[Spontaneous cutaneous fistula of hydatid liver cysts]. / La fistulisation cutanée spontanée des kystes hydatiques du foie.

BACKGROUND: Spontaneous cutaneous fistula of hydatid liver cysts is a rare complication. Its genesis involves anatomic factors as well as other local factors. AIMS: An exhaustive literature review was conducted to identify the characteristics of this complication, treatment modalities and the results obtained. PATIENTS AND METHODS: An exhaustive bibliographic search was made for all articles published in French and English relating to parietal complications of hydatid liver cyst, from which we retained only those involving cases of cutaneous cyst fistulas (communicating rupture), to which we added our own case. RESULTS: Seventeen cases of cystocutaneous fistula have been reported. The reason for consultation was productive cutaneous fistula. Morphological investigations were highly evocative of the diagnosis. Thirteen patients were treated by surgery, two underwent percutaneous debridement, and two declined treatment. DISCUSSION: Cutaneous fistula constitutes a rare mode of discovery of hydatid cyst. Fistulography and CT scan are extremely useful for diagnosis. Percutaneous debridement of the hydatid cyst represents a debatable alternative to surgical therapy.

Can ventral TAPP achieve favorable outcomes in minimally invasive ventral hernia repair? A systematic review and meta-analysis.

PURPOSE: The concept of the transabdominal preperitoneal (TAPP) was transferred from the inguinal hernia repair to be adopted in minimally invasive ventral hernia repair (VHR) and since then it has been gaining popularity. However, there are minimal data supporting the ventral TAPP (vTAPP) technique which may lead to reticence in the adoption of this approach. The aim of this meta-analysis was to evaluate the outcomes of patients who received minimally invasive vTAPP for VHR. STUDY DESIGN: A systematic search was performed of PubMed, Science Direct, Google Scholar and Cochrane Library until July 2022. We selected studies that compared the vTAPP technique with any of other minimally invasive techniques. A meta-analysis was done for the outcomes of perioperative characteristics and postoperative parameters. RESULTS: A total of 9 studies (1429 patients) were identified. vTAPP was associated with considerable benefit when compared to IPOM. vTAPP was less painful (MD = - 1.01; 95% CI [- 1.39, - 0.64], p < 0.00001), of reduced average cost (MD = - 457.10; 95% CI [- 457.27, - 456.92], p < 0.00001) and decreased SSI (OR = 0.29; 95% [0.09, 0.96], p = 0.04). On the other hand, the vTAPP approach consumed less operative time (MD: - 31.01, 95% CI [- 33.50, - 28.51]), p < 0.00001) and shorter hospital stay than the e-TEP approach. CONCLUSION: vTAPP appears to be safe and effective procedure for VHR, superior or similar to other minimally invasive techniques for perioperative characteristics and short-term outcomes.

Suppressive subtractive hybridization method analysis and its application to salt stress in grapevine (Vitis vinifera L.).

Two subtracted cDNA libraries of grapevines (Vitis vinifera. L) under short term salt stress incubation were constructed using the suppression subtractive hybridization (SSH) method combined with the differential screening approach. The mRNA isolated from leaves of the salt-tolerant grapevine cultivar Razegui grown without stress was used as a "driver," and the corresponding mRNAs isolated after a short-term treatment 6 or 24h of salt stress were used as "testers." The differentially expressed cDNA fragments were identified by differential screening of these 2 libraries. During SSH procedure, each step was operated exactly according to the manual of the kit and the results were verified correct before following step. The libraries consisted of about 7000 recombinant clones, with the average size being of 500 bp, ranging from 100 bp to 900 bp. Using a PCR-select differential screening kit, 1000 recombinant clones were randomly chosen from the subtracted cDNA libraries and hybridized with forward, reverse subtracted and unsubtracted probes for two rounds. As a result, 848 positive clones were obtained. Sequencing of randomly selected clones from the differential screening revealed that most of transcripts over-expressed by salt stress have been reported as responsive to abiotic stress response.

Myxoid esophageal liposarcoma: A case report of a rare tumor.

INTRODUCTION: Esophageal liposarcoma represent a rare cause of esophageal tumor. According to the literature, since the first case reported in 1983, only 42 cases of esophageal liposarcoma were reported. PRESENTATION OF CASE: We present a case of liposarcoma in the lower oesophagus treated by surgical resection. DISCUSSION: Liposarcoma in the oesophagus gastrointestinal tract is an uncommon. An analysis of the literature reports 42 cases.In many cases the diagnosis was established in postoperative period.Surgery is the standard treatment including polypectomy, total or subtotal oesophagectomy. CONCLUSION: There is no conventional treatment of this pathology. The curative treatment requires surgical resection or endoscopic approach for selected tumor.

Original treatment for ischaemic stenosis of colon interposition: Report of two cases.

INTRODUCTION: The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined. CASE REPORT: We report two cases of patients operated for ischaemic stenosis of the cervical extremity of the colon interposition for caustic stenosis of the oesophagus. Treatment consisted of resection of the stenosis with creation of a new cervical anastomosis after complete release of the colon graft via a neck and upper midline incision in one patient and a new ileocolic graft exclusively replacing the stenotic segment of the oesophagoplasty in the second patient. DISCUSSION: These two cases illustrate the complex treatment modalities required for this complication. CONCLUSION: The treatment of choice of ischaemic stenosis of colon interposition is resection with creation of a new anastomosis, but repeat graft may sometimes be the only available treatment option.

[Trans-hepatico cystic coledochostomy for the opening hydatid cyst in the biliary tract: Indications and outcome evaluation of 25 cases]. / La cholédochostomie transhépaticokystique dans le traitement des kystes hydatiques ouverts dans les voies biliaires : revue des indications et analyse des résultats d'une série de 25 cas.

The treatment of hydatid cysts of the liver opened in the bile ducts is sometimes difficult and complex. The trans-hepaticocystic coledochostomy (CTHK) is one of these processes. We conducted a review of the indications for this surgical procedure and its perioperative outcomes through a series of 25 patients and then we analyzed predictor factors of complications. During the period's study, 909 patients with liver hydatid cyst went under the surgery. Ninety two (92, i.e. 10.1%) of them had an opening in the bile ducts through a large fistula. Twenty five (25, i.e. 27%) had a trans-hepaticocystic coledochostomy. The sex ratio was 0.6. The population was young with an average age of 47 years. The trans-hepaticocystic coledochostomy was performed because of a thick pericyst associated with a nonsutured fistula in 18 cases, a voluminous residual cavity with a soft pericyst but the fistula was unexposed in six cases and in a case where the pericyst was thick, fistula was exposed. Its suture was associated with a high risk of bile duct stenosis. Specific morbidity was 20% due to a length of the intraductal coledochostomy under 2 cm (P = 0.016), the absence of an epiploplasty (P = 0.004) and the existence of a leak of contrast material outside the fistula on the cholangiography (P = 0.005). The trans-hepaticocystic coledochostomy is a safe and reliable technique, often indicated when other conservative methods are failing. The application of its technical requirements and avoidance of mounting errors allow reducing its morbidity.

[Paroxysmal nocturnal hemoglobinuria and intestinal ischemia: a very wide choice]. / L'ischémie intestinale au cours de l'hémoglobinurie paroxystique nocturne: l'embarras du choix.

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare hematologic disorder that can exceptionally be complicated by splanchnic thrombosis and intestinal necrosis. The discovery of multiple and dispersed distal ischemia of the small bowel is a real problem because the therapeutic approach depends on the range and the number of the segments to resect and also on the risk of recurrence of new peri-operative ischemic lesions. We report the case of a patient suffering from PNH, operated with the diagnosis of mesenteric infarction. We discovered multiple distal ischemic lesions of the gut extending from the first duodenum to the penultimate loop without perforation. Resection was then ruled out and curative anticoagulation was initiated. Outcome was favorable with restitution ad integrum of the digestive lesions without progression to secondary stenosis. Discovery of distal ischemic lesions without perforation in patients with PNH does not necessarily require resection. Curative anticoagulation can avoid surgery that may be insufficient.

Severe anaphylactic choc revealing vascular rupture of a liver hydatid cyst observed in an emergency unit in Tunis (Tunisia).

Anaphylactic shock is an exceptional mode of revelation of a liver hydatid cyst and it is in almost all cases secondary to an intraperitoneal rupture. The spread of hydatid cyst content into the bloodstream is even more exceptional. We report the case of a 36 years-an old woman who presented a severe anaphylactic shock preceded by abdominal pain. Abdominal CT showed a liver hydatid cyst with a vascular communication. Operative findings confirmed the imaging data. The spread of hydatid cyst content into the bloodstream poses a double challenge as regards the management of the anaphylactic shock, and for the perioperative precautions.

[Spontaneous rupture of a superior mesenteric artery: report of two cases]. / Rupture spontanée d'un anévrisme de l'artère mésentérique supérieure : à propos de deux cas.

Superior mesenteric artery aneurysms are rare. Diagnosis and treatment are a real challenge. We report two cases of this type of vascular anomaly revealed by spontaneous rupture. The diagnosis was made by abdominal computed tomography angiography and treatment consisted in aneurysmorraphy in one case and bowel resection with the distal aneurysm in the second.

T-tube drainage of the common bile duct choleperitoneum: etiology and management.

External drainage of the common bile duct by placement of a T-tube is a common practice after choledochotomy. This practice may result in the specific complication of bile peritonitis due to leakage after removal of the T-tube. This complication has multiple causes: some are patient-related (corticotherapy, chemotherapy, ascites), and others are due to technical factors (inappropriate suturing of the drain to the ductal wall, minimal inflammatory reaction related to some drain materials). The clinical presentation is quite variable depending on the amount and rapidity of intra-peritoneal spread of of bile leakage. Abdominal ultrasound (US), with US-guided needle aspiration and occasionally Technetium(99) scintigraphy are useful for diagnosis. Traditional therapy consists of surgical intervention including peritoneal lavage and re-intubation of the choledochal fistulous tract to allow for a further period of external drainage. When leakage is walled off and well-tolerated, a more nuanced and less invasive conservative therapy may combine percutaneous drainage with endoscopic placement of a trans-ampullary biliary drainage.

Gas gangrene of the abdominal wall due to late-onset enteric fistula after polyester mesh repair of an incisional hernia.

The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional hernia repair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material.

Surgical treatment of late dysfunction of an esophagocoloplasty.

Replacement of the esophagus by colon interposition often has late complications, frequently due to technical defects. We report the case of a patient who presented 12 years after surgery with complex dysfunctions of a colonic interposition, including cervical and retrosternal strictures associated with a redundant portion of the colon graft. The interest of this case lies in its combination of many late complications of this surgery in a single person together with the simplicity of the treatment.