[Pseudomyxoma peritonei (PMP) secondary to mucinous carcinoma of the ovary: a case study]. / Pseudomyxome péritonéal secondaire à une tumeur mucineuse de l'ovaire: à propos d'un cas.

Pseudomyxoma peritonei (PMP), also referred to as gelatinous ascites, is a rare disorder, described for the first time by R. Wyerth in 1884. It is characterized by diffuse peritoneal involvement, composed of mucinous ascites and multifocal mucinous epithelial implants. This disease mainly affects women. Its incidence is estimated at 2 cases per one million inhabitants. Pseudomyxoma peritonei can be asymptomatic, discovered during a laparotomy. The most common symptom is abdominal distension associated with diffuse abdominal pain. Abdominal CT scan is the most specific diagnostic tool. It shows pathognomonic signs of gelatinous ascites. Mucinous neoplasms of the appendix are the most frequent cause of pseudomyxoma peritonei accounting for 90% of cases. Pseudomyxoma peritonei of ovarian origin is very rare. There are essentially two types of treatment: multiple debulking surgery and cytoreductive surgery with perioperative intraperitoneal chemotherapy consisting of hyperthermic intraperitoneal chemotherapy with or without immediate postoperative intraperitoneal chemotherapy. We report a case of pseudomyxoma peritonei secondary to mucinous carcinoma of the left ovary.

[Colonic lymphoma revealed by ileocecal intussusception in adults: about a case]. / Lymphome colique révélé par invagination iléo-caecale chez l'adulte: à propos d'un cas.

Intussusception is a very common condition in pediatrics, while in adults it is rare and accounts for only 10% of intussusceptions and 4% of intestinal occlusions. Colonic lymphoma revealed by intussusception is a very rare disease. We report the case of a 21-year old woman admitted with intestinal subocclusion to the Emergency Department at the Military Hospital Moulay Ismail, Meknes Morocco. Abdominal CT scan showed "sausage-shaped" mass as well as its organic cause in the colon. Surgical resection was the treatment of choice, followed by anatomo-pathological examination of the surgical specimen which showed diffuse large B-cell lymphoma. After surgery, chemotherapy was indicated in order to improve the prognosis and to avoid a possible relapse.

[Epidemiological and pathological profile of colorectal cancer: about 36 cases]. / Profil épidémiologique et anatomopathologique du cancer colorectal: à propos de 36 caswe.

Colorectal cancer is classified among the most common cancers in the world (after breast cancer and prostate cancer) and it is the second digestive tract cancer in Morocco after stomach cancer. However, its incidence in our country is lower than that of western countries (2.5 to 3.3 / 100 000 ha) but it coincides with that of Maghreb countries where this cancer affects young subjects in 27% of cases. Colorectal cancer (CRC) is one of the best examples of multistep carcinogenesis. Knowing the anatomopathological characteristics of CRC will certainly affect our therapeutic approaches. We conducted a retrospective epidemiological and anatomopathological study in the Department of Visceral Surgery at the Military Hospital Moulay Ismail, Meknes over a period of 5 years from January 2012 to December 2016. The study involved 36 patients: 14 women and 22 men. The aim of this study was to analyze the epidemiological profile and the anatomopathological features of colorectal cancers. The analysis of our results shows a specific epidemiological profile which is characteristic of a type of colorectal cancer affecting younger subjects, mainly male patients. Sporadic carcers are largely predominant, occurring mainly in the rectosigmoid region. A low degree of differentiation of adenocarcinomas with mucinous features is correlated with advanced TNM and Aster Coller staging and with lymph node status with poor prognosis. This multidisciplinary approach will be a novelty at national level, thus making our structure of clinical practice and research one of the centres for multidisciplinary management of colorectal cancer in Morocco.

The management of a cystic hepatic lesion ruptured in the bile ducts: a case report.

BACKGROUND: Hepatic cystadenoma is a rare benign cystic tumor; it tends to recur after incomplete surgical resection and has malignant potential. We report the case of a patient with a ruptured biliary cystadenoma in the common bile duct that caused diagnostic and therapeutic problems. CASE PRESENTATION: A 34-year-old North African woman, admitted for angiocholitis, was operated 2 months before for a hepatic cystic lesion taken for a hydatid cyst compressing her common bile duct. The clinical and the complementary examinations converged toward recurrence of the hydatid cyst for which a surgical resection was decided. Intraoperative findings as well as the histological study of the "membranes" extracted from her common bile duct indicated a hepatic cystadenoma. CONCLUSIONS: The rarity of hepatic cystadenoma and the non-specificity of clinical and imaging signs make diagnosis of hepatic cystadenoma difficult, especially when it is complicated by rupture in the bile ducts; this contributes to a delay in diagnosis and an inadequate therapeutic approach.

[Role of splenectomy in the treatment of non-cirrhotic portal hypertension: about 3 cases]. / Place de la splénectomie dans la prise en charge de l'hypertension portale non cirrhotique: à propos de 3 cas.

Non-cirrhotic portal hypertension was first described by Guido BANTI in 1898 as a condition characterized by the association of portal hypertension with splenomegaly, anemia and healthy liver. The diagnosis was based on abdominal ultrasound, splenoportography and liver biopsy. Our study aimed to evaluate the role of splenectomy in non-cirrhotic portal hypertension. We conducted a retrospective study of 3 patients (2 women and 1 man) treated by our staff over the period January 2010 -September 2016. The diagnosis of idiopathic portal hypertension was based on the following criteria: portal hypertension, the presence of oesophageal varices associated with splenomegaly, the absence of cirrhosis or of other liver disorders responsible of portal hypertension. All patients underwent splenectomy. Outcome after splenectomy was marked by the standardization of clinical, radiological and biological signs of this disease associated with the absence of oesophageal varices recurrence. Splenectomy associated with ligation of oesophageal varices may be sufficient to treat this syndrome and especially its consequences without using splenorenal bypass.

An exceptional collision tumor: gastric calcified stromal tumor and pancreatic adenocarcinoma.

The authors report an exceptional case of collision tumor comprised of a gastric calcified stromal tumor and a pancreatic adenocarcinoma. The pancreatic tumor was detected fortuitously on the histological exam of resection specimen.

Analysis of prognostic factors affecting mortality in Fournier's gangrene: A study of 72 cases.

INTRODUCTION: Fournier's gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality. METHODS: We carried out a retrospective study of 72 patients treated for Fournier's gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and non-survivors and potential prognostic factors were analyzed. RESULTS: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier's Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002). CONCLUSION: Fournier's gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.

An unusual localization of retroperitoneal paraganglioma: a case report.

Paragangliomas are rare tumors arising from extra-adrenal chromaffine tissues. The diagnosis of non-functional retroperitoneal paraganglioma and its surgical management can be difficult. We report a case of a retroperitoneal paragangliomaof an unusual localization that renders the surgery more challenging. A 40 year-old woman presented to our department with a four-month history of upper quadrant pain with no vomiting, no fever, nor jaundice. Physical examination was normal. Ultrasonography showed a retro duodenal homogenous mass and computed tomographyscan showed a well-circumscribed round mass of heterogeneous density, which was in close contact with the aorta and the left kidney vein. Laboratory tests were normal. The patient underwent surgical management. The surgical exploration found a retroperitoneal tumor that was encapsulated and showing intimate contact with the abdominal aorta. We performed a complete resection of the tumor. Histological examination of the surgical specimen revealed a paraganglioma. The post operative course was uneventful. Paragangliomas are rare tumors. They can be asymptomatic for a long time and thus be diagnosed at late stage. A follow-up of patients is then essential. Surgical treatment is the only radical treatment and should be performed even in paragangliomas in close contact with the great vessels.

Long-standing insulinoma: two case reports and review of the literature.

BACKGROUND: Insulinomas are rare pancreatic endocrine tumors. Most are benign and solitary. However, the nonspecific symptoms and small size of these tumors led to difficulties of diagnosis and localization. CASE PRESENTATION: We present two Arab patients with pancreatic long-standing insulinoma. Both patients presented episodic hypoglycemic symptoms respectively during 10 and 2 years. Biochemical and morphological workup detected localized pancreatic insulinoma. Open procedure surgery was done for the two patients and insulinomas were successfully removed by enucleation. CONCLUSION: Insulinoma remains a diagnostic challenge to practitioners. Diagnosis of suspected cases is easily confirmed by standard endocrine tests, especially the supervised fasting test. Accurate preoperative localization is essential for more effective and safest surgery.