A rare case of small intestinal metastasis from lung cancer.

We report the case of a 61-year-old male patient who was admitted with abdominal pain, vomiting and constipation. He had a past medical history of epidermoid lung cancer .computed tomography revealed distended stomach with mural bowel thickening. It was peroperatively two small-bowel metastasis from lung cancer that we resect.

Acute post-traumatic dermoid peritonitis: A rare entity.

Rupture of ovarian dermoid-cyst is rare case. We report the case of a woman admitted for acute post-traumatic abdominal pain due to ruptured ovarian cyst. The patient was operated and we found a very abundant peritoneal effusion with left ovarian cyst which was broken. we performed a left adnexectomy.

[Predictive factors for anastomotic leakage after colon cancer surgery]. / Facteurs prédictifs de fistule anastomotique après colectomie pour cancer.

Introduction: in colon cancer surgery, anastomotic fistula (AF) is considered the most feared complication. The purpose of this study was to identify predictive factors associated with anastomotic fistula after colon cancer surgical resection and to describe the impact of this complication on mortality and postoperative length of stay. Methods: we conducted a retrospective, descriptive and analytical study in the Department of General Surgery at the Habib Bourguiba Hospital in Sfax, Tunisia from 1st January 2013 to 31 December 2020. Results: we collected data from the medical records of 163 patients who had undergone surgery for colon cancer. The average age of patients was 62.7 years with a sex ratio of 1.36. The postoperative course was uneventful in 64.4% of cases and complicated in 35.6% of cases. Surgical morbidity was mainly due to anastomotic fistulas (22 patients). This study demonstrated that predictors of the development of this complication were: diabetes p = 0.04, smoking p = 0.01, hypoalbuminaemia p = 0.01, preoperative haemoglobin less than 10g/dl, p < 0.01, anastomotic fistula located in the left colonic angle p = 0.02, perioperative transfusion p <0.01, and duration of surgery longer than 180 min p = 0.04. Moreover, the occurrence of anastomotic fistula was associated with specific mortality rate (9%) and significantly prolonged postoperative length of stay. Conclusion: the prevention of anastomotic fistulas should be part of a multimodal approach based on the correction of nutritional deficiencies and possible pre-operative anemia.

[Dermatofibrosarcoma protuberans (Darier-Ferrand) of the abdomen: a case report]. / Localisation abdominale d'un dermatofibrosarcome de Darrier et Ferrand: à propos d'un cas.

Dermatofibrosarcoma is a rare skin tumor. Morphological characteristics can be misleading and unknown to most of physicians. Diagnostic delay may affect patient´s management and prognosis. We here report the case of a young patient with lesions protruding from the abdominal wall mistaken for benign cysts. X-ray examination revealed subcutaneous adipose tissue mass. This was suspected of being a fibrosarcoma. The mass was resected with a macroscopic safety margin. The anatomo-pathological study confirmed the diagnosis of dermatofibrosarcoma. Clinical and radiological follow-up examinations didn´t show any recurrence. This study highlights the importance of suspecting this rare tumor requiring specialist treatment.

Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases.

BACKGROUND: The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens. METHODS: All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis. RESULTS: A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (P < 10-6) and cholesterolosis was more prevalent in young patients (P < 10-6). There was no gender predilection for GBC (P = 0.739). CONCLUSIONS: The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.

Should we treat white line hernias by laparoscopy? About a prospective study of 42 cases.

UNLABELLED: We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric hernia operated by laparoscopy with a 1 year mean follow-up. The purpose of our study is to investigate the contribution of laparoscopy in the treatment of in terms of results in the short and medium term. Early surgical morbidity was 14.3%. There was no mortality. At 6 months of the intervention, 28.5% of patients have kept umbilical pain. At 1 year of intervention, 2 patients have kept umbilical chronic pain. No case of recurrence was noted. In conclusion, the laparoscopic approach should be reserved for cases of large hernias and for recurrent and incisional hernias. KEY WORDS: Epigastric hernia, Laparoscopy, Mesh, Umbilical hernia.

[Surgical complications of colostomies]. / Les complications chirurgicales des colostomies.

BACKGROUND: The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. AIM: reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. METHODS: A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. RESULTS: Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. CONCLUSION: Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.

Acute pancreatitis as initial manifestation of adult Henoch-Schönlein purpura: report of a case and review of literature.

Abdominal pain observed in Henoch-Schönlein purpura (HSP) is usually attributed to edema and hemorrhage in the small bowel wall, secondary to a small-vessel vasculitis. Pancreatitis secondary to HSP is extremely rare. Here we report a 53-year-old man presented with acute pancreatitis that developed into characteristic rashes seen during HSP at the second day of the clinical onset, together with arthritis and glomerulonephritis. HSP is a rare and benign cause of acute pancreatitis. This complication can occur as an initial manifestation of HSP. Elevated serum amylase level can be considered as the early diagnostic tool for HSP pancreatitis. The patients with HSP who have abdominal pain as their chief complaint should be evaluated for pancreatitis, by routine serum amylase and abdominal computed tomography scan, to plan the specific treatment and avoid unnecessary surgery.

Traditional versus three-dimensional teaching of peritoneal embryogenesis: a comparative prospective study.

INTRODUCTION: Anatomy teaching is newly boosted by the development of interactive three-dimensional (3D) teaching techniques. Nevertheless, their superiority as teaching aids has never been demonstrated. The aim of this study was to compare 3D and traditional chalk teaching efficiency in terms of student memorization concerning peritoneal embryogenesis. MATERIALS AND METHODS: 165 students from the Faculties of Medicine of Sfax (Tunisia) (n = 81) and of Paris-Descartes (France) (n = 84) were taught peritoneal embryogenesis either via a 3D technique (interactive DVD ROM) (3D group, n = 85) or via the traditional chalk technique (CL group, n = 80). Both groups were subjected to an evaluation test including 34 questions distributed in six chapters at the end of the course. RESULTS: The overall rate of correct answers was higher in the 3D group (65.12 +/- 14.88 vs. 49.33 +/- 16.17%, p < 0.001). It was the same for five of the six chapters of questions excluding the chapter concerning the clinical implications (p = 0.06). There was no significant difference between 3D and CL groups regarding the 20 questions focusing on static phenomena (64.52 +/- 27.10 vs. 58.87 +/- 23.67%, p = 0.24), but the rate of correct answers was higher in the 3D group for the 14 questions focusing on dynamic phenomena (65.96 +/- 20.97 vs. 28.17 +/- 24.40%, p < 0.001). CONCLUSION: The 3D technique is significantly more efficient than the traditional chalk technique for the teaching of peritoneal embryogenesis in terms of short-term memorization and particularly for the assimilation of dynamic phenomena. Medium-term and long-term studies are needed to demonstrate that this benefit has a long-lasting impact.

[Hydatid cysts of the spigelian lobe (segment I) of the liver: clinical and therapeutic particularities]. / Kystes hydatiques du lobe de Spiegel: particularités cliniques et thérapeutiques.

OBJECTIVE: Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. METHODS: We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy. RESULTS: We treated 44 hydatid cysts of segment I surgically in 10 men and 34 women, with a mean age of 40.6 years. Ten patients (22.7%) had a history of hydatid cysts. Symptoms or complications were noted at admission in 45% of cases. Only five cases (11.4%) required emergency surgery. Surgical examination confirmed vascular compression in 17 cases (38.6%) and a biliary fistula in 17 cases (38.6%). Surgical treatment consisted of deroofing in 37 cases (84,1%), with omentoplasty in 23 (54%), subtotal pericystectomy in 3 and simple drainage in 4. Large biliary fistulas (> 5 mm) were treated with bipolar drainage in 2 cases and internal transfistulary drainage in 3. Some hemorrhaging occurred during surgery in 5 cases, and one cyst ruptured in the peritoneal cavity. Albendazole was prescribed postoperatively for nine patients. There was one intraoperative death, secondary to hemorrhage resulting from erosion of the inferior vena cava. Morbidity was 25%. After a mean follow-up of 32 months, five patients had recurrences in the liver but outside segment I. CONCLUSION: Segment I of the liver is a rare site for hydatid disease, and a site where vascular and biliary complications are frequent. Its management requires a good knowledge of the vascular anatomy of the liver and wide experience of hydatid cyst surgery and especially of simple surgical procedures.