Surgical management of sclerosing encapsulating peritonitis (SEP) secondary to tuberculosis: A case report and review of the literature.

INTRODUCTION: Sclerosing encapsulating peritonitis (SEP), commonly known as abdominal cocoon syndrome (ACS), is considered one of the rare causes of bowel obstruction [1]. CASE PRESENTATION: In this article, we report the case of a 20-year-old male patient with a 6-month history of recurrent colicky right-sided upper abdominal pain accompanied by nausea, vomiting and bloating, which gradually increased in severity and frequency. The contrast-enhanced abdominal computed tomography suggested a small bowel obstruction with a differential diagnosis of SEP. Later exploratory laparotomy and histopathological examination confirmed the diagnosis of ACS. Intraoperative adhesiolysis was performed and the patient's symptoms resolved. DISCUSSION: This syndrome is characterised by the formation of a fibrous-collagenous membrane that partially or completely engulfs the small intestine, less commonly the colon and other abdominal organs. SEP is most commonly associated with long-term peritoneal dialysis, although drugs, peritoneal infection and systemic inflammatory disorders have been implicated. Patients often present with symptoms of partial bowel obstruction, which is difficult to diagnose before laparotomy. Of the available investigations, contrast-enhanced CT of the abdomen is the most sensitive, showing a fibrous sac-like membrane covering the intestinal loops and the fluid collection. Definitive treatment includes excision and adhesiolysis. CONCLUSION: This article presents a rare case and focuses on the management of this pathology with a review of the literature.

Recto-vaginal fistulas: A case series.

INTRODUCTION: Rectovaginal fistula (RVF) is defined as an abnormal communication between the anterior wall of the rectum and the posterior wall of the vagina. Many surgical techniques have been described in the treatment of RVF. However, none has proved its superiority. The aim of the study was to evaluate the functional results of surgical treatment of RVF using Martius and Falandry techniques in order to assess the feasibility and the efficacy of these techniques which were first described for vesico-vaginal fistulas. METHODS: The study was a retrospective case series conducted in a single centre: Department of general surgery at Ibn Sina University Hospital in Rabat. We included patients with rectovaginal fistula consecutively recruited from 2011 to 2014. 10 patients developed RVF after surgery for rectal cancer (9 cases), uterine cancer (1 case). One patient had RVF for ano-rectal malformation. Colostomy was performed before the treatment of fistula in 9 cases (82 %). They underwent surgical treatment using Falandry (8 patients) and Martius techniques (3 patients) performed by an experienced urologist surgeon. RESULTS: No postoperative complications were recorded. Time to discharge was postoperative day 3-4. There was a complete disappearance of RVF in 8 patients (72.7 % of cases), relapse in 2 cases (18 %), and failure in one case (9%). The average follow-up was 12.6 +/-10 months. Functionally, no long-term cases of fecal incontinence or dyspareunia were noted. CONCLUSION: The choice of surgical technique in the treatment of RVF remains difficult because of poor literature data and absence of consensus. RVF repair results either by Martius or Falandry techniques are encouraging with low morbidity.

Incidents and complications of permanent venous central access systems: a series of 1,460 cases.

BACKGROUND: Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. METHODS: Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. RESULTS: About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. CONCLUSION: PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.