Amoeboma of the gallbladder mimicking a cholangiocarcinoma: A case report.

INTRODUCTION AND IMPORTANCE: Amoeboma is a pseudotumoral presentation of amebiasis which is a parasitic infection caused by entamoeba histolytica. Its location in the gallbladder is extremely rare. Indeed, only one other case was found in the literature. Therefore, we present this case report on managing a gallbladder amoeboma mimicking a cholangiocarcinoma. CASE PRESENTATION: A 62-year-old presenting for consultation for biliary colic that has been developing for 4 months without associated signs. MRI and thoraco-abdominal CT concluded to a cholangiocarcinoma of the gallbladder extended to the liver with probable localized peritoneal carcinosis. We, therefore, performed extended cholecystectomy with lymphadenectomy for the diagnosis of cholangiocarcinoma. Pathology concluded to an amoeboma of the gallbladder extended to the liver and duodenum. CLINICAL DISCUSSION: To our knowledge, there is only one case of gallbladder amoeboma in the literature making this case report valuable. It is important to draw lessons of this observation. Indeed, in front of the discrepancy between the clinic, biology (good general condition and negative tumor markers) and the imaging, we prefer this therapeutic strategy: make a biopsy of the hepatic parenchyma, realize amoebic serology to confirm the diagnosis. Then subject the patient to a therapeutic test based on metronidazole and confirm the disappearance of suspicious lesions by CT scan. CONCLUSION: Gallbladder amoeboma is an exceptional entity, but it needs to be kept in mind in case of an atypical presentation of a cholangiocarcinoma. Evoking and confirming the diagnosis preoperatively makes it possible to avoid excessive surgery.

Complications, treatment, and follow-up of peutz-jeghers syndrome: About 2 case reports.

INTRODUCTION: Peutz-Jeghers syndrome is an inherited disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. Treatment of the polyps is never definitive, with most patients needing several laparotomies. For this reason, surgeons should be economical in terms of surgical resection to prevent a short bowel syndrome in the long run. In this paper, we report two observations of patients presented a Peutz Jeghers syndrome (PJS). CASES PRESENTATION: Case report 1: A 32-year-old women, who was operated on for an intestinal perforation related to a Peutz-jeghers hamartoma of the small bowel and was later re operated on for colonic intussusception, Case report 2: A 15-year-old patient that has been operated on three times already for small bowel intussusception and later for duodenal obstruction. CLINICAL DISCUSSION: In an attempt to reduce complications, the 2010 guidelines updated in 2021 by the European Hereditary Tumor group introduced obligatory monitoring by fibroscopy and colonoscopy associated with an entero-MRI or a videocapsule from the age of 8 years. Laparotomy is indicated when endoscopic treatment is impossible or in emergency setting. When surgery is indicated, intestinal resection should be reserved for rare cases in order to avoid short bowel syndrome. The association of an intraoperative endoscopic treatment is recommended by some authors. CONCLUSION: Peutz Jeghers syndrome is a rare entity with a complicated surveillance. Adequate polyp mapping is necessary for adequate planning of the treatment. The need for multiple laparotomies makes a comprehensive approach to surgery mandatory to prevent short bowel syndrome.

Surgical treatment of a presacral schwannoma: A case report.

Introduction and importance: Schwannomas are rare benign tumors that develop from Schwann cells that represent 0.3 to 0.4 cases per 100,000 persons per year. We report a case of pre-sacral schwannoma, a rare tumor, especially in the pelvic area. This case comes to help further teams in their management as its scarcity made any attempt to make proper recommendations obsolete. Case presentation: a 53-year-old otherwise healthy woman who presented with a 2-year history of right-sided sciatica. The radiologic characteristics of the mass suggested presacral schwannoma type III of the Klimo classification as the most possible diagnosis.Therefore, surgical resection was decided, and an anterior approach was chosen. By laparotomy a 6cm retroperitoneal encapsulated mass with no invasion of the adjacent organs. We performed a digital enucleation of the tumor through a capsulotomy.Pathology confirmed the diagnosis of schwannoma. There were no features of malignancy. The post-operative period was uneventful. A follow-up examination at 6 months showed no signs of numbness or weakness in the right leg. The previously described pain totally regressed. Discussion: Although schwannoma is a benign lesion, it may become malignant, especially when associated with neurofibromatosis making its surgical removal primordial. Its pelvic location may make its diagnosis delayed due to non-specific symptoms mainly through compression of local organs. Its surgical management can be challenging due to large size tumors with adherence to peritoneal and retroperitoneal organs. Quality of the resection is important in the recurrence and necessity for reoperation. A multidisciplinary approach is therefore recommended to ensure optimal treatment. Conclusion: Due to its rareness, there is no clear consensus in on the management of schwannomas therefore we chose to write our case in order to further enrich the literature to achieve one-day guidelines for schwannoma treatment.

Surgical management of primary crohn's disease. descriptive study about 226 patients.

BACKGROUND: The surgery is required in more than 80% of patients with Crohn's disease (CD). Studies before confirm the specific genetic variation of CD in the Tunisian population compared with the others ethnic groups. AIM: This article aims to study the epidemiological, anatomical and therapeutic principles of surgical forms of CD in a cohort of Tunisian patients. METHODS: We report a retrospective study from January 1998 to September 2010 that studied 226 patients originated only from Tunisia (in North Africa), operated on for MC. We had been interested in epidemiological, anatomical, clinical, therapeutic, topographic progression of the disease, the procedure and the postoperative follow-up. RESULTS: The median age was 33 years. The average time between the onset of the disease and the surgical procedure was 31 months. The diagnosis of CD was established preoperatively in 213 patients (94%). The diagnosis was made intraoperatively because of an acute complication in 5 cases (2.2%) and postoperatively in 8 cases (3.5%). The most common location was the ileocecal junction in 184 cases (81.4%). Achieving the most common was the mixed form (stricture and fistula) in 123 cases (54.4%). Operative mortality was 0.04% (n = 1). Specific morbidity was 8.4% (n = 19). In long term, a surgical recurrence was noted in 17 patients (7.5%). In multivariate analysis the independent risk factors for surgical recurrence were: smooking (p = 0.012, ORs = 3.57) and post-operative medical treatment (p = 0.05, ORs = 2.6). CONCLUSIONS: Achieving stenosing and fistulizing the ileocecal junction is the most frequent surgical form in Crohn's disease. Our series is unique for a lower rate of the postoperative recurrence (7.5%).

Risk factors associated with pancreatic fistula after distal pancreatectomy.

BACKGROUND: Pancreatic leak (PL) remains a major cause of postoperative morbidity in patients undergoing pancreatic resection. AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP). METHODS: 35 patients underwent DP during a 10-year period (2000- 2009). Informations regarding diagnosis, operative details, and perioperative morbidity and mortality were collected. Nine risk factors were examined. RESULTS: Indications for DP included primary pancreatic disease (n=23; 66 %) and non-pancreatic disease (n = 12; 34 %). Postoperative morbidity rate was 43 % and none patient died. No patients required a reoperation. Pancreatic fistula was occurred in 11 patients (31 %). On univariate analysis, incidence of pancreatic fistula rate was not significantly associated with these risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, additional procedures, intra operative bleeding and texture of pancreatic parenchyma. We observed significant statistical difference between male and female, 47 % of females experienced a pancreatic fistula, while 17 % males developed a pancreatic leakage (p =0.05). The role of the technique of pancreatic stump closure in the development of pancreatic leak remains unclear because of the few number of patients on who we used stapler. CONCLUSION: The rate of pancreatic fistula after left pancreatectomy is 31 %. The female was identified as a risk factor for occurrence of pancreatic fistula after left pancreatectomy. The role implicated in the use of a mechanical claw for the treatment of pancreatic stump requires a larger number of patients to conclude. The body mass index has not been studied in our series.

[Colo-urachal-cutaneous fistula in an adult]. / Fistule colo-cutanée d'origine allantoïde chez un adulte

BACKGROUND: An infected urachal cyst is an uncommon finding in adults. AIM: To report a case of a sigmoid- urachal- cutaneous fistula. CASE REPORT: A 51 years old adult male presented with fecaloid leaking from rupture of an infected urachal cyst. Definitive management consisted of resection of the urachus with a bladder cuff, along with removal of the affected bowel segments. CONCLUSION: Colo-urachal-cutaneous fistula is a rare condition; its management is rather complex.

[Malignant intraductal papillary mucinous tumours of the pancreas. A three cases report]. / Tumeurs intracanalaires papillaires et mucineuses dégénérées du pancréas: à propos de trois cas.

BACKGROUND: Intra ductal papillary mucinous tumors of pancreas are rare and are characterized by a risk of malignant transformation. AIM: To clarify their clinical presentation and the performance of different imaging examinations to determine their benign or malignant and achieve their staging. CASES: We report three cases of degenerate intra ductal papillary mucinous tumors of pancreas. The combination of CT, the pancreato- MRI and duodenoscopy has led to the diagnosis in all cases. A pancreaticoduodenectomy were performed in two cases. CONCLUSION: The various imaging techniques allow better detection and analysis of the tumor including the evaluation criteria of degeneration. The treatment of these lesions is still surgery.

Acinar cell carcinoma of the pancreas: a rare tumor with a particular clinical and paraclinical presentation.

Acinar cell carcinoma (ACC) of the pancreas is a rare tumor with an extremely low incidence rate. While the number of reported patients with ACC is relatively small, a long-term survival rate has been noted in patients with neuroendocrine differentiation. A 39-year-old woman visited our emergency department for upper gastrointestinal bleeding. Endoscopy indicated extrinsic compression of the posterior body of the stomach, together with a large, 10-cm, central ulcer covered with necrotic tissue. Abdominal computed tomography (CT) indicated a lesion that involved the whole of the pancreas, with a fistula in the stomach, which was suspected of being a degenerative intraductal papillary mucinous tumor of the pancreas. Magnetic resonance imaging (MRI) of the pancreas was performed, and the results further strengthened our suspicions by demonstrating the presence of cystic lesions and tumor buds. A total duodenopancreatectomy, including total splenectomy and gastrectomy, was performed, along with two independent Roux-en-Y anastomoses (one esojejunal and one hepaticojejunal). The tumor also had a wide opening in the stomach. The patient's postoperative course was marked by partial thrombosis of the portal vein, which was treated medically. Histopathological examination provided evidence of pancreatic ACC. The diagnosis of ACC should be considered in the presence of cutaneous lesions, which were absent in the case of our patient, and colonoscopy is also highly desirable because of the various forms associated with familial adenomatous polyposis. The prognosis, which includes a 5-year survival rate of 45%, in the population with an R0 resection is better than that for ductular adenocarcinoma, thus prompting the more aggressive management of this type of tumor.

[Tomodensitometric diagnosis of internal herniation: report of 3 cases]. / Apport de l'enteroscanner dans le diagnostic pre operatoire des hernies internes: a propos de 3 cas.

AIMS: To study the value of the CT scan in the diagnosis of internal herniation and to evaluate its performance comparing its features to preoperative data. CASES: We report 3 cases of patients with internal hernias (two men and one woman whose age is 23, 45 and 60 years) hospitalised in emergency for a small bowel obstruction. There were no previous abdominal surgeries or trauma, The three patients underwent CT scan. Signs of tranmesenteric hernias and hernia through the falciform ligament were diagnosed preoperatively and confirmed at laparotomy. CONCLUSION: The internal hernia is rare cause of small bowel obstruction. The CT scan is an important way to make diagnosis and to choose the surgical strategy.

[Peripancreatic sporadic gastrinoma]. / Gastrinome sporadique péri-pancréatique.

BACKGROUND: The peri-pancreatic sporadic gastrinoma represents a paradigm of digestive endocrinology. It was originally an abnormal secretion of gastrin fits the syndrome Zollinger-Ellison. AIM: The objective of our work is to clarify the diagnostic strategy and therapeutic conduct of gastrinoma. CASE: We report the case of a patient aged 42 years, hospitalized for bleeding duodenal ulcer, revealed a Zollinger-Ellison syndrome. The different explorations have shown that it was a primitive péripancréatique sporadic gastrinoma. In surgery, we discover a rétropancréatique tumor associated to a stenosis post-bulbar ulcer. It was conducted a enucleation of the tumor with vagotomie troncular and gastroenteroanastomosis. The forecast was favourable with normalization of the values of gastrinémie. CONCLUSION: The sporadic gastrinoma is rare, its emphasis is increasingly being facilitated by the technology of modern medical imaging, belonging to a polyendocrinopathie must be systematic search. Treatment of pancreatic gastrinoma is multidisciplinary. Surgery is the only cure for this disease.

[Early gastric adenocarcinoma]. / Adénocarcinome superficiel de l'estomac.

AIM: the purpose of this study was to determine the epidemiological and clinical behaviour of the superficial adenocarcinoma of the stomach, to clarify its pathological characteristics, its therapy and prognosis. METHODS: Over a period of 14 years (1990-2004), 16 patients were operated for a superficial gastric adenocarcinoma among 155 gastric cancers treated during the same period in the service of general surgery "A" La Rabta. RESULTS: The superficial gastric adenocarcinoma represented 10.3% of our series. The mean age was 59 years, 8 men and 8 women. Two patients were followed for a chronic stomach ulcer, a patient is followed for Biermer anaemia and another one for Menetrier disease. Among these cancers, 12 were intra mucosal and 4 invaded the submucousa. Lymph node involvement was present only in one case. The cancer was located in the antrum in 8 cases and was multifocal in 3 cases. One patient died in postoperative case because of a medical cause. The 5-year-overall survival was 65,6%. The recurrence had interested only one patient. CONCLUSION: the superficial gastric adenocarcinoma is rare. The follow up of precancerous states allows its diagnosis. The treatment is based on the gastric resection associated to the D1-type lymph node clearance. The multifocal character imposes a surveillance of the remaining gastric stump.

[Laparoscopic ileocecal resection for Crohn's disease]. / Resection ileo-caecale laparoscopique pour maladie de Crohn.

UNLABELLED: The aim was to evaluate the reliability and safety of laparoscopic ileocecal resection for Crohn's disease and to report our preliminary results. METHODS: A retrospective analysis of 20 patients undergoing a laparoscopic ileocecal resection for Crohn's disease was carried out between November 2003 and June 2005. First of all, we defined the inclusions and exclusions criteria which allowed us to select the patients who would be resected laparoscopically. Fistulizing disease, emergent surgery (perforation, occlusion), large mass and patients with previous laparotomy were excluded. Duration of operation, rate of conversion, complications and time from discharge from hospital were evaluated. RESULTS: Median operation time was 160 min. Conversion to laparotomy was needed in three cases. There was no death. Minor complications occured in 2 patients. Median postoperative time for discharge was 5 days. CONCLUSION: These preliminary results indicate that laparoscopic ileocecal resection is a feasible and safe alternative in patient with Crohn's disease offering many advantages thanks to a strict patient selection.