Laparoscopic management of a left hepatic vein injury during one -step laparoscopic Roux-en-Y gastric bypass after adjustable gastric banding removal: A case report.

INTRODUCTION AND IMPORTANCE: The occurrence of a left hepatic vein injury during laparoscopic removal of an adjustable gastric band is exceptional and should be known by any surgeon approaching the hiatal region. We report here the laparoscopic control of such a wound. CASE PRESENTATION: A 39-year-old morbidly obese woman (body mass index 47.7 kg/m2) presented the failure in weight loss following a laparoscopic adjustable gastric banding. It was decided to perform a one-step laparoscopic Roux-en-Y gastric bypass. Laparoscopic exploration showed post-surgical tissular retraction and adhesions. After the lap-band™ removal the left hepatic vein was accidentally bluntly injured while freeing adhesions between left hepatic lobe and the stomach. After a direct hemorrhagic control, intraoperative diagnosis of left hepatic vein injury was confirmed. A laparoscopic repair was performed by two running sutures using absorbable monofilament 4/0. Then, a Roux-en-Y gastric bypass was performed without any other complications. Operative time was 119 min; intraoperative blood loss was estimated as 200 cm3. No blood transfusion was necessary. The total hospital stay was 48 h. The excess weight lost after 10 years was 87,9%. CLINICAL DISCUSSION: Adjustable gastric band can modify anatomic landmarks, leading to a wrong dissection path, with possibility of left hepatic vein injury. CONCLUSION: The left hepatic vein injury can occur during revisional surgery for laparoscopic adjustable gastric banding failure. Its laparoscopic management can be done safely, in trained hands without increasing morbidity.

Sister Mary Joseph's nodule revealing a jejunal adenocarcinoma: A case report.

INTRODUCTION AND IMPORTANCE: Adenocarcinoma of the jejunum is a diagnostic challenge for the physician because of its extreme rareness and the fact that it classically presents with vague clinical symptoms. On the other hand, the Sister Mary Joseph's nodule is a rare clinical sign that refers to umbilical metastasis of an internal malignancy. We here report a rare case of jejunal adenocarcinoma revealed by a Sister Mary Joseph's nodule. CASE PRESENTATION: A 55-year-old man presented with an ulcerated umbilical tumor, which was found to be a secondary lesion of an advanced jejunal adenocarcinoma invading the transverse colon. He underwent surgical resection of the umbilical tumor and the intestinal primitive. CLINICAL DISCUSSION: The presence of umbilical metastasis usually represents advanced disease but can be its first manifestation. Gastro-intestinal tract tumors such as jejunal adenocarcinomas and gynecologic malignancies are the most common primary sites. CONCLUSION: Practicians must be aware of clinical implication of Sister Mary Joseph nodule. Aggressive surgery when feasible can be beneficial for survival.

Surgical management of erosive adenomatosis of the nipple: A case report.

INTRODUCTION AND IMPORTANCE: Known as a very uncommon disease, erosive adenomatosis of the nipple is a benign neoplasm of the breast. However, its destructive process can have a considerably negative impact on patient's quality of life. CASE PRESENTATION: We report the case of a 45-year-old woman who presented at the visceral surgery department of the National Teaching Hospital of Cotonou-Benin (CNHU-HKM) for a burgeoning mass of the left nipple. She was diagnosed an erosive adenomatosis of the nipple and underwent a nipple resection with reconstruction. CLINICAL DISCUSSION: Erosive adenomatosis is one differential diagnosis for lesion of the nipple. Clinically, it should be discussed with malignant nipple tumours including Paget's disease. CONCLUSION: Surgery is the cornerstone of the treatment, and the prognosis is excellent.

Internal hernia strangulated on appendicular tourniquet: a case report of an exceptional anomaly of the appendix revealed by a rare hernia.

BACKGROUND: Internal hernias and the appendicular tourniquet are two rare pathologies. CASE PRESENTATION: We report here a case of a 68-year-old obese patient, who has acute small bowel obstruction due to strangulated internal hernia through an appendicular tourniquet. This appendicular tourniquet results from the adhesion between the tip of the appendix and its body. This obstruction was complicated by plugged perforation. Resection of the small bowel segment was performed, in addition to appendectomy, lavage, and drainage. The postoperative recovery was uneventful. CONCLUSION: Acute bowel obstruction secondary to strangulation of an internal hernia through an appendicular tourniquet is exceptional.

Résultats des cures herniaires inguinales par prothèse à l'hôpital de zone de Ouidah

Les cures herniaires inguinales occupent la 2e place des activités chirurgicales à l'hôpital de zone de Ouidah. La plupart des cures à froid se font par prothèse depuis 2016. L'objectif de ce travail est d'analyser les résultats préliminaires dans cet hôpital. Il s'agit d'une étude transversale rétrospective à visée analytique avec revue des patients qui a pris en compte les malades opérés d'une hernie inguinale par prothèse à l'hôpital de zone de Ouidah de juillet 2016 à août 2017. Trente-six patients ont été recrutés au cours de notre étude. La moyenne d'âge de nos patients était de 55,33 ans, avec des extrêmes de 35 à 75 ans. Notre échantillon d'étude était exclusivement de sexe masculin. Chez 69,44% des patients la hernie est survenue par efforts physiques. Elle est survenue spontanément chez 22,22 %. Le reste des hernies étaient survenu dans un contexte de dysurie chez 2,78 % des patients et de constipation chronique chez 5,56%. Le siège prédominant de la hernie de l'aine dans notre série est inguinal droit chez 58,33 % alors qu'à gauche il n'est que de 33,33 %. Nous avons réalisé nos interventions chirurgicales sous anesthésie locorégionale type rachianesthésie chez tous nos patients. La moyenne de la durée des interventions était de 68,88 minutes. Selon la classification de Nyhus, 58,33 % de nos patients étaient classés Nyhus IIIa. La durée moyenne d'hospitalisation était de 56 heures. Les suites opératoires étaient simples chez 88,89 % des patients. Nous avons noté une mauvaise représentation psychologique de la prothèse chez 2,78%

[Severe acute pancreatitis during pregnancy among black African women: about a case]. / Pancréatite aiguë sévère sur grossesse chez le noir Africain: à propos d'un cas.

Acute pancreatitis is rare during pregnancy. It is associated with high maternofoetal mortality. It is mainly caused by biliary lithiasis but, in many cases, the cause of acute pancreatitis is undetermined. We here report the case of a 37-year old patient presenting with acute pancreatitis revealed by acute febrile bowel obstruction at 29 weeks of amenorrhea. The diagnosis was made during surgery. The patient had a miscarriage in the postoperative period. She died on the 8th postoperative day.