Enterosalpingeal fistula complicating Crohn's disease: Report of two cases and review of the literature.

INTRODUCTION AND IMPORTANCE: Reports of enterosalpingeal fistulae complicating Crohn's disease are scarce. They involve the last ileal loop and lead to a progressive destruction of the salpinx. Usually, no genital symptoms are found. In all the cases reported in the literature, the fistula was diagnosed intra-operatively and resection of the right salpinx was performed without the patient's pre-operative consent. CASE PRESENTATION: We describe 2 cases of women presenting with an Enterosalpingeal fistulae complicating Crohn's disease. Radiological findings allowed a pre-operative diagnosis. Thus, the patients were warned of the right salpinx resection and consent was obtained. CLINICAL DISCUSSION: Enterosalpingeal fistulae complicating Crohn's disease are exceptional. Indeed, to the best of our knowledge, only five cases have been reported till now. In all the reported cases, no genital signs were present. As for our patients who didn't experience such symptoms. Moreover, no radiological evidence of the enterosalpingeal fistula was found in the literature. Consequently, the fistula was always diagnosed intra-operatively. For our patients, radiological findings allowed a pre-operative diagnosis. This permitted to warn them of a possible resection of the fallopian tube. Intra-operative findings were unfortunately conflicting with its preservation. CONCLUSION: Enterosalpingeal fistula is an exceptional complication of the Crohn's disease. No clinical findings are present. The diagnosis should be evoked when the CT-scan or the MRI show an abnormal apposition between the fallopian tube, the last loop and the cecum. Surgical resection of the involved salpinx with the diseased intestinal segment is unfortunately usually needed in a young patient population.

Tuberculous severe acute colitis. A case report.

INTRODUCTION: and importance: Intestinal tuberculosis represents 2% of the ten million cases of tuberculosis reported in 2018. Herein, we report a case of tuberculous severe acute colitis. It is a rare and life-threatening condition. Our literature review found only five published cases. It occurs generally in immunocompromised patients. Extended colonic inflammation seems to be the main predictive factor of death. Moreover, an early diagnosis and rapid onset of antituberculous treatment are mandatory to save the patient's life. CASE PRESENTATION: Herein, we present a case of tuberculous severe acute colitis with a review of the reported cases. The patient presented with a severe and idiopathic acute colitis. He was put on broad-spectrum antibiotics and intravenous corticosteroids. At day two, he developed septic shock and colic perforation. Colectomy was performed. Microbiology investigation and pathology examination confirmed tuberculous colitis. CLINICAL DISCUSSION: Tuberculous severe acute colitis occurs generally in immunocompromised patients. Extended colic inflammation seems to be the main predictive factor of death. Moreover, an early diagnosis and rapid onset of antituberculous treatment are mandatory to save the patient's life. However, diagnosis is difficult as symptoms aren't specific. Microbiology and pathology were compulsory to retain colic tuberculosis in all the reported cases. CONCLUSION: Tuberculous severe acute colitis is a challenging and life-threatening condition. It usually occurs in immunocompromised patients. Abdominal CT-scan may evoke the diagnosis. Microbiology and pathology are mandatory to retain the diagnosis. Early diagnosis and onset of antituberculous treatment are compulsory to save the patient's life.

Intraperitoneal migrating mesh plug wrongfully taken for right colon cancer: A case report.

BACKGROUND: The use of mesh has become nowadays a standard for hernia repairs. It allows a tension-free hernioplasty and has shown that it is an effective way to prevent recurrences. But complications have been described. Intraperitoneal migration of mesh plug is an uncommon complication. CASE REPORT: In this paper we report a case of a 57 year old male who has been operated on 12 years ago, he had a mesh plug repair for a ventral incisional hernia. The mesh migrated into the abdominal cavity and it was wrongfully taken for a locally advanced right colon cancer. Colonoscopy was done and biopsies were taken, but the results were not conclusive. He was operated on. We found the mesh that had migrated and eroded the hepatic flexure. There was a granulation tissue that also included some of the small intestine. There was also an abscess in the abdominal wall. He had an en-bloc resection of a part of the abdominal wall, small intestine and right colon. CONCLUSION: Mesh hernioplasty is a frequent, simple and effective procedure with a low recurrence rate but it can be associated to serious complications such as mesh migration.

Validation of the Lacaine-Huguier predictive score for choledocholithiasis: prospective study of 380 patients.

UNLABELLED: The aim of this study was to validate the Lacaine-Huguier score for the prediction of asymptomatic choledocholithiasis. METHODS: The study enrolled patients over age 18 with symptomatic chronic or acute calculous cholecystitis. Patients already known to have common bile duct stones (CBDS), as evidenced by symptomatic presentation with acute cholangitis or acute gallstone pancreatitis, were not included. We compared the group of patients with a score less than 3.5 versus those with a score greater or equal to 3.5; we also compared the group of patients who underwent intraoperative cholangiography (IOC) with those who did not undergo IOC. The negative predictive value of the Lacaine-Huguier score was calculated. RESULTS: We note that 308 women and 72 men were consecutively enrolled between February 2008 to March 2009; the average age was 51±16.4 years. The score was less than 3.5 in 154 patients (40.5%). IOC was only performed in 135 of the 226 patients with a score greater or equal to 3.5; reasons for this included a very narrow cystic duct in 67 cases, preoperative miscalculation of the score in nine cases, a technical problem in eight cases, an unspecified reason in four cases, contraindication due to pregnancy in two cases, and intraoperative difficulties in one case. CBDS were detected by IOC in 18 cases. Performance of IOC lengthened the median operative time by 20 minutes. The median follow-up was 8 months (range: 0-30 months). Eleven patients were lost to follow-up (2.9%), six of these had a score less than 3.5. Two patients had residual common bile duct (CBD) stones, one of whom had a score less than 3.5. The negative predictive value was 99.4% (95% confidence interval (CI 95%)=[98-100%]). The risk of leaving a stone in the CBD was 0.6%. When data was analyzed according to the worst case scenario, the negative predictive value became 95.5% (CI 95%=[92-99%]) with a risk of residual CBDS of 4.5%. CONCLUSION: This study confirmed the validity of the Lacaine-Huguier score. When the score is less than 3.5, the surgeon can refrain from performing IOC with a risk of asymptomatic residual CBDS ranging from 0.6% to 4.5%.

[Radiologic diagnosis of enterosalpingeal fistula complicating Crohn's disease]. / Diagnostic radiologique d'une fistule entérotubaire compliquant une maladie de Crohn.

Enterosalpingeal fistula is a rare complication of Crohn's disease which is rarely diagnosed preoperatively. We describe a new case of this complication suspected by CT scan and confirmed by hysterosalpingogram and contrast from the ileum. This case is about a 50-year-old woman suffering from ileal Crohn's disease diagnosed two years previously and actually complicated by stenosis and entero-salpingeal fistula. The treatment consisted on resection of the ileocaecal region with salpingectomy. Postoperative course was uneventful.

[Unopened colostomy in colorectal surgery: a renewal interest?]. / La colostomie à ouverture potentielle en chirurgie colorectale: un regain d'intérêt?

INTRODUCTION: Anastomotic leak or disruption is a grave complication of colorectal surgery. Protection of an at-risk anastomosis by an upstream open diverting colostomy (OC) reduces this gravity. An unopened upstream loop colostomy is a surgical alternative which may diminish the unpleasant consequences of an open colostomy while maintaining the option of diversion in case of need. The aim of this study is to report the results of this approach and to define its indications. MATERIAL AND METHODS: [corrected] We report a retrospective series of 34 cases of unopened diverting loop colostomy to protect an at-risk colorectal anastomosis. Indications for this procedure were stool-laden bowel (59%), low serum albumin (11.5%), local inflammation (11.5%), and very low placed anastomosis (17.5%). RESULTS: The loop colostomy was eventually opened after surgery in six cases because of anastomotic leakage diagnosed clinically and/or detected by water soluble contrast opacification which was performed routinely on the sixth post-operative day. In all six cases, there was no need for an urgent surgical intervention. In 28 cases, the anastomosis healed without complication and the exteriorized loop was returned to the abdominal cavity seven days after the initial surgery. This was a short, simple procedure with an average operating time of ten minutes. Average hospital stay after returning the unopened colostomy to the abdomen was two days. CONCLUSION: Unopened loop colostomy offers the advantages of protection of a colorectal anastomosis without proper morbidity or mortality, shorter hospitalization, and improved psychological comfort for the patient. It's principal indication is to minimize the risks related to leakage from an at-risk colorectal anastomosis.