Epidemiology of nosocomial infections: About 70 cases.

Background - The infections associated with care (IAS) constitute a major public health problem by the morbi- mortality than they generate as well as by their cost to support. The prevention of these infections has become a priority for several years everywhere in the world and in the occurrence in Tunisia. Aim - The purpose of our study is to assess the prevalence of nosocomial infections as well as develop their microbiologic  profiles in the different departments of  the hospital of FSI  Marsa Tunisia and try to highlight the risk factors that can influence these infections Methods - It was a retrospective study about  patients with noscomila infection who were admitted in the different care unit of the Hospital of FSI  Marsa and this on a period of 6 years from 1 January 2009 to 31 December 2014 Results - We have identified seventy(70) patients having contracted a nososcomial infection during the period of study for 24600 hospital admission, with a prevalence rate of 0.28%. The unit of intensive care   had the highest prevalence rate (30%), followed by the general surgery unit (17.1%) and orthopaedics (15.7%). Four bacterial species accounted for almost ¾ of germs isolated: Pseudomonas aeruginosa (22.86%), Staphylococcus  ( 15.71%), Klebsiella pneumoniae (15,71 %) and Escherichia coli in 8.75% of the helth care associated infections. Conclusion - Nosocomial infections represent an important indicator of the quality of care. Serious efforts but simple, especially as regards the respect of the rules of aseptic and hand hygiene are effective to significantly reduce the occurrence of infections in hospital.

Altemeier operation for gangrenous rectal prolapse.

A stranguled rectal prolapse is a rare cause of intestinal occlusion. It requires emergency surgery. A patient who underwent emergency perineal proctectomy, the Altemeier operation, combined with diverting loop sigmoid colostomy is described. The postoperative course was uneventful, with an excellent final result after colostomy closure. The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual scenario of bowel incarceration.

[Colo-urachal-cutaneous fistula in an adult]. / Fistule colo-cutanée d'origine allantoïde chez un adulte

BACKGROUND: An infected urachal cyst is an uncommon finding in adults. AIM: To report a case of a sigmoid- urachal- cutaneous fistula. CASE REPORT: A 51 years old adult male presented with fecaloid leaking from rupture of an infected urachal cyst. Definitive management consisted of resection of the urachus with a bladder cuff, along with removal of the affected bowel segments. CONCLUSION: Colo-urachal-cutaneous fistula is a rare condition; its management is rather complex.

[Unusual evolution of a complex bile duct injury after a laparoscopic cholecystectomy]. / Evolution insolite d'une plaie complexe de la voie biliaire principale post cholécystectomie cœlioscopique.

Since the advent of laparoscopic surgery of cholelithiasis the incidence rate of bile duct injuries has increased significantly in the literature in relation to the operators' learning curve. Unknown injuries can have dramatic, immediate consequences and progress to bile peritonitis. Moreover surgical repair of external biliary fistula at the stage of bile duct dilatation requires biliodigestive anastomosis or liver resections "réglées".

Hydatid Cyst of the Spleen: Tunisian Series of 21 Cases.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus. Splenic involvement is rare even in endemic areas. The aim of this study is to specify epidemiologic features, diagnostic tools, and therapeutic modalities of this uncommon entity. This is a retrospective study of 21 patients operated on for a splenic hydatid cyst between January 1996 and December 2011. The mean age was 43.8 years (range 15-72 years). Sixteen patients (76.2 %) had symptoms related to a splenic location of hydatid disease. While splenic hydatid disease was solitary in 8 patients (38.1 %), other locations were present in 13 patients (61.9 %), mainly in the liver. Most splenic cysts were type I (39.3 %) or III (42.8 %). Nine patients (42.8 %) underwent resection of the protruding dome with one postoperative complication (suppuration of residual cavity). Total and partial splenectomies were performed in nine and three patients, respectively, without any complication. No death was noted. After a mean follow-up period of 36 months (range 2-108 months), no recurrence was observed. Splenic hydatid cyst is a rare location. The diagnostic is usually easy, based on serology and imaging. The surgery is the mainstay of treatment. The type of surgical procedure depends on size, number, and location of the cyst. Total splenectomy is more effective but may have high morbidity and mortality and must be reserved to specific situations. Conservative procedure is safer but could increase the rate of recurrence and postoperative collection. Puncture aspiration injection reaspiration could be proposed for small cyst in inoperable patients.

Mature cystic teratoma of the pancreas.

The pancreatic teratoma is a congenital tumor which results from abnormal embryonic development of totipotent cells. The preoperative diagnosis is challenging. We report, to our knowledge, the 26th case in a 64-year-old man in whom the diagnosis was made preoperatively on imaging.