[Evaluation of small bowel involvement in Crohn's disease by small- bowel videocapsule endoscopy: a prospective comparative study with computed-tomography enteroclysis and small bowel radiography]. / Évaluation de l'atteinte du grêle de la maladie de Crohn par vidéocapsule endoscopique : étude prospective et comparative avec le transit du grêle et l'entéroscanner.

BACKGROUND: Small-bowel videocapsule endoscopy (VCE) is a new technique in evaluation of intestinal involvement in several pathologies. Crohn's disease affects principally terminal ileum. Small bowel involvement in Crohn's disease is not well estimated by endoscopic and radiologic conventional techniques. AIMS: To evaluate the performances of VCE in detection of asymptomatic proximal small bowel lesions in consecutive patients with Crohn's disease with terminal ileal involvement, to compare the results of VCE to small bowel radiography and CT-enteroclysis and to determine the therapeutic impact of VCE in these patients. METHODS: A prospective study which included Crohn's disease patients with distal ileal involvement, based on radiological or endoscopic findings. We performed in all patients small bowel radiography, CT enteroclysis and VCE. Proximal involvement was characterized by presence of aphtoid, superficial or deep ulcerations in the jejunum or the proximal ileum. RESULTS: We studied 20 patients (12 men, mean age 31.6 years). VCE confirmed the distal ileal involvement in all patients. Significative proximal lesions was observed in nine patients (jejunum only: one case, jejunum and ileum: six cases and proximal ileum: two cases), in most cases aphtoid or superficial lesions. Deep ulcerations were observed in two patients. Small bowel radiography showed proximal ileal lesions in only two patients, and CT-enteroclysis in only one patient. Treatment by azathioprine was prescribed in two patients with severe and extended small bowel lesions in VCE examination. CONCLUSION: VCE is more accurate than radiologic techniques in detection of small bowel lesions in Crohn's disease. In cases of severe and extended small bowel involvement, VCE can conduct to changes of therapeutic approach.

[Difficulty in diagnosing pseudotumoral autoimmune pancreatitis: two cases]. / Difficultés diagnostiques de la pancréatite auto-immune pseudotumorale: à propos de deux cas.

BACKGROUND: In recent years, autoimmune pancreatitis (AIP) has been increasingly recognized. The diagnosis of AIP is based on a series of clinical, biological and radiological criteria. In imaging, it may appear as two different forms: a diffuse form by destroying channels and pseudotumoral lesions that can cause inadequate resections. AIM: To report two new cases of pseudotumoral autoimmune pancreatitis CASES REPORT: We report two cases of pseudotumoral autoimmune pancreatitis, with different clinical, biological and radiologic features. The diagnosis was established easily in one case and after surgery in a 2nd case. CONCLUSION: Our two cases underline the difficulties still encountered in the diagnosis of AIP.

Assessment of activity of Crohn's disease by Doppler sonography of superior mesenteric artery flow.

BACKGROUND: Evaluation of activity of Crohn's disease is based on CDAI. Several other tools have been studied to assess disease activity with more accuracy. AIMS: To assess the correlation between Doppler parameters of superior mesenteric artery and disease activity and to assess the accuracy of these parameters in discriminating between active and quiescent Crohn's disease. MATERIAL AND METHODS: We perform a prospective study including non-operated and non-complicated Crohn's disease patients involving terminal ileum and/or right colon and sex and age-matched controls. Doppler sonography of superior mesenteric artery was performed in all subjects. RESULTS: We studied 41 patients and 15 controls. There was no statistical difference between patients and controls according to the studied US parameters. The difference in resistance index between the three groups using analysis of variance is not significant (p=0.064). Resistance index was significantly lower in patients with active disease compared to inactive disease patients (0.82 +/- 0.04 vs 0.85 +/- 0.03; p=0.01). Pulsatility index was also lower in patients with active disease compared to inactive disease patients (1.37 +/- 0.21 vs 1.53 +/- 0.15; p=0.01). A value of resistance index less than 0.79 predicted active disease with a sensitivity of 35.3% and specificity of 95.7%. A value of pulsatility index less than 1.56 predicted active disease with a sensitivity of 94.1% and specificity of 43.5%. In case of resistance index less than 0.79 and pulsatility index less than 1.56 in the same patient, the probability of active disease was 86%. However, in case of resistance index over than 0.79 and pulsatility index over than 1.56, this probability was only 9%. In Crohn's disease patients, correlation study showed that resistance index value was significantly correlated with CDAI (r=-0.46; p=0.003). Pulsatility index value was also correlated with CDAI (r=-0.39; p=0.01). CONCLUSION: Doppler sonographic parameters of superior mesenteric artery are significantly correlated with disease activity in non-operated and non-complicated Crohn's disease.

Retroperitoneal abscess: a rare localization of tubercular infection.

Incidence of tuberculosis infection has considerably increased during the past 20 years due to the HIV pandemic and continues to be one of the most prevalent and deadly infections worldwide. Extrapulmonary tuberculosis lacks specific clinical manifestation and can mimic many diseases. It can invade neighbouring tissue and form a big cyst with manifesting clinical symptoms. We describe a rare case of 31-year-old immunocompetent man affected by a retroperitoneal abscess secondary to tubercular infection. Exploratory laparotomy and histopathological examinations of tissue were required for achieving diagnosis of tuberculosis. No pulmonary or spinal involvement was identified. The patient was successfully treated with standard four-drug antitubercular therapy.

[A case of an acute pancreatitis after endoscopic band ligation of esophageal varices: a strong association or an unusual complication?]. / Pancréatite aiguë au décours d'une séance de ligature elastique de varices oesophagiennes: une association fortuite ou une complication inhabituelle?

BACKGROUND: Endoscopic band ligation is considered as the gold standard of treatment for oesophageal varices. Fewer and often mild complications can occur. AIM: To report and to discuss an association between oesophageal variceal endoscopic band ligation and actue pancreatitis. CASE REPORT: We report the original case of a patient with cirrhosis and who had presented an acute pancreatitis 3 days after oesophageal variceal endoscopic band ligation. Common aetiologies of acute pancreatitis was eliminated. The evolution was favourable without specific treatment. CONCLUSION: In the absence of similar case reports, the association between oesophageal variceal endoscopic band ligation and acute pancreatitis observed in our patient remains rather fortuitous even though experimental studies can explain these association.

Chondrosarcoma of sinonasal cavity: a case report and brief literature review.

BACKGROUND: Chondrosarcomas are slow-growing malignant tumors that usually arise from cartilaginous structures. It may occur in the head and neck region with a predilection for the maxillofacial skeleton, where it has been reported to occur particularly in the mandible and maxilla. Chondrosarcoma of the sinonasal tract is very rare. AIM: Report a new case CASE: We present the case of a 43-year-old man presenting with an incidental finding of a chondrosarcoma of the maxillary and ethmoid sinus with nasal extension. The tumor was completely resected using a transnasal endoscopic approach. Treatment has followed by a radiation therapy and the patient was considered free of disease at her 5 years follow-up. CONCLUSION: Surgery is the mainstay treatment of chondrosarcomas. In selected patients, complete resection can be achieved using transnasal endoscopic approach.

[Internal herniation through the falciform ligament revealed by acute intestinal obstruction]. / Hernie interne du ligament falciforme révélée par une occlusion intestinale aiguë

INTRODUCTION: Internal hernias are a rare cause of acute intestinal obstruction. Herniation through the falciform ligament is rare and often diagnosed only during surgery. Abdominal computed tomography (CT), performed on an emergency basis, can help to diagnose this obstruction before surgery and select a therapeutic approach. CASE: A 60-year-old man was hospitalized on an emergency basis for symptoms that had been developing for 3 days, including tympanites and epigastric pain (torsion), associated with vomiting and the cessation of both feces and flatus. Abdominal radiography showed multiple levels of air-fluid levels in the small bowel, some projecting towards the liver area, as well as the presence of a flat intestinal loop continuous with a distended small-bowel segment. Abdominal CT suggested a diagnosis of small-bowel herniation and obstruction, very probably through the falciform ligament. The patient then underwent emergency surgery after a brief resuscitation. Intraoperative exploration confirmed the diagnosis of internal hernia through the falciform ligament. The postoperative course was without problems. DISCUSSION: Abdominal CT is the examination of choice in cases of a "new" acute intestinal obstruction. It makes it possible to diagnose the mechanism of the occlusion and especially the cause, especially for an internal hernia through the falciform ligament. It thus guides the choice of emergency surgical procedure and of appropriate approach. Once diagnosed, emergency surgery is essential to free the intestinal loop, with or without intestinal resection as a function of vitality.

Budd-Chiari syndrome secondary to hepatic echinococcosis.

OBJECTIVES: Hydatid cyst of liver is a parasitosis which is an endemic state in Tunisia and is a very rare cause of Budd-Chiari syndrome. The purpose of this study was to report the clinical features, radiological investigations and therapeutic management. PATIENTS AND METHODS: A retrospective analysis of 12 patients who underwent surgery for Budd-Chiari syndrome secondary to hepatic echinococcosis between January 1990 and December 2004 was performed. RESULTS: The series included ten females and two males with a mean age of 36 years. Budd-Chiari syndrome was subacute in 75% of cases. Ultrasound showed a compression of hepatic veins by cysts with a mean diameter of 13 cm situated in at least two hepatic segments. US Doppler and CT-scan of the liver provided the diagnosis in all cases. Laparotomy was performed in all cases. Operative mortality was 8% and morbidity 66% due to biliary fistula and deep abscess formation. Hepatic vein outflow was successfully re-established in four patients. CONCLUSION: Budd-Chiari syndrome is a rare but severe complication of hydatid cyst of the liver. Early diagnosis is necessary to improve prognosis.

[Cystic lymphangioma of the adrenal gland, from radiologic diagnosis to laparoscopic treatment. A case report]. / Lymphangiome kystique de la surrénale, du diagnostic radiologique au traitement laparoscopique. A propos d'une observation.

BACKGROUND: Cystic lymphangioma of the adrenal gland is a rare tumor, which is often asymptomatic. Pre-operative diagnosis is difficult. Echography and CT scan are essential exploratory techniques. Surgical exploration is usually indicated due to uncertain diagnosis. AIM: Report of a new case CASE: We report a new case of cystic lymphangioma of the left adrenal gland, in a 30 year-old female, treated with a laparoscopic excision and confirmed by anatomopathologic features.

A misleading renal tumour.

Hydatid cyst of the kidney is uncommon and still constitutes about 3% of cases of hydatid disease. The diagnosis can be made by ultrasonbography, Ct-scan and in some difficult cases by MRI. We report a case of a renal hydatid cyst in a 47-year-old man mimicking at imaging, even at MRI, a hypovascular renal tumour.

Fibrolipoma of the median nerve.

Neural fibrolipoma or fibrolipomatous hamartoma is an uncommon benign tumor that usually arises in the median nerve. Fibrofatty tissue proliferates around the nerve and infiltrates the epineurium and perineurium. We report a case of fibrolipomatous hamartoma of the left median nerve in an 18-year-old woman. Our objective was to describe the pathognomonic magnetic resonance imaging features, whose presence obviates the need for a diagnostic biopsy.

[Rupture of hydatid cyst of the liver into the duodenum. A case report]. / Kyste hydatique du foie rompu dans le duodénum. A propos d'un cas.

BACKGROUND: Rupture of hydatid cyst in the digestive tract is a rare complication even in endemic areas. AIM: Authors report a case of a hydatid cyst of the left hepatic lobe ruptured in the duodenum CASE: was discovered at the occasion of epigastric pain and vomiting. Ct-scan revealed presence of air in a calcified hydatid cyst of the left liver lobe and a fistulous tract between the cyst and the duodenum. Endoscopy confirmed the diagnosis by the visualisation of a fistulous orifice of the anterior aspect of the first duodenum with a protrusion of hydatid membrane. Patient was treated surgically and had a partial cysto-pericystectomy and suture of duodenum.

Atypical small hemangiomas of the liver: hypervascular hemangiomas.

Hyperdynamic hemangiomas (HH) are atypical hepatic hemangiomas with an incidence of approximately 16% of all hemangiomas in the liver. We report a case of HH in a 47-year-old woman. Multiphase helical CT scan, MRI appearances and differential diagnoses are discussed.

[Gastrointestinal stromal tumours: clinical and therapeutic features. A report of 25 cases]. / Les tumeurs stromales gastrointestinales: aspects cliniques et thérapeutiques à propos de 25 cas.

AIM: To evaluate the epidemiological clinical features and herapeutic results of gastrointestinal stromal tumour (GIST). PATIENTS AND METHOD: This retrospective study concerned 25 cases of gastrointestinal stromal tumour from January 1993 to December 2002. All patients have been operated and the diagnosis of GIST has been confirmed by histological and immunohistochemical study of pieces of resection or biopsies. RESULTS: Population include II men and 13 women with a mean age of 64 years. Symptomatology was dominated by abdominal pain (54% of cases) and the digestive haemorrhage (46% of cases). A palpable mass has been found in 29% of cases. The tumour was gastric in 17 cases, small intestinal in 6 cases, colic in 1 case and rectal in 1 case. A double gastric localization and small intestinal was found in 1 case. The mean tumour size was 8 cm (1 to 30 cm). A tumour resection has been achieved in 23 cases (96%), extended to neighbourhood organs in 2 cases. The morbidity was 12.5% and there was no operative mortality. Histologically, tumour was of low grade in 10 cases, high grade in 10 cases and unclassified in 5 cases. With a median follow up of 27 months (2 to 108), we observed 4 cases of loco-regional recurrence. Overall survival at 2 years was 74% for the whole population and 35% for the high grade. Independent prognostic factors recovered were the degree of malignancy (p = 0.01) and the local recurrence (p = 0.01). CONCLUSION: The treatment of the GIST is surgical. lymphadenectomy is superfluous. The new oral chemotherapies that inhibits Tyrosine Kinase seems to be promising.

Adrenal cystic phaeochromocytoma: a case report.

Cystic phaeochromocytoma is a rare occurrence. We report a case of a 42-year-old woman who presented with the cardinal symptoms of phaeochromocytoma with elevated serum catecholamine levels. Radiological investigations showed a cystic mass in the right adrenal. Right adrenalectomy through a subcosal incision was performed and pathological examination concluded to a cystic phaeochromocytoma. We discuss the pathophysiology of such cyst formation as well as differential diagnoses.