Encysted Peritoneal Tuberculosis Masquerading as Ovarian Tumour: A Case Report.

Peritoneal tuberculosis (TB) is one of the types of extrapulmonary TB that predominantly involves the omentum, liver, intestinal tract, spleen, or female genital tract. It can occasionally result in gynecological-related oncology diagnoses such as advanced ovarian cancer due to its non-specific signs and symptoms, making it very difficult to detect. This report presents a case of a 22-year-old female who presented with the chief complaints of pain and distension of the abdomen for one month with dysuria. Ultrasonography and magnetic resonance imaging was performed that reported a large uni-loculated cystic pelvic abdominal lesion likely to be of ovarian origin and suggestive of neoplastic etiology with bilateral hydroureteronephrosis. To confirm the diagnosis, an exploratory laparotomy was performed which revealed extrapulmonary abdominal TB, and was registered for Directly Observed Treatment Shortcourse (DOTS) following which anti-tubercular drugs were given. In conclusion, this case report highlighted the masquerading behavior of encysted peritoneal TB as an ovarian tumor, and the fact that it should, therefore, should be considered in the differential diagnosis in regions where TB remains endemic, such as in developing countries. Hence, an appropriate diagnosis can prevent the need for unnecessary surgical operations and adequate therapy can save the patient's life.

Benign disease of the thyroid gland and vocal fold paralysis.

Development of vocal fold paralysis in the presence of thyroid disease is strongly indicative of thyroid cancer, and requires surgical exploration. At the same time, vocal fold paralysis does not relieve the surgeon of his obligation to identify and preserve the recurrent laryngeal nerves, since the cause of the paralysis may be a benign disease, with a fair chance of functional recovery after surgery. We hereby report a case of recurrent laryngeal nerve palsy secondary to a multinodular goitre.

[A rare manifestation of hypothyroidism: intestinal obstruction. Report of 2 cases and review of the literature]. / Manifestation rare de l'hypothyroïdie: l'occlusion intestinale. Rapport de deux cas et revue de la littérature.

Gastrointestinal manifestations of hypothyroidism are unfrequent. They consist particularly in hypomotility, intestinal atony, and pseudoobstruction. A high index of suspicion must exist, especially in elder subjects, in order to avoid unnecessary and even harmful investigation and intervention. We are reporting two cases of intestinal occlusion due to hypothyroidism with review of the literature.

[Laparoscopic adrenalectomy for pheochromocytoma. Case report and review of the literature]. / Surrénalectomie coelioscopique pour phéochromocytome. Rapport d'un cas et revue de la littérature.

Laparoscopic surgery has a wide application in general surgery. Since the first laparoscopic adrenalectomy, this approach has quickly been adopted, and increasing numbers are being reported. The small size of the adrenal gland, the benign nature of most adrenal tumors and the difficulty in reaching the organ via open means make resection of this gland particularly amenable to the laparoscopic approach. The potential benefits of this mini-invasive surgery include decreased operation blood loss, reduced narcotics requirements, shorter hospital stay and recovery time and minimize the parietal trauma. We report herein the first Lebanese case of laparoscopic adrenalectomy for pheochromocytoma with review of the literature.

[Parathyroidectomy under local anesthesia. First two cases in Lebanon and review of the literature]. / Parathyroïdectomie sous anesthésie locale. Deux premiers cas au Liban et revue de la littérature.

The routine use of automated techniques to measure serum calcium levels have made disease states of the parathyroid gland a common endocrinologic problem. Because of the low sensitivity and specificity of early radiologic techniques to identify enlarged parathyroid glands, and because skilled endocrine surgeons report success rates of > 95% in identifying abnormal parathyroid glands, historically most parathyroid glands surgery consisted in a large cervicotomy under general anesthesia without preoperative localization. However, the development of sophisticated imaging techniques has now made it possible to identify the abnormal gland in a significant number of patients, leading some surgeons to choose unilateral neck exploration under local anesthesia for primary hyperparathyroidism. The success of the procedure is ascertained by measuring PTH peroperatively. We report the first two Lebanese patients, presenting with a solitary parathyroid adenoma, who underwent this easy, safe and cost-effective surgical technique.

[Radiation-induced esophageal cancer. Presentation of a case and review of the literature]. / Cancer de l'oesophage radio-induit. Présentation d'un cas et revue de la littérature.

Esophageal cancer induced by radiation is uncommon. Irradiation of the head, the neck, the chest and the abdomen may cause an esophageal cancer several years later. Therefore, regular gastroscopy and biopsy of esophageal mucosa are strongly recommended in symptomatic patients. Surgery combined or not with radiotherapy seems to be the most effective treatment for this kind of cancer. We report a case of squamous cell carcinoma of the esophagus diagnosed 13 years after chemotherapy and radiotherapy for Hodgkin disease stade IIIb.

[Metastatic implants after laparoscopic cholecystectomy in unsuspected gallbladder cancer. A case report and review of the literature]. / Implants métastatiques apres cholécystectomie laparoscopique d'un cancer non suspecté de la vésicule biliaire. Rapport d'un cas et revue de la littérature.

A gallbladder carcinoma, diagnosed preoperatively, is a counter-indication for laparoscopic cholecystectomy. When this cancer is not diagnosed and laparoscopic surgery is undertaken, neoplastic dissemination may occur along the trocars pathways which renders the prognosis even worse. The most probable explanation of the dissemination is a seeding of sloughed cancerous cells onto abdominal wall during exsuflation. The authors report the case of a 36-year-old woman with an adenocarcinoma of the gallbladder discovered after laparoscopic cholecystectomy and who has had rapid intra-abdominal and parietal metastases.

[Unusual metastases of breast cancer]. / Métastases inhabituelles du cancer du sein.

The breast cancer is the common cancer in female. The metastasis may occur any where in the body. The common sites are in the lymph nodes, the bones, the chest, the liver and the brain. Other sites of metastasis have little importance, rarely researched and constitute the objective of this article.

[Spontaneous splenic rupture due to heparin. Report of a case and review of the literature]. / Rupture spontanée de la rate sous héparine. Rapport d'un cas et revue de la littérature.

We describe in this report a case of spontaneous rupture of the spleen in a 68-year-old man on heparin therapy for cerebrovascular disease. This spontaneous splenic rupture is a rare complication of anticoagulant or thrombolytic therapy. Twenty cases were reported in the world medical literature. Only one case was due to heparin. The clinical presentation, which includes mainly abdominal and left shoulder pain with shock, could mimic cardiac diseases and delay or even mask the diagnosis. The mechanism of the rupture is still unknown. It is possible that altered hemostatic mechanisms may aggravate unrecognized micro trauma to provoke a rupture of the spleen. Once the rupture is suspected, the diagnosis can be confirmed with CT scan, or ultrasound. The treatment will be mainly reversal of anticoagulation and splenectomy.

[The place of enucleation in the surgical management of hepatic hemangioma. Report of a case and review of the literature]. / Place de l'énucleation dans le traitement chirurgical de l'hémangiome hépatique. Rapport d'un cas et revue de la littérature.

Hepatic hemangioma is the most frequent benign tumor of the liver. It is often asymptomatic. If surgery is needed the best method will be enucleation of the hemangioma. We report a case of enucleation of a cavernous hepatic hemangioma with review of the literature.

[Gastric metastases of breast cancer]. / Métastases gastriques du cancer du sein.

Breast cancer is the most frequently encountered cancer in women and the first cause of death in the female population. Metastasis may occur ubiquitously depending on the histological type and the presence or absence of oestroprogesterone receptors. We report three cases with gastric metastasis. Signs of gastric involvement are often non-specific and should not be mistaken for simple side reactions to treatment. Hormone chemotherapy is indicated in most situations but surgery may be needed. It should be noted that gastrointestinal metastasis predominates in lobular breast cancers positive for progesterone receptors.

[Aneurysm of the hepatic artery treated by embolization]. / Anévrisme de l'artère hépatique traité par embolisation.

The hepatic artery aneurysm represent 16 to 20% of visceral artery aneurysms. The man of 40 years of age is often affected. This aneurysm is often asymptomatic. The rupture menace its evolution and justify the treatment. Echo-doppler-color constitute a non invasive exam of choice for diagnosis. Embolisation has a more extent indications. A case is reported of an aneurysm of the hepatic artery treated with embolisation with review of the literature.

[Retroperitoneal duodenal rupture during closed abdominal trauma]. / Les ruptures du duodénum rétropéritonéal au cours des traumatismes fermés de l'abdomen.

Duodenal retroperitoneal wound after blunt abdominal trauma, is a well known, and a classical entity. Most of the patients are operated with delay and this lesion could easily be missed at laparotomy if not searched for. Mortality and morbidity are much higher if the diagnosis is delayed more than 24 hours. These lesions should be strongly suspected after any blunt abdominal trauma, and repeated clinical assessment is mandatory in the conscious patient. Gastrografine upper GI study and CT Scan are interesting diagnosis procedures when the patient is unconscious or should be anesthesized. At laparotomy, the presence of a central retroperitoneal hematoma should guide the surgeon to explore the duodenum. Treatment depend on the time of diagnosis, the severity of the wound, and the associated pancreatic lesions.