Total colectomy in Vascular Ehlers Danlos syndrome a case report and literature review.

INTRODUCTION: Ehlers Danlos syndromes (EDS) are a group of genetic disorders, characterized by skin hyperelasticity, joint hyperlaxity and tissue weakness. Vascular EDS is rare and is differs from other types of EDS by an inconsistent acrogenic morphotype and the occurrence of severe digestive and vascular complications, which can be lifethreatening. CASE PRESENTATION: We report the case of a 27-year-old man with a type IV vascular Ehlers-Danlos syndrome revealed by a colonic perforation after appendectomy for peritonitis secondary to appendicitis. The etiology of the perforation remained a challenge till a genetic research was carried out for COL3A1 gene mutation, which was positive in favor of vascular Ehlers Danlos disease. Then, a totalization of the colectomy with ileorectal anastomosis was performed. DISCUSSION: Vascular Ehlers Danlos syndrome (VEDS) is due to qualitative and quantitative abnormalities in the synthesis of type III collagen, which is a major constituent of the vessel wall, skin, joint capsules, uterus and gastrointestinal tract, particularly the colon. Colonic perforation, particularly sigmoidal perforation, is the most frequent complication in SEDV and most often precedes the molecular diagnosis. Colonic perforations are uncommon. The Hartmann procedure is a well-established surgical treatment modality, especially for emergency surgery. Given the iterative risk of colonic perforation and anastomotic leakage, preventive treatment by total colectomy with ileo-rectal anastomosis or definitive ileostomy is recommended by several authors. CONCLUSION: SEDV is a rare pathology with a difficult diagnosis. However, it should be keeped in mind when there is any spontaneous colonic perforation in the young people.

[Strangulated hernia below the umbilicus containing the liver: a case report]. / Hernie sus ombilicale étranglée à contenu hépatique: à propos d´un cas.

Herniation of liver segments through defects in the anterior abdominal wall is rare. To our knowledge, only three cases have been described in the literature. This study reports the case of a 84-year-old man presenting to the emergency department with strangulated hernia of the linea alba showing dullness to percussion with protrusion of a sensitive and firm mass. Laboratory test results were normal. Abdominal CT scan showed herniation of liver segment through the linea alba with calculous cholecystitis. The patient underwent retrograde cholecystectomy with subhepatic Redon drain and repair of the herniation by overlapping suture, associated with two subcutaneous vacuum suction Redon drains. The post-operative suite was simple and the patient was discharged on the second post-operative day. Six months after surgery, our patient was healthy. Herniation of liver segments through defects in the anterior abdominal wall is rare. Patients usually show little evidence if clinical signs. Abdominal CT scan is essential to assess the viability of parenchymal liver cells. Patients´ management is studied on a case-by-case basis, it can be surgical or non-surgical. Herniation of liver segments is rare; few cases have been reported in the literature and, in these cases, patients showed little evidence of clinical signs. CT scan is essential to assess the viability of parenchymal liver cells.

Strangulated Spiegel hernia: About a case and literature review.

The anterolateral abdominal Hernias are a frequent reason for consultation; Spiegel's hernia is a rare spontaneous abdominal anterolateral hernia (0.12% of abdominal hernias) for patients between 40 and 70 years old, There are risk factors such as intra-abdominal hyperpressure secondary to morbid obesity, multiple pregnancies and chronic cough. The surgery is the standard treatment; whether by raphy or prosthetic mesch. We report the case of a 42 year old male admitted to the emergency room for an occlusion syndrome due to the strangulated spiegel hernia with caecal and appendicular contents.

Retrocecal hernia: A case report.

INTRODUCTION: Retroperitoneal Retrocecal hernias are a rare variety of internal hernias and represent an unusual cause of bowel obstruction. Early diagnosis is based on CT scan and requires knowledge of the pathology in order to avoid small bowel resection. We report a case of retrocecal hernia treated surgically and review the characteristics and treatment of retrocecal hernias in the literature. MATERIALS AND METHODS: Our work is a retrospective case report with a descriptive aim concerning a patient operated for retrocecal hernia within the department of general surgery of CHU Ibn Rochd Casablanca. CASE REPORT: A 72-year-old man presented to the emergency department with abdominal pain and vomiting that have been evolving for 9 days complicated by an occlusive syndrome 36 hours before the admission. The patient was apyretic, and the abdominal examination noted abdominal meteorism predominantly in the right iliac fossa, absence of abdominal scarring, and free hernial orifices. The abdominal X-ray showed air-fluid levels and the abdominopelvic CT scan found clumping of the dilated small intestines posteriorly and below the cecum. The diagnosis of retrocecal hernia was suspected and the patient was taken to the operating room. The operation was performed by laparotomy through a midline incision. On exploration, the cecum and ascending colon were pushed forward and viable bowel loops were incarcerated in a fossa located posteriorly and below the cecum. The procedure consisted of a collapse of the retrocecal ligaments by right coloparietal collapse. CONCLUSION: A bowel obstruction in an apyretic patient without abdominal scarring or parietal hernia should suggest the diagnosis of internal hernia, which must be investigated.

Fish bone perforation of the small bowel: A case report.

INTRODUCTION: Fish bone is one of the most common accidently ingested foreign bodies. Normally, it is eliminated from the gastrointestinal (GI) system without any symptomatology, only 1% of the cases will develop a perforation of the GI tract requiring surgical intervention. PRESENTATION OF CASE: A 70-year-old man, presented with a 48h evolving abdominal pain, important abdominal distension, nausea, vomiting, and a last bowel movement reported 2 days ago, The abdomino-pelvic CT-scan objectified a distension of the terminal ileum measured at 30mm, The exploration revealed a sharp foreign body,at the 15 proximal centimeters of the terminal ileum, which penetrated through the wall of the ileum. The foreign body was removed and we noticed that it is a fish bone. The patient recovered well. DISCUSSION: Clinical manifestations are determined by the location of the perforation and the preoperative diagnosis is always difficult to reach. Computed tomography (CT) scan is the indicated method to identify ingested foreign bodies and surgery is the treatment of choice. CONCLUSION: Delay in diagnosis and treatment can be associated with significant morbidity and mortality.

Ischemic volvulus of the transverse colon caused by intestinal malrotation: A case report.

INTRODUCTION: Congenital Intestinal malrotation is a complex disorder caused by incomplete or abnormal rotation of the intestine during fetal development. Volvulus of the transverse colon secondary to intestinal malrotation is a rare cause of acute abdomen in adults. It has a high risk of mortality, hence the need for an urgent diagnosis and surgical intervention. CASE REPORT: We report an unusual case of volvulus of the transverse colon caused by intestinal malrotation. A 21-year-old women presented abdominal pain with nausea and vomiting. On clinical examination, the abdomen was tympanic to percussion with peritoneal sensitivity. The abdominal X-ray revealed a massive obstruction of the distended large intestine with a "U-shaped" loop. He underwent an exploratory laparotomy that revealed the diagnosis of transverse colon volvulus with intestinal malrotation. His condition was treated surgically by transverse colectomy with colostomy. The patient died on the second day following a hemodynamic instability. CONCLUSION: Transverse colonic volvulus is a rare entity with a high mortality, so it requires urgent diagnosis and surgical intervention.

Gastrointestinal manifestations related to infection with SARS-COV-2: Appendicular syndrome (A case report).

INTRODUCTION: The clinical symptomatology of SARS-CoV-2 disease may manifest as an appendicular syndrome. The abdominal CT scan can be used to rule out or confirm the diagnosis of acute appendicitis and a chest CT scan can make the diagnosis of SARS-CoV-2 infection. OBSERVATION: We report the observation of a 30-year-old patient, with no particular pathological history, who presented with appendicular syndrome without extra-digestive signs, and especially, without respiratory syndrome. The CRP was at 35mg/l. A thoracoabdominal CT scan was requested to detect an eventual appendicitis. With three straight frosted glass areas on the thoracic area suggesting COVID 19 infectious pneumopathy, a PCR was requested to detect a positive SARS-CoV-2 viral RNA, then the patient was appendectomized. Post-operative follow-up was simple and the patient was transferred to a department dedicated to covid-19-positive patients for further management. CONCLUSION: CT scan is necessary before considering emergency surgery for acute appendicitis because it can change the patient's management circuit.

Sub-acute transverse colon volvulus an exceptional cause of large bowel obstruction: Case report.

INTRODUCTION: The sub-acute form of transverse colon volvulus manifests with signs and symptoms of large bowel obstruction. The diagnosis is most often done intraoperatively. We report a rare case of transverse colon volvulus in a 65-year-old female patient with no particular pathological or surgical history. CASE PRESENTATION: Sub-acute transverse colon volvulus in an elderly woman with no pathological or surgical history. Manifested with signs and symptoms of colonic obstruction. Surgically treated by a two-stage procedure with good postoperative outcomes. DISCUSSION: The transverse colon volvulus represents only 2-4% of all colonic volvulus. We discuss the diagnostic and therapeutic approach of our case of transverse colon volvulus through a literature review. CONCLUSION: Transverse colon volvulus should be considered as a differential diagnosis in the face of large bowel obstruction. Early diagnosis and treatment improve the prognosis.

Phytobezoar: An unusual cause of small bowel obstruction.

Phytobezoars are concretions of indigested fruit and vegetables fibers in the gastrointestinal tract. The past of gastric surgery is most common risk factor of phytobezoar. We present the case of a 39-year-old female was admitted to the emergency department and who presented with small bowel obstruction due to phytobezoar, her past medical history was marqued by truncal vagotomy and simple suture recurrent perforated gastric ulcer 15 years earlier. Her postoperative recovery was uneventful.

Acute colonic occlusion over endometriosis: About a case.

The gastrointestinal tract is the most common site of extra pelvic endometriosis, with the rectum and sigmoid colon being the most frequently affected areas. Its diagnosis is still very difficult, especially when it manifests itself as an acute occlusion. We report the case of a patient admitted to the emergency room for an occlusive syndrome on a sigmoid process and who was operated on with colorectal resection and it was the anatomopathological examination that led to the diagnosis of endometriosis.

Total gastric necrosis following acute pancreatitis in a patient with COVID -19: Case report and literature review.

The Coronavirus Disease Pandemic - 2019 (COVID-19) has spread to more than 200 countries worldwide, affecting more than 2 million people and >120,000 deaths, Acute pancreatitis of infectious origin can be caused by different viruses but currently no study has concluded that COVID-19 is directly responsible for acute pancreatitis. We report the case of a COVID-19 patient admitted to the emergency room in a state of respiratory distress associated with stage E pancreatitis according to the classification of balthazar whose surgical exploration found total necrosis of the stomach. A total gastrectomy was performed with an esophagostomy and a wide drainage of the abdominal cavity, the postoperative sequelae were marked by the death of the patient at D6 postoperatively by cardiorespiratory arrest.

Primary appendiceal Burkitt's lymphoma presenting as acute appendicitis: An extremely rare case report and review of the literatture.

Primary lymphomas of appendix are extremely rare tumors. The incidence is 0.015% out of all gastrointestinal lymphomas; furthermore, limited data is available in literature. The appendiceal neoplasms are most commonly presented as acute appendicitis followed intestinal obstruction, intussusception or perforation. We present a case of a 22 year-old male patient who presented with acute appenditis and underwent emergency laparotomy. On abdominal exploration, swollen and enlarged appendix measured 3cm was present for which appendectomy were performed. The histopathological examination of appendectomy specimen revealed a Burkitt's Lymphoma. The patient received R-COPADEM protocol of chemotherapy. Primary gastrointestinal lymphoma is a extremely rare neoplasm without guidelines for therapy.

Polysplenia with agenesis of the dorsal pancreas and preduodenal portal vein, about a case.

PURPOSE OF THE STUDY: Polysplenia is a complex polymalformative syndrome that is frequently accompanied by an inconsistent spectrum of visceral and vascular anatomical abnormalities and is extremely undiscovered in adulthood. The objective of this article is to limit the intraoperative risks generated by the lack of knowledge of these anatomical variations by insisting on the inconstancy of all these variations and the perfect knowledge of the reference anatomy and the exploration of the anatomical variations in imaging before the surgery. PATIENT AND METHODS: The patient was 50-year-old who was hospitalized in our department for gastric adenocarcinoma. During her extension assessment, a polysplenia syndrome was accidentally discovered on the scan images, which showed an exceptional association between preduodenal portal vein, agenesis of the dorsal pancreas, and polysplenia. CONCLUSION: There are neither specific clinical symptoms of the polysplenia syndrome, nor any biological sign; hence, the interest of recognizing this pathology is to avoid diagnostic errors, but also to guide the surgeon during the surgical act performed.

Nutcracker syndrome due to aorto-mesenteric compression in adults: Case report and literature review.

Nutcracker syndrome is a rare entity that corresponds to an abdominal pain following compression of the left renal vein during its passage between the aorta and the superior mesenteric artery, with a peak prevalence in adults between 20 and 30 years old, The typical clinical presentation includes hematuria, orthostatic proteinuria with or without flank pain. doppler ultrasound has a sensitivity of 78% and specificity of 100%, Both CT and MRI can show the compression of the left renal vein between the aorta and the superior mesenteric artery. We report the case of a young patient admitted to the emergency room for abdominal pain mainly localized in the left hypochondrium, with microscopic hematuria, a CT scan was performed showing a reduced aorto mesenteric angle with a compression of the left renal vein and collateralization of venous circulation of left gonadal vein.

Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) and its receptor PROKR2 are associated to human colorectal cancer progression and peritoneal carcinomatosis.

BACKGROUND: The highest risk factor for mortality among malignant tumors is metastasis. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an angiogenic factor which biological activity is mediated via two G protein-coupled receptors, prokineticin receptor1 (PROKR1) and PROKR2. Recent studies suggested that EG-VEGF expression is deregulated in multiple cancers including colorectal cancer (CRC). METHODS: Using distinctive CRC and peritoneal carcinomatosis (PC) cohorts and a corresponding control cohort, we determined the circulating levels of EG-VEGF and its in situ expression, and that of its related receptors. RESULTS: Circulating EG-VEGF levels were significantly increased in patients with metastatic PC compared to CRC and control patients (p< 0.05). Furthermore, according to clinicopathologic examinations, local EG-VEGF expression correlated with higher tumor and nodal stages (p< 0.001) of CRC. EG-VEGF and PROKR2 were highly expressed in colorectal primary lesions compared to positive controls. PROKR1 expression was lower and did not change in tumor specimens. Also, EG-VEGF and its receptor PROKR2 were differentially expressed in the colorectal primary lesions and in the control groups. CONCLUSION: Altogether these findings suggest that EG-VEGF/receptors system might be an important actor in the CRC progression into PC and might be involved in the ability of tumor cells to invade other organs. Circulating EG-VEGF could be proposed as a prognostic marker in human CRC and its progression into PC.

Hepatic fascioliasis presenting with bile duct obstruction: a case report.

Fascioliasis is a zoonotic infection caused by a liver trematode: fasciola hepatica; which commonly affects cattle and sheep, humans are accidental hosts. Several cases have been reported in the literature worldwide with a large geographical distribution. We present a case of bile duct obstruction due to a hepatic fascioliasis, successfully treated with both a combined surgical and medical approaches. A high index of suspicion should be kept in mind for all cases of obstructive jaundice, especially in areas in which human fascioliasis infection is repeatedly reported.

[Descriptive epidemiology of peritoneal carcinosis of gastrointestinal origin at the Ibn Rochd University Hospital, Casablanca (2008-2010)]. / Épidémiologie descriptive de la carcinose péritonéale d'origine digestive à l'Hôpital Universitaire Ibn Rochd de Casablanca (2008-2010).

INTRODUCTION: Peritoneal carcinosis is characterized by ineluctably terminal diffuse spread of abdominal cancer. It is the sign of an advanced disease or a re-emerging disease most often associated with a dark prognosis. Approximately two thirds of all peritoneal carcinomas are of gastrointestinal origin and one third are of non-digestive origin. METHODS: We conducted a retrospective descriptive study between January 2008 and December 2010 in order to establish epidemiological features and risk factors of peritoneal carcinosis of gastrointestinal origin at the Ibn Rochd University hospital, Casablanca. RESULTS: Forty-seven cases of peritoneal carcinosis of gastrointestinal origin were recorded (22 women, 25 men), corresponding to a prevalence of 6.19% and to a mean number of 15.6 cases per year. Age was the major risk factor in our case series (with an average age of 55.55 ± 12.32 years). Even family history was a risk factor to consider. CONCLUSION: This study concluded that the major risk factors for peritoneal carcinosis of digestive origin are age and family history at the Ibn Rochd University hospital, Casablanca (2008-2010).

Post-operative transmesosigmoid hernia causing small bowel obstruction: a case report.

Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Transmesosigmoid hernia is rare type among others mesosigmoid hernia was rarely reported in the literature. We report the case of a 44-year-old male who presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiography examination were suggested intestinal obstruction due to postoperative adhesion. The diagnosis of small bowel obstruction due to internal hernia was confirmed by laparotomy exploration. The herniated loop was reduced successfully and the defect was approximated with interrupted sutures. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This case report highlight difficulty and importance of high index of suspicion considering an internal hernia as a cause of small bowel obstruction in individuals of all age groups with or without a previous history of abdominal surgery.

Spontaneous perforation of Meckel's diverticulum: a case report and review of literature.

Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.