The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study.

BACKGROUND: Migration is the most common complication of the fully covered metallic self-expanding esophageal stent (SEMS). This study aimed to determine the potential preventive effect of proximal fixation on the mucosa by clips for patients treated with fully covered SEMS. METHODS: In this study, 44 patients (25 males, 57%) were treated with fully covered SEMS including 22 patients with esophageal stricture (4 malignant obstructions, 6 anastomotic strictures, and 12 peptic strictures) and 22 patients with fistulas or perforations (10 anastomotic leaks, 4 perforations, and 8 postbariatric surgery fistulas). The Hanarostent (n = 25), Bonastent (n = 5), Niti-S (n = 12), and HV-stent (n = 2) with diameters of 18 to 22 mm and lengths of 80 to 170 mm were used. Two to four clips (mean, 2.35 ± 0.75 clips) were used consecutively in 23 patients to fix the upper flared end of the stent with the esophageal mucosal layer. Stent migration and its consequences were collected in the follow-up assessment with statistical analysis to compare the patients with and without clip placement. RESULTS: No complication with clip placement was observed, and the retrieval of the stent was not unsettled by the persistence of at least one clip (12 cases). Stent migration was noted in 15 patients (34%) but in only in 3 of the 23 patients with clips (13%). The number of patients treated to prevent one stent migration was 2.23. The predictive positive value of nonmigration after placement of the clip was 87%. In the multivariate analysis, the fixation with clips was the unique independent factor for the prevention of stent migration (odds ratio, 2.3; 95% confidence interval, 0.10-0.01; p = 0.03). CONCLUSIONS: Anchoring of the upper flare of the fully covered SEMS with the endoscopic clip is feasible and significantly reduces stent migration.

Gas gangrene of the breast: management of a potential life-threatening infection.

INTRODUCTION: Gas gangrene of the breast is a rare infection and potentially mortal. CASE REPORT: We report a case of a fast extension of a painful right breast erythema whose starting point was a right parasternal cutaneous abscess. A diagnosis of gas gangrene of the right breast was made. A right mammectomy was carried out in Emergency and an antibiotherapy adapted to the germs was given. CONCLUSION: Mixed anaerobic and aerobic florae are often responsible for the infection. Its medico-surgical management is an emergency.

[Spontaneous rupture of the spleen in chronic calcifying pancreatitis: report of three cases]. / Rupture spontanée de rate sur pancréatite chronique calcifiante.

Spontaneous rupture of the spleen is a rare complication of chronic calcifying pancreatitis. Anemia and hemorrhagic shock may not occur, making diagnosis more difficult. Favourable response to conservative treatment does not prevent the need for splenectomy, as calcifiying chronic pancreatitis may progress locally. We report three cases of spontaneous rupture of the spleen. In two cases, splenic rupture revealed calcifying chronic pancreatitis and both patients underwent urgent splenectomy. In the third case, the patient was known to have calcifying chronic pancreatitis, and splenectomy was performed because of unsuccessful conservative treatment. We discuss the role of distal pancreatectomy during splenectomy to reduce the rate of postoperative complications and additional surgery. We also discuss the role of arterial embolisation and laparoscopy in the management of this rare condition.

[Hemobilia due to pseudoaneurysm of the right hepatic artery following laparoscopic cholecystectomy]. / Hémobilie par pseudoanévrysme de la branche droite de l'artère hépatique après cholécystectomie coelioscopique.

Although laparoscopic cholecystectomy is considered to be the gold standard for treatment for symptomatic cholelithiasis, it is associated with an increased risk of biliary and vascular injury compared to the traditional technique. We report the case of a 36-year-old woman with haemobilia secondary to a pseudoaneurysm of the right branch of the hepatic artery, that occurred two months after laparoscopic cholecystectomy. The patient was successfully treated with embolisation of the right hepatic artery. Hemobilia is a rare complication that should considered when managing patients with bleeding or jaundice even several months after laparoscopic cholecystectomy.

Laparoscopic repair of intrathoracic mesenterioaxial volvulus of the stomach in an adult: report of a case.

Intrathoracic gastric volvulus is an uncommon entity, in which the stomach undergoes organoaxial torsion occurring in the chest due to the concomitant presence of an enlargement of the hiatus. We herein report an unusual case of acute intrathoracic mesenterioaxial volvulus of the stomach. Gastric rotation occurred at the transverse axis and the mobile pylorus herniated in the chest through a large hiatal defect. Following a reduction of the volvulus through the use of a nasogastric tube, the patient underwent an elective laparoscopic repair. The mechanisms of volvulus with the relative diagnostic and therapeutic implications are discussed.