Bezoar in Meckel's diverticulum: Case report and narrative review.

INTRODUCTION: Bezoars are a known cause of complications in Meckel's diverticulum. We present a case in which a bezoar in a Meckel's diverticulum resulted in intestinal obstruction. In addition, we conducted a narrative review to explore the association between Meckel's diverticulum and bezoars. CASE PRESENTATION: We present the case of a 22-year-old patient admitted for bowel obstruction persisting for three days and periumbilical tenderness. Abdominal CT tomography revealed a hyper dense circular structure with a diameter of 2 cm, small bowel distension of 41 mm, and free fluid. During surgical exploration, a Meckel diverticulum was found between the antimesenteric border of the small bowel and posterior wall of the umbilicus. The Meckel diverticulum was resected, and upon examination, it was found to contain a calcified phytobezoar. The postoperative course was uneventful. DISCUSSION: The clinical and paraclinical presentation of bezoars in Meckel's diverticulum is nonspecific and diagnosis remains challenging despite improved diagnostic modalities. The association between Meckel's diverticulum and bezoars is often identified during surgery, as it is difficult to diagnose using CT scans. The choice between laparoscopic and open surgery depends on the patient's situation. CONCLUSION: Diagnosing a bezoar in a Meckel's diverticulum remains challenging. Treatment involves surgery, and the choice of surgical approach depends on the context.

Pylephlebitis complicating acute calculous cholecystitis: A case report.

Pylephlebitis is a complication of intra-abdominal infections. Its occurrence during cholecystitis is a rare situation. We report the case of a 43-year-old female patient who presented with septic thrombosis of the right portal branch following acute calculous cholecystitis diagnosed on abdominal CT. The clinical evolution was favorable under antibiotic therapy and a cholecystectomy was scheduled.

Epidemiology of Digestive Surgical Emergencies in a Sub-Saharan African Country: A Multicentre Pilot Study Protocol.

Introduction: Digestive surgical emergencies remains one of the main general surgery activities. Despite the associated mortality rate in low income countries, epidemiologic data about this subject is rare and multicenter studies are even more. We aimed to study an epidemiology of digestive surgical emergencies in Senegal by multicenter protocol. Methods and analysis: it will a prospective multicenter pilot study from May to July 2022. The patients were from General surgery departments of these teaching hospital in Senegal: Dakar Principal Hospital, Aristide le Dantec Hospital, Dalal Jamm hospital and Saint-Louis Regional Hospital. The Schwartz formula was used. We used a proportion of abdominal surgical emergency of 20%. We had a sample size of 246 patients. Ethics and dissemination: this research protocol will be submitted to Ethics committee of four hospital that included. The results of this study can help to get better the management of our digestives emergencies and at the same time improve mortality rate. Highlights: Digestive surgical emergencies is a public health issueBecause of high mortality rate in poorest countries, epidemiological data in Senegal must be knownThese information can help to lower associated mortality.

Laparoscopic treatment for colonic injuries following penetrating trauma: A feasible option in a surgical department of Sub-Saharan Africa.

Introduction: The management of abdominal penetrating trauma remains complex. Between the risk of negative laparotomy and missed visceral injury, laparoscopy is a good alternative. We report 2 cases of abdominal penetrating trauma with colonic injury diagnosed and treated with laparoscopic approach. Observations: The first patient was 15 years old, with no medical history and received at 3 h of a penetrating trauma by stabbing. Hemodynamic status was normal. An exploratory laparoscopy was performed. It objectified a penetration of the peritoneum on the left flank with an injury of the anti-mesenteric edge of the descending colon that was sutured. The second patient was 20 years old, with no history, who had a penetrating trauma of the left iliac fossa by stabbing. Arterial pressure was normal. He was received 6 h after the trauma. An exploratory laparoscopy objectified an injury of 2 cm located at the sigmoid colon which was sutured with a good evolution. Conclusion: Laparoscopy in abdominal wounds is a good option in selected patients. It has a diagnostic and therapeutic importance in colonic injuries. The limits are represented by the possibility of unrecognized visceral lesions that can lead to additional morbidity.

Management of midline ventral hernias in a surgical department of sub-Saharan Africa: A retrospective cohort study.

Introduction: The linea alba is the second most frequent site of abdominal wall hernias after the inguinal region. Prosthetic approach, often recommended, comes up against the low socio-economic level and the availability of these materials in developing countries. Our objective is to evaluate the indications and results of midline ventral hernia surgery. Methods: This was a retrospective cross-sectional study over 36 months including all adult patients (over 15 years old) treated for primary or recurrent midline ventral hernias. The parameters studied were: age, sex, risk factors, type of hernia according to the classification of the European Hernia Society (EHS), clinical presentation, hernial ring size, surgical technique and results (recurrence, chronic pain). Results: We included 65 patients. The mean age was 40.5 years ± 16.4. There was a female predominance (56.3%, n = 36) with a sex ratio of 0.77. According to the EHS classification, type M3 (umbilical) was more common (67.2%), followed by type M2 (epigastric) in 25% and M4 (infra-umbilical) in 1.6%. According to the clinical presentation, 85.6% (n = 55) were uncomplicated, 10.9% (n = 7) were strangulated in and 3.1% (n = 2) incarcerated. A primary suture was performed in 93.8% (n = 61) and a mesh repair in 6.15% (n = 4). With a mean follow-up of 8.2 ± 11.9 months, we noted a recurrence in 6.1% (n = 4) and chronic pain in 6.1% (n = 4). Conclusion: There is a need to individualize or contextualize the guidelines. In our context where meshes are not always available, pure tissue repairs keep their place in the treatment.

Efficacy of laparoscopic surgery in the treatment of hepatic abscess: A systematic review and meta-analysis.

BACKGROUND: Liver abscess is a common cause of intra-abdominal infection and its treatment depends on the presentation. Laparoscopy, in addition to its classic benefits, has particular advantages in the management of liver abscess but its role is not well defined and studies done in that field are heterogenous. The objective of this systematic review is to evaluate the efficacy of laparoscopic surgery in the management of liver abscess. METHODS: We realized a systematic review and meta-analysis including studies published in the 20 last years. The primary outcome was the pooled prevalence of recurrent or residual liver abscess after laparoscopic treatment. RESULTS: We retrieved 190 studies regarding laparoscopic surgery in liver abscess and 17 studies were included in the quantitative and qualitative synthesis. A total of 608 patients was included and 299 of them (49.1%) were treated by laparoscopic surgery. The indications were mainly failure of first line treatment (antibiotic treatment and/or percutaneous drainage and/or needle aspiration) and ruptured multiloculated, or caudate lobe liver abscess. The surgical gesture performed was laparoscopic drainage in all studies. The post-operative rate of recurrent or residual liver abscess after treatment by laparoscopy was 4.22% (95% CI: 2.29-7.07). CONCLUSIONS: This systematic review showed that laparoscopic drainage had a considerable place in the management. The post-operative rate of recurrence was low with no mortality suggesting that laparoscopy is safe and feasible for liver abscess management.

QSIRS Can Improve Accuracy of QSOFA and SIRS in Prediction of Mortality in Surgical Emergencies.

Background The quick sequential organ failure assessment (QSOFA) score and the systemic inflammatory response syndrome (SIRS) criteria were developed to predict the risk of sepsis and death in patients received in emergency. To improve sensitivity in predicting death, the association of the two scores was proposed under the term QSIRS (QSOFA + SIRS). Our aim was to determine the accuracy of QSOFA, SIRS, and QSIRS in prediction of mortality in surgical emergencies, and to compare these scores. Patients and Methods This is a prospective study over a period of 1 year. Patients older than 15 years who presented a digestive surgical emergency (bowel obstruction, peritonitis, appendicitis, strangulated hernia) were included. For each score, the specificity, the sensitivity, the positive predictive value, the negative predictive value, and areas under the receiver operating characteristic (ROC) curve (AUC) were compared. Results One hundred and eighteen patients were included and 11 deaths were recorded (9.3%). There was a statistically significant relationship between each score and death (QSOFA p = 0.01, SIRS p = 0.003, and QSIRS p = 0.004). The realization of the ROC curve found a higher AUC for QSIRS (0.845 [0.767-0.905]) compared with QSOFA (0.783 [0.698-0.854]) and SIRS (0.737 [0.648-0.813]). QSIRS (90.9%) had a higher sensitivity compared with the two other scores alone (SIRS = 81.9% and QSOFA = 36.3%). Conclusion Our study found that QSIRS improves the ability to predict death in digestive surgical emergencies.

Is Desarda technique suitable to emergency inguinal hernia surgery? A systematic review and meta-analysis.

BACKGROUND: Despite the fact that Lichtenstein is the gold standard for uncomplicated inguinal hernia, the use of mesh in an emergency context remains controversial. Pure tissue repairs have an essential role in the management of incarcerated or strangulated inguinal hernia. To date, there has been little agreement on what is the best surgical technique suitable for emergency hernia surgery. This systematic review aims to evaluate the efficacy and safety of the pure tissue Desarda technique for emergency inguinal hernia repair. METHODS: A complete search of electronic databases including PubMed/Medline, Web of Science, Embase and, Cochrane library was realized. Newcastle-Ottawa-Scale (NOS) (selection and outcome criteria) was used for quality assessment of included studies. The pooled prevalence of post-operative complications (surgical site infection, hematoma/seroma, chronic pain and, recurrence rate) was estimated. RESULTS: We included 5 studies from different countries. There were 2 randomized controlled trial and 3 observational cohort studies. Totally, there were 199 patients with a mean age of 57.6 years. Male patients were predominant (n = 196). The pooled prevalence of surgical site infection and hematoma/seroma was respectively 16.56% (95% CI: 11.74-22.39) and 12.43% (95%CI: 6.90-20.108). The pooled prevalence of chronic pain and recurrence was respectively 4.35% (95% CI: 1.04-11.47) and 2.10% (95%CI: 0.61-5.14). CONCLUSIONS: In summary, Desarda technique is feasible in emergency context with good results. We found any particularly important rate of complications considering the surgery in emergency context. Further studies should be realized to raise the level of evidence.

Gingival metastasis of a breast carcinoma.

We report a case of metastasis to the gingiva of breast carcinoma. The breast tumor was treated with neoadjuvant chemotherapy followed by a radical mastectomy associated with axillary dissection. The gingival lesion occurred 7 months after surgery; the metastasis was confirmed by a biopsy.

Synchronous sigmoid and transverse volvulus: A case report and qualitative systematic review.

INTRODUCTION: Colonic volvulus is defined as a torsion of a part of the colon causing large bowel obstruction by strangulation which may lead to ischemia and then necrosis. The synchronous occurrence of a sigmoid colon and transverse colon volvulus is exceptional. We describe a case of synchronous sigmoid and transverse volvulus in a patient with a qualitative systematic review of this condition. PRESENTATION OF THE CASE: This is a 74-year-old patient with a history of chronic constipation, who consulted for bowel obstruction. Plain abdominal radiography showed diffuse gas distension of the colon with the absence of rectal gas. An exploratory laparotomy was performed and showed sigmoid colon volvulus associated with synchronous transverse colon volvulus without bowel necrosis. A left hemicolectomy with loop colostomy was performed. The restoration of bowel continuity was done 3 weeks. The post-operative course was uneventful. DISCUSSION: The occurrence of a simultaneous sigmoid and transverse colonic volvulus is an exceptional situation. Due to the rarity of this clinical entity, the literature concerning its description is sparse and the treatment options are poorly codified. There are no guidelines in the treatment and a tailored approach should be used for each patient. CONCLUSION: The dual location of strangulation makes this situation a major surgical emergency with a high risk of gangrene and septic shock. Colectomy with delayed anastomosis should be preferred in the treatment.

Withdrawal Notice: Prevalence and Factors Associated with Lower Limb Amputation in Patients Hospitalized for Diabetic Foot: A Cross-sectional Study

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Strangulated spigelian hernia with necrosis of the caecum, appendix and terminal ileum: an unusual presentation in the elderly.

Spigelian hernia is a rare form of abdominal wall hernias. We report an unusual case of a strangulated spigelian hernia with necrotic contents of the caecum, appendix and terminal ileum in the elderly. An 84-year-old woman, with a history of eight pregnancies, was admitted for bowel obstruction evolving for 7 days. The computed tomography scan showed a strangulated right spigelian hernia. Surgical exploration with an incision centered on the mass confirmed the diagnosis with extensive necrosis of the caecum, appendix and 10 cm of the terminal ileum. A right hemi-colectomy with an ileo-colic anastomosis was performed. The post-operative course was marked by the death of the patient in intensive care due to multi-visceral failure. The occurrence of strangulation with necrosis of the caecum, appendix and terminal ileum in spigelian hernia is extremely rare. It requires early diagnosis and treatment to reduce post-operative morbidity and mortality.

[A case of bilateral gestational gigantomastia]. / Un cas de gigantomastie gravidique bilatérale.

We here report the case of a 29-year old gravida 2, para 2 patient with no particular past medical history. Symptoms evolved over 2 months and were marked by bilateral breast growth impairing her daily activities. Clinical examination showed hypertrophied breasts and bilateral breast ulcers. She had a history of 28-weeks amenorrhea. Anatomopathological examination of ulcers showed fleshy bud-like tissue. The patient had high levels of prolactin (1345 µUI/ml). The levels of FSH and LH were normal. The patient underwent bromocriptine therapy without success. Patient's evolution was marked by decrease in size and regression in skin ulcers six months after vaginal birth. Gestational gigantomastia is a breast hypertrophy characterized by a breast volume exceeding 1500 cm3 . Its cause is unknown. Radical treatment is based on bilateral mastectomy.