Laparoscopy for perforated duodenal ulcer: A morbidity score based on a cohort study of 384 patients.

BACKGROUND: The Laparoscopic treatment of perforated ulcer is accompanied by a lesser morbidity and mortality compared with treatment by laparotomy. However, the morbidity of the laparoscopic approach is not nil (4%). It is influenced by pre and intraoperative factors. The aim of our work is to establish a morbidity score in patients undergoing laparoscopic surgery for acute peritonitis with perforated duodenal ulcer. METHODS: This is a retrospective study conducted in a General Surgery Department. We included 384 cases of perforated duodenal ulcer operated laparoscopically over a fourteen-year period ranging from January 2000 to December 2014. We conducted a multivariate logistical regression analysis by step-by-step-descending method. From these independent factors we established a score using the ROC curves. The threshold with the best sensitivity and specificity for predicting morbidity was investigated. In all statistical tests, the significance level was set at 0.05. RESULTS: The overall morbidity rate of our patients was 3.38% (13 patients). Multivariate analysis has identified five independent morbidity risk factors: temperature higher than 37.6° C, renal failure, age> 45 years, a number of stitches of two or higher and operating time to 75 minutes or longer. Our morbidity score took into account these 5 factors by integrating the intrinsic value of each factor. The threshold of the score having the best torque sensitivity specificity to predict morbidity was 10. CONCLUSION: A morbidity score for perforated duodenal ulcer surgery performed by laparoscopy may be useful to organize the post-operativecare of these patients usually young and active. A lower score than the threshold predictive of morbidity could allow a rapid rehabilitation of these patients and a one day hospitalization management.

Percutaneous treatment versus hepatic resection for the treatment of small hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas. MATERIAL AND METHODS: A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment. RESULTS: Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment (hepatic resection) was performed in 54% cases while percutaneous treatment was proposed for 46%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. The corresponding 6 months and 1- year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively (p=0,04). The disease free survival were not significantly different. CONCLUSION: Our results showed the efficacy and safety of percutaneous ablation treatments (radiofrequency ablation and ethanol injection) in patients with small hepatocellular carcinoma.

Hepatocellular carcinoma arising from hepatic adenoma in a young woman.

Hepatocellular carcinoma (HCC) arising from hepatic adenoma is an infrequent situation. Only a few cases were reported in the literature. We present a rare case of hepatocellular carcinoma arising from HA in a young woman with no medication history of oral contraceptives. Surgical resection is the only available treatment.

[Isolated adenomatous polyposis of the appendix. Report of two cases]. / Polypose adenomateuse isolee de l'appendice. A propos de deux observations.

BACKGROUND: Adenomas are rarely diagnosed in the appendix and may be isolated or may coexist with other neoplasms in the gastrointestinal tract. This emphasizes the need for postoperative colonoscopy when a polyp of the appendix is found. Moreover, the polyps are considered to be premalignant lesions. AIM: Report two new cases of adenomas of the appendix. CASES: We report the cases of 23-year-old and 22-year-old men, for whom appendicectomy performed for acute appendicitis. In both cases, histologic studies revealed adenomas in moderate dysplasia ; colonoscopy did not reveal any polyps.

[Value of admission for observation in the management of acute abdominal right iliac fossa pain. Prospective study of 205 cases]. / Douleurs aiguës de la fosse iliaque droite: intérêt de la surveillance clinique hospitalière. Etude prospective de 205 cas.

INTRODUCTION: Because of the potential severity of acute appendicitis, many authors recommend the broad use of appendectomy. In this case, 15 to 20% of appendectomies are ultimately found to have been unnecessary. Hospital observation with repeated clinical and laboratory exams can be useful for patients with atypical clinical presentation. This paper assesses our approach, in which some patients with pain in the right iliac fossa (RIF) are admitted for observation before a decision about appendectomy. PATIENTS AND METHODS: All patients (205 cases) admitted from March 2002 through February 2003 for acute abdominal pain of the RIF were included in this prospective study. The 120 women and 85 men (sex ratio=0.7) had a mean age of 27 years. We classified the patients into 3 groups: those who had an emergency appendectomy, those who had surgery after an observation period, and those discharged without appendectomy after observation. RESULTS: The first group included 110 patients: 63% had a (rectal) temperature greater than 38 degrees C; 44% had guarding of the RIF and 87% elevated white blood cell counts (>10000/mm3). At surgery, appendicitis was diagnosed in 92%. After a mean delay of 36 hours of observation, 50 of the patients in the second group underwent surgery: 44% with (rectal) temperature > 38 degrees C, RIF guarding in 8%, and elevated white blood cell count (>10000/mm3) in 74%. In this group, 94% were diagnosed with appendicitis during surgery. Forty-five patients were discharged without surgery after 36 hours of observation. COMMENTARY: In this study, pain and RIF guarding, associated with temperature greater than 38 degrees C and elevated white blood cell counts, were predictive of appendicitis in 96% of cases. Admission for observation of patients with atypical presentation avoided 45 unnecessary appendectomies (22%).

[Treatment of primary and secondary malignant tumor of the liver. Opinion of the surgeon]. / Le traitement des tumeurs malignes primitives et secondaires du foie. Le point de vue du chirurgien.

Hepatocellular carcinoma is the most frequent primitive cancer of the liver. This tumor mainly develops in cirrhotic liver that is a true precancerous state. Treatment can be surgical or not surgical. Orthotopic liver transplantation is the only treatment that definitively address both the metachronous occurrence risk of hepatocellular carcinoma and the underlying disease. Liver metastases from colorectal carcinomas are the most frequent secondary tumors. Only complete resection offers the potential for curative treatment of these metastases.

[An uncommon trichoepithelioma: the giant solitary trichoepithelioma]. / A propos d'une forme rare de trichoépithéliome: le trichoépithéliome giant solitaire.

A case of giant solitary trichoepithelioma of the perianal region is described so to draw attention to this rare benign neoplasme and to discuss its clinical and histopathological chracteristics.

[Concurrent occurrence of a gastric cancer with a hepatocellular carcinoma: report of a case: incidental or causal association?]. / Survenue synchrone d'un cancer gastrique et d'un hétpatocarcinome, a propos d'un cas: association fortuite ou lien de causalité?

Little information regarding synchronous gastric cancer associated with hepatocellular carcinoma is available and has been sporadically reported. We report a new case of 60 years old patient operated for gastric carcinoma. The radiological investigations revealed a hepatic nodule which correspond to a hepatocellular carcinoma on histological examination. The aim of this study is to clarify the clinicopathologic and therapeutic features of this association.

[Dubin-Johnson syndrome: molecular basis and pathogenesis]. / Le syndrome de Dubin-Johnson: bases moleculaires et pathogenie.

The Dubin-Johnson syndrome (DJS) is an autosomal recessive liver disorder characterized by a chronic conjugated hyperbilirubinemia a dark greenish appearance of liver tissue, a double peaked sulfobromophthalein clearance curve, and a characteristic lysosomal accumulation of black pigment "melanine-like" in the hepatocytes. Laboratory datas indicated an increased urinary excretion of coproporphrin isomer I and leukotriene metabolites. In an effort to understand the morphological pattern and the pathogenesis of this disease we reviewed four cases of DJS.

[Endometriosis: a rare cause of acute intestinal obstruction]. / Endométriose: cause rare d'occlusion intestinale aigue.

In the differential diagnosis of intestinal obstruction, the endometriosis is an uncommon disease, rarely reported preoperatively. Surgical objective is a total resection of endometriomas, to guarantee symptom relief and ovoid recurrence. In elective cases, preoperative GH-RH analogue hormonal treatment makes easier the surgical procedures. Conservative surgery of the ovaries is mandatory in premenopausal patients.

[Isolated splenic metastasis revealing colon cancer]. / Métastase splénique isolée révélant un cancer du colon.

Splenic metastasis of colon cancer is uncommon especially when isolated. In fact, they are usually associated to multi visceral location. Malignant melanoma, cancer of breast and lung and ovarian carcinoma are the most common cancer which metastases in spleen. Splenic metastasis of colon cancer is rare and exceptionally isolated. Ten cases of isolated splenic metastasis in colon cancer are reported in literature. We report a new case of intra splenic kystic metastasis revealing an asymptomatic sigmoid cancer in a 63 years old patient.

Leiomyosarcoma of the inferior vena cava.

Vascular leiomyosarcoma (LMS) are unique. The inferior vena cava (IVC) is the most affected organ (about 38% cases). We report the observation of a 50-year old woman who consulted for right upper quadrant pain. Imaging studies revealed a retroperitoneal mass that mimic a LMS of the IVC. The patient was operated. A resection of the IVC along with the tumor was performed without reconstruction. The management of LMS is surgical and depends upon the location and tumor characteristics.

Metachronous cancer of gallbladder and pancreas with pancreatobiliary maljunction.

Pancreaticobiliary maljunction is a congenital anomaly in which the junction between the pancreatic duct and the common bile duct is located outside the sphincter of Oddi. It is well known that pancreaticobiliary maljunction is frequently associated with carcinoma of thebiliary tract. We report a case of metachronous cancer of the gallbladder and pancreas associated with pancreaticobiliary maljunction and cystic dilatation of common bile duct in a 68-year-old Tunisian woman who underwent a cholecystectomy for acute cholecystitis. The pancreatic tumor was an adenosquamous carcinoma. Pancreaticobiliary maljunction allows for pancreatobiliary or biliopancreatic reflux which may induce biliary tract carcinoma. Few cases of multifocal cancer associated with this anomaly have been reported. The association with pancreatic carcinoma remains rare. Close attention should be given to both the biliary tract system and pancreas during the long-term follow-up of patients with pancreaticobiliary maljunction, especially after they have undergone a choledochojejunostomy.