An epigastric mass? And what if it was an intra-abdominal esophageal duplication cyst: Case report.

INTRODUCTION AND IMPORTANCE: Duplication of the alimentary tract are uncommon congenital malformations that may be found anywhere from mouth to anus. Esophageal cystic duplication is a congenital cystic malformation of the alimentary tract consisting of a duplication of the segment of the esophagus to which it is adjacent. CASE PRESENTATION: We report the case of a 29-year-old female who had complained of intermittent epigastric pain and post prandial nausea for several weeks. Physical examination was without particularity except for the presence of abdominal epigastric mass. Transabdominal sonography combined with CT scan showed an epigastric cyst with no topographic relation to the pancreas measuring about 80 mm in diameter. Because of persistence of the epigastric pain and the nausea we decided to operate the patient. Histological exam than showed that the cystic mass was in fact an esophageal cystic duplication with no histological signs of malignancy. CLINICAL DISCUSSION: Here we describe a case of intra-abdominal esophageal duplication cyst in adult patient. Most of duplications cause symptoms in infancy or early childhood. Digestive duplication revealed at adulthood is a condition considered rare. CONCLUSION: Esophageal duplication cysts are uncommon developmental lesions arising from the primitive foregut, when diagnosed or encountered incidentally. The diagnosis of this anomaly in adulthood is exceptional and requires surgery.

Surgical management of benign noninfected urachal cysts in adult patients: two case reports.

BACKGROUND: Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition. CASE PRESENTATION: Herein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts. DISCUSSION: Laparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach. CONCLUSION: Managing persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities.

Closed loop small bowel obstruction due to small intestine volvulus associated with early adhesion after laparoscopic appendectomy: Case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Nowadays the majority of appendectomies are undertaken laparoscopically. The associated per and postoperative complications are well established and known. However, some rare postoperative complications continue to be reported such as small bowel volvulus. CASE PRESENTATION: We report the case of 44-year-old women who developed a small bowel obstruction from acute small bowel volvulus due to early postoperative flanges five days after a laparoscopic appendectomy. CLINICAL DISCUSSION: Laparoscopy is associated with less adherences and morbidity however we must be careful in post operative course. Mechanical obstruction can happen even with laparoscopy procedure. CONCLUSION: Occlusion earlier after surgery even with laparoscopy procedure must be explored. Volvulus can be incriminated.

Focal Mass-Forming Autoimmune Pancreatitis Mimicking Pancreatic Cancer: Which strategy?

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis that predominantly affects men in their fifth and sixth decades and often presents with obstructive jaundice and pancreatic enlargement. It is relatively easily diagnosed by characteristics of diffuse swelling of parenchyma and irregular narrowing of the main pancreatic duct. However, focal mass-forming AIP is hard to distinguish from pancreatic cancer. Problematic issue : How to differentiate a focal AIP from a pancreatic cancer and avoid a heavy and unnecessary surgical treatment?. Summary of the observation : We report three cases of mass-forming autoimmune pancreatitis that were preoperatively suspected to be pancreatic cancer, and review their clinical, radiological and histological features. We emphasize on the strategy of diagnosis and we try to understand the histopathological features of this disease. Conclusion : In patients with obstructive jaundice suggestive of pancreatic carcinoma, AIP should be considered in the differential diagnosis to avoid unnecessary laparotomy or pancreatic resection. To the best of our knowledge, this report is from the rare publications to present a histopathological comparison of mass-forming AIP with the adjacent uninvolved pancreatic tissues.

Ureteral tumor in an ectopic duplex system: a case report.

INTRODUCTION: Ureteral ectopia is a rarely observed anomaly. It may be totally asymptomatic. An association with a duplex system is exceptional. Diagnostic and therapeutic approaches are challenging. Carcinologic surgery must consider the anatomic variant, mainly related to the ectopic site of the ureteral orifice. OBSERVATION: We report a case of a ureteral urothelial carcinoma in a North African 52-year-old male patient, in a right duplex system. Radiological explorations concluded a non-functional upper right kidney. A suspect mass was observed in the lumbar part of the ureter of the right upper system. The meatus of the tumorous ureter ended in the right lobe of the prostate. A right hemi-nephro-ureterectomy was performed. A histological examination concluded a pT2G2 urothelial carcinoma. CONCLUSION: Even if malignancy is rarely observed in ureteral ectopia, it should be evoked mainly in cases of hematuria with risk factors for urothelial tumors.

[Treatment of idiopathic varicocele: comparative study of three techniques about 128 cases]. / Traitement de la varicocèle idiopathique : Étude comparative de trois techniques à propos de 128 cas.

BACKGROUND: Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one. AIM: To compare the results of three techniques of varicocelecomy. METHODS: Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the open surgery by retro peritoneal way for 42 patients (GI), the varicocelectomie coelioscopique for 41 patients (GII) and the antegrade scrotal sclerotherapy done for 45 patients (GIII), between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67 % of the cases, followed by the hypofertility in 20.3 % of the cases and the association both in 12,5 % of the cases. The varicocele was in leftsider in 71.1 % of the cases, to the right side in 5.4 % of the cases and was bilateral in 23.43 % of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups Results: The global rate success was 81.2 %, with the highest rate found in the group III which was treated by antégrade scrotal sclerotherapy (84.4 %). The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by antégrade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by antégrade scrotal sclerotherapy (13.3%). The main postoperative complications were hydrocele (16%) followed by testicular hypotrophy (3 patients). CONCLUSION: Three techniques of varicocele treatment, offer either a similar success rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in proposed, regarding its efficiency, of the ease of its realization, its moderate cost and its feasibility in case of recurrence if varicocele was treated with open way'GIII).

[Sigmoido-vesical fistula: a case report]. / Fistule sigmoido-vesicale: a propos d'un cas.

BACKGROUND: Colovesical fistula is a rare complication of inflammatory and neoplasic pelvic diseases (0.2%). AIM: To report a new case. CASE: We report the case of a 74-year-old woman, with a charged previous medical history and had not had hysterectomy. She was admitted because of cystitis with haematuria associated to faecaluria and pneumaturia confirmed by an intravenous pyelogram. Water-soluble contrast medium show the sigmoidovesical fistula. A sigoid sticture is identified at colonoscopy and biopsy was realised. The patient had had sigmoidectomy with Hartmann's procedure. Histologic study confirm the diverticulatis with peridiverticular abcess and fistula. We suggest that early diagnosis and management of sigmoid diverticulatis is required to prevent complicatins like stricture and fistula.