Meckel's diverticulum complicated by acute intestinal obstruction: a case report.

Introduction and importance: Meckel's diverticulum is a rare congenital intestinal anomaly that can sometimes cause serious complications. The authors' aim is to review the literature on this condition by reporting the clinical case of a young adult with Meckel's diverticulum complicated by acute intestinal obstruction. Case presentation: This was a 24-year-old young man, operated on for open bladder stones received for occlusive syndrome. Abdominal computed tomography (CT) suggested a flange occlusion. Surgical exploration found a Meckel's diverticulum creating a flange around the last one. An intestinal resection was performed with direct anastomosis with simple consequences. Clinical discussion: Meckel's diverticulum is a rare congenital intestinal anomaly. It is discovered incidentally or in the face of serious complications such as intestinal obstruction. Intestinal resection with one-stage anastomosis emerges as a standard and safe management approach. Conclusion: A Meckel's diverticulum can be complicated by acute intestinal obstruction mimicking a postoperative flange that can err the diagnosis.

[Management Of Colonic Pseudotumor Anecdotal In Peace Hospital Of Ziguinchor]. / Une Pseudotumeur Colique Anecdotique Pris En Charge A l'Hopital De La Paix De Ziguinchor.

Colonic pseudotumors secondary to fishbone perforation are rare and not easily diagnosed, as the clinical presentation is often misleading. We report the case of a 61-year-old man patient with no medicalhistory, whose clinical picture was in favor of a colonic tumor. The diagnosis of colonic perforation by fishbone was not possible preoperatively due to lack of CT scan. The diagnosiswas made intraoperatively by the visualization of a colonic perforation by fishbone. Pathological examination of the surgical specimen confirmed the inflammatory pseudotumor of the colon without histological sign of malignancies.

les pseudotumeurs coliques secondaires à une perforation par arête de poisson sont rares et ne sont pas de diagnostic facile, car le tableau clinique est souvent trompeur. Nous rapportons le cas d'un patient de 61 ans, aux antécédents d'épigastralgie, dont le tableau clinique était en faveur d'une tumeur colique. Le diagnostic de perforation colique par arête de poisson n'a pas été possible en pré opératoire par faute de scanner. Le diagnostic a été retenu en peropératoire par la visualisation d'une perforation colique par arête de poisson. L'examen anatomopathologie de la pièce opératoire a confirmé la pseudotumeur inflammatoire du côlon sans signe histologique de malignes.

[Giant lipoma of the back: a case report and litterature review]. / Lipome géant du dos: rapport de cas avec revue de la littérature.

Lipoma is a benign soft tissue tumour. It is a benign proliferation of mature adipocytes. It is described as giant when its weight exceeds 1 kg or its diameter exceeds 5 cm. Functional and aesthetic impairment may be a major reason for surgical excision. It can be located everywhere, but it mainly occurs in the posterior segment of the chest. We here report a case of giant lipoma of the left posterior-superior segment of the chest.

[Superior mesenteric artery syndrome in gastric cancer: a case report]. / Syndrome de la pince aorto-mésentérique sur cancer gastrique: à propos d'un cas.

Superior mesenteric artery syndrome or Wilkie syndrome is due to the compression of the third duodenum between the superior mesenteric artery and the aorta. It causes acute or chronic upper bowel occlusion. Abdominal CT scan facilitates the diagnosis. Severe malnutrition is its main etiological factor. Medical treatment can be based on aspiration of gastric contents and parenteral nutrition. If this fails, surgery is necessary. We here report the case of a 46-year-old patient, with a history of smoking, presenting with profuse postprandial bile and food vomiting. He had had weight loss of 7% over a period of 6 months. Upper GI endoscopy revealed non-stenotic antro-pyloric tumour mass. Histological examination showed poorly differentiated tubular gastric adenocarcinoma. Staging was without any peculiarity and allowed for the detection of superior mesenteric artery syndrome at an angle of 8°C. The patient received parenteral nutrition for 10 days, followed by inferior pole gastrectomy and gastrojejunal anastomosis (omega loop). The postoperative course was uneventful. Adjuvant chemotherapy was indicated.

Id3 modulates cellular localization of bHLH Ptf1-p48 protein.

Ptf1-p48 is a pancreas-specific bHLH transcriptional protein, which, in the normal adult pancreas, shows a restricted expression in acinar cells where it is predominantly localized in the nucleus and activates the transcription of exocrine-specific genes. Ptf1-p48 partners with two proteins to form the PTF1 active complex: a bHLH E-protein and suppressor of hairless RBP-J. Cytoplasmic mislocalization of Ptf1-p48 has been reported in pancreatic pathologies, suggesting its contribution in the early steps of pancreatic carcinogenesis. The aim of the our work was to elucidate the mechanisms regulating Ptf1-p48 subcellular localization. We hypothesized a role of Id proteins acting in a dominant-negative fashion by heterodimerizing with bHLH proteins. We reproduced Ptf1-p48 cytoplasmic mislocalization in acinar AR4-2J cells and demonstrated that a proliferative signal elicited by gastrin leads to increases in Id3 protein expression and levels of Id3/E47 and Id3/Ptf1-p48 interactions, and a decrease in the level of E47/Ptf1-p48 interaction. By contrast, Id3 silencing reversed the cytoplasmic mislocalization of Ptf1-p48 induced by gastrin. As E47 is responsible for the nuclear import of the PTF1 complex, disruption of this complex via Id3 interactions with both E47 and Ptf1-p48 appears to induce cytoplasmic mislocalization of Ptf1-p48. We then found that Ptf1-p48 is either absent or mislocalized in the cytoplasm and Id3 is overexpressed in human and murine pancreatic preneoplastic lesions. Our data provide novel insight into the regulation of Ptf1-p48 function and provide evidence that Ptf1-p48 cytoplasmic mislocalization and Id3 overexpression are early events in pancreatic cancer progression.

Cystic mesenteric lymphangioma: A case report.

INTRODUCTION: Cystic lymphangioma is a benign malformative tumor. The abdominal localization is rare. The diagnosis is not easy in preoperative period. The surgery is the choice in the abdominal and symptomatic localization. PRESENTATION OF CASE: We report a 26 years old women. She consulted with left hypochondrial pain. The exam found left hyphochondrial swelling with 10 cm of diameter. The biologic screeming was normal. The ultrasound showed a multiloculated cyst which measured 130*80 mm. the CT scan showed a mesenteri cyst mass measured 15 cm. A fine needle aspiration cytology guided by abdominal ultrasound was realized and the cytology doesn't show malignant cell. A median laparotomy found a mesenteric cystic mass measured 15 cm of diameter. A resection was realized. The histologic exam membranous fibrosis cyst limited by an endothelium. CONCLUSION: Mesenteric localization of cyst lymphagioma is rare. The surgery is safe and efficiency for the treatment.

[Acute intestinal occlusion revealing abdominal pregnancy: a case study]. / Occlusion intestinale aiguë révélant une grossesse abdominale: à propos d'un cas.

Abdominal pregnancy (AP) is defined as the implantation and the development of the fertilized egg in the peritoneal cavity. It is a rare type of ectopic pregnancy, whose detection can be fortuitous, mimicking surgical emergency. We report a rare case of acute febrile bowel obstruction revealing abdominal pregnancy in a 27-year old patient, with no particular past medical history, admitted to hospital for the treatment of occlusive syndrome evolving over the last week. Physical examination showed shiny, distended, meteoric, completely sensitive abdomen. Laboratory tests showed white blood cell count 20300, haemoglobin 7,2g/dL. Surgical exploration showed hemoperitoneum 2000ml, retrouterine encapsulated mass, strongly adherent to the mesosigmoid and to the sigmoid, responsible of a stenosis of the descending colon. The patient underwent monobloc exeresis, which showed a portion of placenta next to the mesosigmoid attached to the fetus, right annexectomy and colostomy.

[Complicated Meckel diverticula: about 15 cases]. / Diverticules de Meckel compliqués: à propos de 15 cas.

We conducted a retrospective study of 15 patients with complicated Meckel diverticula treated in the emergency surgery at the Aristide Le Dantec Hospital, Dakar, over a period of 13 years (January 2003-June 2016). The study included 10 men and 5 women, whose average age was 27.8 years, ranging between 1 months and 73 years. The two main circumstances of detection were occlusive syndrome and peritoneal irritation. Emergency laparotomy allowed clinicians to affirm the involvement of Meckel diverticulum in the clinical picture. In the case of occlusion, the mechanism was always a flange. Ten patients had intestinal necrosis with perforation at the time of diagnosis. All 15 patients underwent segmental resection of the intestine with elimination of the diverticulum. This resection was followed by immediate anastomosis in 12 cases. The morbidity was constituted of 2 cases of fistulas and 2 cases of postoperative peritonitis. A case of death due to septic shock was reported. Three patients had heterotopic mucosa, including gastric heterotopia, colic heterotopia and an association between colic heterotopia and gastric heterotopia in the same patient. The complications of Meckel diverticula are digestive emergencies requiring early and adapted surgical treatment. This is characterized by a non-negligible morbidity.

Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.

INTRODUCTION: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. PATIENTS AND METHODS: We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. RESULTS: Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. CONCLUSION: The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.

INTRODUCTION: Les traumatismes du diaphragme comprennent les ruptures et les plaies du diaphragme. Leur incidence varie entre 0,8 % et 15 %. Elles sont très souvent méconnues malgré les techniques performantes d'imagerie médicale. Leur prise en charge chirurgicale reste controversée. La mortalité de cette pathologie est liée aux lésions associées. Le but de notre étude était d'apprécier l'incidence des lésions diaphragmatique dans les traumatismes thoraco-abdominaux, et de discuter les aspects épidémiologiques, diagnostiques et thérapeutiques. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective sur 21 ans allant du 1er janvier 1994 au 30 juin 2015. Cette étude a été réalisée au Service de Chirurgie Générale de l'Hôpital Aristide Le Dantec de Dakar. Etaient inclus dans cette étude tous les patients qui présentaient une lésion diaphragmatique consécutive à un traumatisme abdominal et/ou thoracique ouvert ou fermé. RÉSULTATS: Durant cette période d'étude, nous avons reçu 1535 patients victimes de traumatisme thoracique et/ou abdominal. Il s'agissait de 859 cas de contusions et 676 cas de plaies thoraciques et/ou abdominaux. Notre étude portait sur 20 cas de lésions diaphragmatiques (1,3 %). Le sex-ratio était de 4. L'âge moyen était de 33 ans. Les agressions par arme blanche représentaient 60 % (12 cas). L'incidence des lésions diaphragmatiques était de 2,6 %. La plaie cutanée était de siège thoracique dans 60 % (7 cas). La radiographie du thorax était contributive dans 45 % (9 cas). Le diagnostic de lésion diaphragmatique était préopératoire dans 45 % (9 cas). La brèche diaphragmatique siégeait à gauche dans 90 % (18 cas) et la taille moyenne était de 4,3 cm. Le geste chirurgical avait consisté en une réduction des viscères herniés et une suture du diaphragme par des points en « X ¼ dans 85 % (17 cas). Le drainage thoracique était systématique. Le taux de morbidité était de 10 % et la mortalité de 5 %. CONCLUSION: Leur diagnostic est difficile. Elles siègent le plus souvent à gauche. Leur traitement est chirurgical et la voie d'abord préférentielle est la laparotomie.

Arterial and vena caval resections combined with pancreaticoduodenectomy in highly selected patients with periampullary malignancies.

BACKGROUND/AIMS: To obtain a margin-negative resection and increase the indication for resection of periampullary malignancies, pancreaticoduodenectomy with a SM-PVR (superior mesenterico-portal vein resection) has been performed. However, an arterial resection, other vascular resections except SM-PVR (e.g., an inferior vena caval resection), or a metastatic tumor resection combined with pancreaticoduodenectomy has yet to be fully elucidated because of the high risk of postoperative complications and extremely poor long-term survival in patients undergoing these exceptional procedures. The present report focused on highly selected patients undergoing an arterial resection or a vena caval resection associated with pancreaticoduodenectomy. METHODOLOGY: Besides 31 patients with periampullary tumors undergoing pancreaticoduodenectomy associated with SM-PVR in our department, a group of 4 patients underwent arterial resections and another patient underwent pancreaticoduodenectomy combined with a resection of liver metastasis together with an inferior vena caval resection. These five patients were reported in the present study. RESULTS: A 27 year-old-woman presented pancreatic ductal adenocarcinoma of the pancreatic head and a liver metastasis in which involvements of the superior mesenterico-portal vein and the inferior vena cava were shown. Pancreaticoduodenectomy was performed with SM-PVR associated with a left hemihepatectomy combined with a segment 1 resection and an inferior vena caval resection. The patient did not present severe postoperative complications and experienced a good quality of life during 16 months after surgery. Four other patients underwent arterial resections. These arterial resections were performed only when a margin-negative resection was feasible. The superior mesenteric artery was resected and reconstructed with a Goretex graft in one patient. The right hepatic artery was resected and reconstructed with a saphenous graft in two patients. The other patient underwent a resection of the common hepatic artery and reconstruction was performed with the splenic artery. Three of the four patients presented postoperative complications but were conservatively treated. Two patients are still alive 25 months and 8 months after surgery. One patient died of sepsis 5 months after surgery, and the other died of cancer progression 19 months after surgery. CONCLUSIONS: The indication for retropancreatic arterial resection associated with pancreaticoduodenectomy should be carefully evaluated only when a margin-negative resection can be achieved. An appropriate bypass method of arterial reconstruction should be selected because a direct end-to-end anastomosis is not always feasible. Hepatectomy for metastases of pancreatic ductal carcinoma should be also regarded as an exceptional procedure.

Giant splenic pseudocyst, a rare aetiology of abdominal tumor: a case report.

INTRODUCTION: Splenic pseudocysts are nonparasitic cyst without epithelial lining. We report this case especially by its way of revelation, its large size and its per operative presentation which needed total splenectomy. To this opportunity, we discuss the diagnostic procedure and therapeutic indications. CASE PRESENTATION: A twenty-year old Senegalese woman, was admitted with a three-month history of spontaneous abdominal mass associated with a pain. Ultrasonography and CT scan found the giant splenic pseudocyst with a diameter of 20 cm which needed a total splenectomy by median laparotomy. CONCLUSION: Usually, symptomless splenic cysts are untreated. When surgical treatment is indicated, recommendations are to preserve splenic parenchyma by partial splenectomy or fenestration especially by laparoscopy. Total splenectomy retains some guidance.

[The surgical treatment results of ulcerous pyloro-duodenal stenosis: about 160 cases]. / Resultats du traitement chirurgical de la stenose ulcereuse pyloroduodenale: a propos de 160 cas.

OBJECTIVE: To evaluate the outcomes of the surgical treatment of ulcerous pyloro duodenal stenosis at Dakar. PATIENTS AND METHODS: We carried out a retrospective study including 160 medical records of patients presenting an ulcerous pyloroduodenal stenosis from January 2000 to December 2006. After a mean follow up of 16 months, surgical outcomes were evaluated including mortality and morbidity. The functional results were evaluated using Visick Classification. RESULTS: The mean age of our patients was 42 years and 6 months (range: 17-20 years). Our population included 126 men (78,7%) and 34 women (21,3%). Oeso-gastro-duodenal fibroscopy was performed in 136 patients (85%) whereas barium meal was carried out in 82 patients (51,25%). Surgical approach was laparoscopy in 132 cases (82%) and laparotomy in 28 cases (18%). All patients underwent a troncular vagotomy. In addition a gastroentero anastomosis was performed in 89,2% of cases, a pyloroplasty in 10% of cases and an antrectomy in 0,6% of cases. Mortality rate was 0%. The morbidity rate was 10% including parietal suppuration, diarrhoea and hiccups. Functional outcomes were as follows: Visick I in 91% of cases, Visick II in 6,3% of cases and Visick III in 2,7%. CONCLUSION: Ulcerous pyloro duodenal stenosis is a frequent complication of ulcer disease. Its treatment is surgical based on a vagotomy with gastric discharge. The outcomes are satisfactory in our context.

Appendicular peritonitis in situs inversus totalis: a case report.

INTRODUCTION: Situs inversus is a congenital anomaly characterized by the transposition of the abdominal viscera. When associated with dextrocardia, it is known as situs inversus totalis. This condition is rare and can be a diagnostic problem when associated with appendicular peritonitis. CASE PRESENTATION: We report the case of a 20-year-old African man who presented to the emergency department with a 4-day history of diffuse abdominal pain, which began in his left iliac region and hypogastrium. After examination, we initiated a surgical exploration for peritonitis. We discovered a situs inversus at the left side of his liver, and his appendix was perforated in its middle third. A complementary post-operative thoracic and abdominal tomodensitometry revealed a situs inversus totalis. CONCLUSION: Appendicular peritonitis in situs inversus is a rare association that can present a diagnostic problem. Morphologic exploration methods such as ultrasonography, tomodensitometry, magnetic resonance imaging, and laparoscopy may contribute to the early management of the disease and give guidance in choosing the most appropriate treatment for patients.

Internal supravesical hernia as a rare cauase of intestinal obstruction: a case report.

INTRODUCTION: Supravesical hernias develop at the supravesical fossa between the remnants of the urachus and the left or right umbilical artery. They are often the cause of intestinal obstruction. We describe the anatomical variant of the supravesical hernia in this case and discuss the pre-operative findings revealed by computed tomography. We discuss diagnostic and therapeutic procedures, and review other anatomical variants. CASE PRESENTATION: A 60-year-old Senegalese man was admitted with a two-day history of small bowel obstruction. A physical examination showed abdominal distension. An abdominal X-ray revealed dilated small bowel loops. A computed tomography scan showed an image at the left iliac fossa that suggested an intussusception. A median laparotomy showed a left lateral internal supravesical hernia. The hernia was reduced and the defect was closed. The patient recovered uneventfully. CONCLUSIONS: Supravesical hernia is a possible cause of intestinal obstruction and diagnosis is very often made intraoperatively. Morphological examinations, such as computed tomography scanning, can lead to a preoperative diagnosis. Laparoscopy may be useful for diagnosis and therapy.