[Treatment of bleeding duodenal ulcer. A study of mortality and indication of surgical treatment. Apropos of 557 cases]. / L'ulcère duodénal hémorragique. Etude de la mortalité et des critères d'opérabilité. A propos de 557 cas.

From 1986 to 1996, 557 patients are treated for acute ulcer bleeding. The sex ratio is five to one for men, the average age is 40 years old. The duodenal ulcer is revelated by haemorrhage in 25.8%. 181 patients underwent a surgical operation (32%). This percentage is higher that those encountered in the literature, due probably to our specific context (patients from low socioeconomic level, can not afford medical treatment, medical surveillance or control, lack of blood products in emergency. The most practiced surgical treatment is weinberg operation: "Troncular Vagotomy" with "pyroloplasty" and "ulcer sean" practiced in 86.1% of the cases; "Troncular Vagotomy" with "Gastro-intestinal anastomosis" is operated in 7.7% of the cases; "Superselective Vagotomy" and "Seromyotomy" is practiced in 3.8%, with the "Antroduodenectomy" is practiced in 1.1% of the cases. The overall death rate observed is about 4% this value increase to 11% after surgical treatment. This death rate is lower than the literature, that's probably anociated the fact that most of our patients are young and do not hold severe weaknesses. This study indicates that mortality was related to the patient's age, the patient's condition and recurrent haemorrhages.

[An unusual cause of colonic perforation: sinus haemophagocyte histiocytosis]. / Une cause exceptionnelle de perforation colique: l'histiocytose sinusale hémophagocytaire.

The authors report about one case of colic perforation due to sinus histiocytosis with massive lymphadenopathy. This observation has permitted us to give a point of view about this uncommon affection with unknown cause.

[Spontaneous hemoperitoneum complicating intraperitoneal paraganglioma]. / Hémopéritoine spontané compliquant un paragangliome intra-péritonéal.

A young man of 27 years was admitted to the medical ward because of increasing ascites over 3 months. There were no signs of portal hypertension and a diagnostic tap produced hemorrhagic liquid. Ultrasound confirmed ascites associated with an abdomino-pelvic mass. Anemia progressed and right aorto-iliac axis arteriography was carried out and demonstrated a poorly vascularised mass. Emergency surgery was carried out and demonstrated an encapsulated firm and cystic abdomino-pelvic mass of 23/18 cm with a rich vascular supply from the greater omentum and a hemoperitoneum of 7 litres secondary to rupture of this pseudo-lymphangiomatous mass. Besides large vessels from the and some loose fibrous adhesions in the pouch of Douglas there was no true implantation site attaching this mass to retroperitoneal structures, gastrointestinal tract or bladder. After ligation of the vessels the entire mass was easily resected. The post-operative course was uncomplicated. Pathological examination confirmed a paraganglioma. A full clinical pathogenic, therapeutic and evolutive study is described.

[Reflections on the post-cholecystectomy syndrome]. / Réflexions sur le syndrome post-cholécystectomie.

To look for the explanation about the post-cholecystectomy syndrome, the authors study 637 liver's biopsies during cholecystectomy for cholelithiasis. 373 liver's biopsies showed hepatic lesions (58.5 per cent). The post-cholecystectomy syndrome is observed in 36 per cent of patients who had hepatic lesions, and only 13 per cent of patients with normal liver biopsies.