[Chilaïditi's syndrome responsible for an occlusion with necrosis of the small intestine after a caesarean section: first case report]. / Syndrome de Chilaïditi responsable d'une occlusion avec nécrose du grêle après une césarienne: cas princeps.

Chilaïditi's syndrome is the association of a radiological and clinical semiology of the interposition of large colon or small intestine between the lower side of diaphragm and liver. We report the case of a 32-year-old woman, primigravida, who undergone a caesarean section at 39 weeks of amenorrhoea, for a clinical picture of persistent abdominal pain and a beginning hepatic cytolysis. The patient presented one day after the ceasarean section an occlusive syndrome of the small intestine. The etiology of the occlusion of the small intestine in post-partum was a Chilaïditi's syndrome with inter hepatodiaphragmatic incarceration of the small intestine discovered at the computed tomography. An exploratory laparotomy confirmed and permitted to treat Chilaïditi's syndrome complicated by an occlusion.

[Practicability of the vaginal prolapse surgery in the elderly woman]. / Faisabilité de la chirurgie vaginale du prolapsus chez la patiente très âgée.

OBJECTIVE: To evaluate the vaginal prolapse cure in the elderly woman. PATIENTS AND METHODS: A retrospective study is carried out on 38 patients of more than 80 years, operated for a vaginal genital prolapse cure between November 1997 and October 2004. The patients' general state of health, the type of analgesia, the operative type and time, the per- and postoperative complications and the evolution of the patients one month after the intervention, had been assessed. RESULTS: The average age of the patients was 84.2 (80-95). The patients' general state of health, according to the ASA classification was about 55.3% ASA II, and about 44.7% ASA III. The anaesthesia was general in 92.1% and spinal in 7.9%. The operating type was vaginal hysterectomy associated to a Marion-Kelly and a posterior perineorrhaphy in 68.4%; and a simple vaginal hysterectomy, associated more or less to the installation of a TVT in 13.1%; an intervention of Lefort, a case of Richter and a case of simple colpectomy in 10.5%. The average operative time is about 43 minutes. The peroperative complications can be summed up in a conversion in laparotomy due to haemorrhage, and a case of ligation of the right urethra. The transfer in an intensive care unit during 24 hours is necessary only for one case in 38. The postoperative complications are in one case death at eleventh day as a result of a pulmonary embolism, and a case of temporospatial disorientation and a prolapse relapse at 6 months. The duration of stay in hospital is about 7 days (2-18). The surgery did not affect the autonomy of the patients at one month. DISCUSSION AND CONCLUSION: Vaginal prolapse concerning the elderly woman is workable in quite common practice; it involves a good cooperation between anaesthetist and surgeon. The vital risk is really present but relative. This functional surgery must not be delayed by the installation of a pessary which must be used only for the inoperable patients.