of GT is varied and nonspecific, making the preoperative diagnosis of GT difficult; it may mimic acute cholecystitis to frank malignancy as seen in our case. Preoperatively, GT poses a diagnostic dilemma despite advanced imaging modalities, leading to missed diagnosis. The biology remains non-specific also. The diagnosis is usually made upon histological examination after cholecystectomy. CONCLUSION: Even though the clinical presentation and the radiology are aspecific and misleading, It seems to us justified to evoke the diagnosis of tuberculosis faced with such a presentation, especially if the patient comes from a tuberculosis-endemic country. Diagnosis is made upon histopathological examination.

Acute Gastric Volvulus on Hiatal Hernia.

The gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, creating the conditions of an upper abdominal obstruction with gastric dilation and risk of strangulation. It is a rare entity that requires a surgical treatment, and its diagnosis is often delayed due to frequently aspecific symptoms. We will describe the observation of a 62 year old patient who presented to the emergency department for acute epigastric pain with dyspnea. The thoracoabdominal CT has demonstrated a stasis stomach on pyloric obstacle evoking a gastric torsion. An upper gastrointestinal endoscopy (EGD) and an upper gastrointestinal contrast made it possible to diagnose an acute gastric volvulus on hiatal hernia. A midline laparotomy was performed with detorsion of the stomach and repair of the hiatal hernia. The patient recovered gradually and was discharged on the sixth postoperative day. Three months after the operation, the patient remained asymptomatic.

[Pseudomyxoma peritonei (PMP) secondary to mucinous carcinoma of the ovary: a case study]. / Pseudomyxome péritonéal secondaire à une tumeur mucineuse de l'ovaire: à propos d'un cas.

Pseudomyxoma peritonei (PMP), also referred to as gelatinous ascites, is a rare disorder, described for the first time by R. Wyerth in 1884. It is characterized by diffuse peritoneal involvement, composed of mucinous ascites and multifocal mucinous epithelial implants. This disease mainly affects women. Its incidence is estimated at 2 cases per one million inhabitants. Pseudomyxoma peritonei can be asymptomatic, discovered during a laparotomy. The most common symptom is abdominal distension associated with diffuse abdominal pain. Abdominal CT scan is the most specific diagnostic tool. It shows pathognomonic signs of gelatinous ascites. Mucinous neoplasms of the appendix are the most frequent cause of pseudomyxoma peritonei accounting for 90% of cases. Pseudomyxoma peritonei of ovarian origin is very rare. There are essentially two types of treatment: multiple debulking surgery and cytoreductive surgery with perioperative intraperitoneal chemotherapy consisting of hyperthermic intraperitoneal chemotherapy with or without immediate postoperative intraperitoneal chemotherapy. We report a case of pseudomyxoma peritonei secondary to mucinous carcinoma of the left ovary.

[Epidemiological and pathological profile of colorectal cancer: about 36 cases]. / Profil épidémiologique et anatomopathologique du cancer colorectal: à propos de 36 caswe.

Colorectal cancer is classified among the most common cancers in the world (after breast cancer and prostate cancer) and it is the second digestive tract cancer in Morocco after stomach cancer. However, its incidence in our country is lower than that of western countries (2.5 to 3.3 / 100 000 ha) but it coincides with that of Maghreb countries where this cancer affects young subjects in 27% of cases. Colorectal cancer (CRC) is one of the best examples of multistep carcinogenesis. Knowing the anatomopathological characteristics of CRC will certainly affect our therapeutic approaches. We conducted a retrospective epidemiological and anatomopathological study in the Department of Visceral Surgery at the Military Hospital Moulay Ismail, Meknes over a period of 5 years from January 2012 to December 2016. The study involved 36 patients: 14 women and 22 men. The aim of this study was to analyze the epidemiological profile and the anatomopathological features of colorectal cancers. The analysis of our results shows a specific epidemiological profile which is characteristic of a type of colorectal cancer affecting younger subjects, mainly male patients. Sporadic carcers are largely predominant, occurring mainly in the rectosigmoid region. A low degree of differentiation of adenocarcinomas with mucinous features is correlated with advanced TNM and Aster Coller staging and with lymph node status with poor prognosis. This multidisciplinary approach will be a novelty at national level, thus making our structure of clinical practice and research one of the centres for multidisciplinary management of colorectal cancer in Morocco.

[Colonic lymphoma revealed by ileocecal intussusception in adults: about a case]. / Lymphome colique révélé par invagination iléo-caecale chez l'adulte: à propos d'un cas.

Intussusception is a very common condition in pediatrics, while in adults it is rare and accounts for only 10% of intussusceptions and 4% of intestinal occlusions. Colonic lymphoma revealed by intussusception is a very rare disease. We report the case of a 21-year old woman admitted with intestinal subocclusion to the Emergency Department at the Military Hospital Moulay Ismail, Meknes Morocco. Abdominal CT scan showed "sausage-shaped" mass as well as its organic cause in the colon. Surgical resection was the treatment of choice, followed by anatomo-pathological examination of the surgical specimen which showed diffuse large B-cell lymphoma. After surgery, chemotherapy was indicated in order to improve the prognosis and to avoid a possible relapse.