[Primary hepatic tuberculosis in an immunocompetent patient: a case report]. / Tuberculose hépatique primaire chez un immunocompétent: à propos d'un cas.

Tuberculosis (TB) is a common infectious disease that most often affects the lungs, but it can also affect any other organ with a wide range of clinical manifestations. There are three forms of hepatic involvement: diffuse hepatic tuberculosis combined with pulmonary tuberculosis; diffuse hepatic tuberculosis without pulmonary involvement; and nodular or focal/local hepatic tuberculosis, which is a very rare form and presents a diagnostic challenge. We here report the case of a young Moroccan man presenting with biliary colic that had been evolving for a month, associated with a forme fruste of tuberculous impregnation. CT scan and magnetic resonance imaging (MRI) of the liver showed nodular hepatic lesions. The diagnosis of focal hepatic tuberculosis was confirmed based on anatomopathological examination of biopsies obtained during laparoscopy. The patient received antitubercular treatment with good clinical-biological outcome.

[Exploration of the small intestine through single-balloon enteroscopy, experience in the Mohammed V Training Military Hospital in Rabat: about 51 cases]. / Exploration du grêle par entéroscopie simple ballon, expérience de l´Hôpital militaire et d´instruction Mohamed V de Rabat: à propos de 51 cas.

Enteroscopy has become an indispensable technique for the exploration and, in particular, the treatment of small intestine lesions. It is usually performed following video capsule endoscopy of the small intestine. Three equivalent techniques exist: double balloon enteroscopy, single balloon enteroscopy and spiral enteroscopy. The purpose of this study is to describe the technical feasibility of single balloon enteroscopy as well as its tolerance, indications and the results obtained in our context. We conducted a retrospective and descriptive analysis of the records of patients undergoing single balloon enteroscopy in the Department of Gastroenterology at the Mohammed V Training Military Hospital in Rabat over an 8-year period. Inclusion criteria were: small intestine disease or the suspicion of small intestine disease on imaging tests or video-capsule endoscopy and having undergone single balloon enteroscopy. The variables studied were the technical feasibility of single balloon enteroscopy, its indications, results and complications. Fifty-one (51) patients, including 30 men and 21 women with an average age of 48 years (18 years-91 years), were included in the study. The technique used in all patients was single balloon enteroscopy under general anesthesia with intubation. The mean duration of single balloon enteroscopy via the upper gastrointestinal (GI) tract (antegrade) was 45 min and 60 min via the lower GI tract (retrograde). The small intestine was explored up to the proximal ileum via the upper gastrointestinal (GI) tract and through more than 120cm from IAD via the lower GI tract. The indications included: unexplained digestive bleeding (72%), small intestine wall thickening (17%), the suspicion of small intestine tumor (6%), evaluation of Crohn´s disease (4%) and endoscopic video capsule (ECV) reduction (2%). Diagnosis was made or confirmed in 29 patients, reflecting a diagnostic efficiency of 57%. Angiodysplasia accounted for 70% of the lesions, ulcerations 10%, stenoses 7%, tumors 7%, diverticula 3% and spontaneous ECV reduction 3%. Endoscopic treatment was performed in 20 patients, with a therapeutic efficiency of 39%; it was based on argon plasma coagulation of gastroenteric angiodysplasia lesions. No complications were observed in our case series. Single balloon enteroscopy is a well-tolerated examination which allows for the exploration of a long portion of the small intestine. Multiple and various indications were provided in our study and the diagnostic and therapeutic benefits were satisfactory.