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INTRODUCTION: Intussusception is highly uncommon in adults and accounts for only 5% of all reported cases. It is more commonly secondary to an identifiable bowel lesion in 90% of cases, whereas 10% have no discernable cause. Diagnosis is difficult due to non-specific symptoms of the disease. Diagnostic imaging plays an important role in the diagnosis of the condition. Sonography and computed tomography are the most commonly used imaging techniques. In adults, intussusception usually requires treatment by surgical resection of the affected bowel. CASE PRESENTATION: A 35-year-old Moroccan woman presented with a five-month history of intermittent abdominal pain and one episode of bleeding from the rectum. At physical examination an abdominal mass was noted. Abdominal sonography revealed a 6.3 × 8.5 cm midline mass in her upper abdomen that was tender. In transverse section, the mass had the multiple concentric rings of hypoechoic and echogenic layers associated with the sonographic appearance of intussusception. In longitudinal section, the mass had the sonographic aspect of multiple parallel lines, giving the so-called "sandwich appearance".A corresponding contrast-enhanced abdominal computed tomography scan also demonstrated the intussusception. Surgery confirmed a colocolic intussusception with a large, firm, indurated mass as the lead point. A right hemicolectomy was undertaken because of concern about possible malignancy. The resected ascending colon was then opened up, to find a protruding tumor of the ascending colon that was acting as the lead point. It measured 7.6 × 6.9 × 2.4 cm. Pathology diagnosed an infiltrating, differentiated adenocarcinoma of the ascending colon invading through the muscularis propria. No lymphovascular invasion was seen. Our patient has recovered well. CONCLUSION: Intussusception is relatively rare in the adult population, and this, along with the vague clinical features, makes diagnosis difficult. Ultrasonography and computed tomography have been proven to be effective diagnostic modalities. Ultrasonography can be performed quickly and accurately, and is widely available. In adults, intussusception is usually associated with an underlying cause and requires treatment by surgical resection.
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AIM: To assess the role of the major risk factors for hepatocellular carcinoma (HCC) development in the western part of North Africa. METHODS: A multicenter case control study was conducted in Tunisia, Morocco and Algeria in collaboration with Pasteur Institutes in these countries. A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included. Prevalences of HBsAg, anti-hepatitis C virus (HCV) and diabetes were assessed. HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients. RESULTS: The mean age of patients was 62 ± 10 years old for a 1.5 M:F sex ratio. Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg. Diabetes was detected in 18% of cases. Odd ratio (OR) and 95% confidence intervals (CI) were 32.0 (15.8 - 65.0), 7.2 (3.2 - 16.1) and 8.0 (3.1 - 20.0) for anti-HCV, HBsAg and diabetes respectively. Multivariate analysis indicated that the three studied factors were independent. 1b HCV genotype and D HBV genotype were predominant in HCC patients. HCV was the only risk factor significantly associated with an excess of cirrhosis (90% vs 68% for all other risk factors collectively, P = 0.00168). Excessive alcohol consumption was reliably established for 19 (17.6%) cases among the 108 HCC patients for whom data is available. CONCLUSION: HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa. An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.