Primary cystic echinococcosis of the peritoneum: a case report.

BACKGROUND: Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that constitutes a diagnostic and therapeutic challenge. CASE REPORT: A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months. He has a 10 cm hypogastric mass. Biological-tests were normal. A computed tomography Scan showed a cystic mass on the pelvis measuring 13 × 17 cm without echinococcosis cyst in the liver. The patient was operated and we found a cystic mass of 17 cm located on the Douglas cul-de-sac that suggest a pelvic hydatid cyst. We have performed an aspiration of the cyst confirms the diagnosis followed by injection of hypertonic solution, extarction of the germinal layer and a maximal reduction of the pericyst. The postoperative course was uneventful. CONCLUSION: Trough our case, we try to focus on the diagnosis and therapeutic options of this rare entity that we should think of in front of a patient with isolated peritoneal cyst especially in endemic country.

[The effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy: a prospective randomized controlled double-blind study]. / Intérêt de la déxaméthasone en intrapéritonéale dans l'analgésie post cholécystectomie laparoscopique: étude prospective contrôlée randomisée en double aveugle.

Introduction: the effect of intravenous corticosteroids on postoperative pain has been well demonstrated; however, few studies have focused on the efficacy of intraperitoneal corticosteroid use after laparoscopic surgery. The purpose of this study was to evaluate the effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy. Methods: we conducted a prospective, randomised, double-blind, controlled study, including patients scheduled for laparoscopic cholecystectomy and randomised into two groups: the group D (receiving 16 ml: 12 ml saline and 4 ml solution containing 16mg dexamethasone) and the group T (receiving 16 ml saline). The primary endpoint was: Visual Analogue Scale (VAS) for abdominal pain during the first 24 hours after surgery. The secondary endpoints were the incidence of shoulder pain, time to first request for analgesia, the consumption of morphine in the post-intervention surveillance room (PACU), the consumption of non-opioid analgesics and the incidence of nausea and vomiting during the first 24 hours after surgery as well as the presence of complications. Results: sixty patients were included in the study and divided into two groups of 30. Demographic parameters, duration of surgical and anesthesia procedures, as well as intraoperative fentanyl consumption were comparable between the two groups. Abdominal pain VAS values (p≤0.001), the incidence of shoulder pain (p<0.001), opioid and analgesic consumption (p<0.001) and the incidence of nausea (p=0.002) and vomiting (p=0.012) during the first 24 hours after surgery were significantly lower in group D. No complications related to dexamethasone administration were noted. Conclusion: intraperitoneal dexamethasone reduces postoperative pain after laparoscopic cholecystectomy.

Laparoscopic diverticulectomy of perforated right-sided colonic diverticulitis.

The perforation of the right-sided colonic diverticulitis (RSCD) is a rare surgical emergency with highly variable clinical presentations. The preoperative distinction between acute appendicitis and perforated diverticulitis represent a dilemma for surgeon. The laparoscopic repair is a feasible method instead of ileocecectomy in selected cases.

Primary leiomyosarcoma of the inferior vena cava: Is vascular reconstruction always necessary?

Both MRI and CT scan can determine tumor size and its extension. PLV have a poor prognosis if surgical resection cannot be achieved. We recommend no reconstruction for type II PLV if venous contact is less than 180° or where the implantation base does not exceed one third of the vena cava.

Isolated cecal necrosis: Report of two cases.

Isolated cecal necrosis is a rare variant of ischemic colitis. Diagnosis is difficult because of nonspecific clinical and radiological findings. It especially affects patients with comorbidities affecting mesenteric perfusion.

Strangulated obturator hernia: Report of two cases.

Obturator hernia is a rare condition, which can be life-threatening if misdiagnosed. We must consider the diagnosis in case of a bowel obstruction especially in elderly women.

Tailgut cyst: 2 case reports.

Tailgut cysts, or retrorectal cystic hamartomas, are rare congenital developmental lesions. It is a benign lesion, but there is a risk of degeneration, so surgical resection is necessary.

Primary Hydatid Cyst of the Thoracic Aorta Revealed by Peripheral Arterial Embolism.

Primitive aortic hydatidosis is exceptional. We report the case of a 55-year-old woman who had pain in her left lower limb for a week. A computed tomographic angiogram showed a multivesicular and fluid-density mass intimately contiguous to the descending thoracic aorta seen on an endoluminal subtraction image and hydatid cysts in the spleen. The surgical approach was through a thoracophrenolombotomy with right femorofemoral bypass. Complete resection of the destroyed aortic portion was performed, and continuity was restored by an aortoaortic bypass using a Dacron (INVISTA, Kennesaw, Georgia) prosthesis. Hydatid fragments were evacuated after thrombectomy of the left iliac artery. The surgical procedure was completed by a splenectomy. Postoperative follow-up was uneventful. After 6 months, computed tomographic angiography showed a patent bypass.

Right Trisectionectomy and Caval Reconstruction with Peritoneal Patch Under Short Total Vascular Exclusion for Hepatocellular Carcinoma with Tumoral Thrombus in Suprahepatic Vena Cava.

BACKGROUND: Hepatocellular carcinoma (HCC) can be complicated by major vascular invasion, and resection can be beneficial in some patients.1 Some of these patients are traditionally operated under total vascular exclusion (TVE), refrigeration, extracorporeal circulatory bypass, and cardiac surgery, with high morbidity and mortality.2 However, HCC thrombi are not adherent to the venous wall, and with advances in surgical techniques, resection can be simplified and performed during short-duration TVE alone. Patients who need resection under any degree of TVE represent < 5% of our hepatectomies. PATIENT AND METHODS: A 59-year-old male patient was admitted for management of a right large HCC (developed on a metabolic syndrome without cirrhosis). After 12 months of treatment, HCC progressed after arterial chemoembolization followed by antiangiogenic treatment, with tumoral thrombus extension to the intrathoracic vena cava up to the right atrium. Surgical resection under TVE and intrathoracic control of the vena cava was decided. Liver transection was performed with intermittent clamping of the hepatic pedicle and low central venous pressure. During 25 min of TVE and vascular remplissage, resection was completed with complete thrombectomy and reconstruction of the vena cava with a peritoneal patch.3 RESULTS: Surgery lasted 330 min, with blood loss of 500 ml and transfusion of 2 units of blood. Postoperative course was uneventful with 10-day hospital stay. Four months after resection, the patient is well with no disease recurrence. CONCLUSION: As surgical techniques improve, complicated liver resection can be performed during short-duration total vascular exclusion.

An uncommon cause of acute bowel obstruction: the left para-duodenal hernia.

Internal hernias of the abdomen are uncommun. They represent less than 1% of bowel obstruction cases. The left paraduodenal hernia is the most frequent type of internal hernias. We report a case of 77 year-old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal paraduodenal hernia by showing incarcerated jejunal loops in a paraduodenal hernia through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities. KEY WORDS: Computer tomography Internal hernia, Paraduodenal hernia, Small bowel obstruction.

Jejunal diverticulitis. Review and treatment algorithm.

Diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and relatively sterile jejunal content. Complications of jejunal diverticulitis are acute intestinal obstruction, diverticular bleeding and mainly perforation with mesenteric abscess, localized or generalized peritonitis. The Multi-detector row computed tomography is now the best diagnostic imaging for small bowel diverticulitis as well as its complications. Magnetic resonance enterography is also quite useful but it is still impractical to resort to such an imaging in an abdominal emergency. Non-surgical treatment is usually sufficient for jejunal diverticulitis without peritonitis but it does not prevent recurrence of diverticulitis. Surgery is mandatory in case of generalized peritonitis or voluminous local abscess complicating small bowel diverticulitis. In case of extensive small bowel diverticulosis, resection should be limited to the intestinal loop with complicated diverticulum (local abscess, peritonitis or bleeding) to avoid short bowel syndrome. Poor prognostic factors are advanced age, associated comorbidities, delayed diagnosis and mainly the time interval between perforation and surgery.

An uncommon cause of acute bowel obstruction: the left para-duodenal hernia.

Internal hernias of the abdomen are uncommon. They represent less than 1% of bowel obstruction cases. The left Paraduodenal hernia (PH) is the most frequent type of internal hernias. We report a case of 77 year- old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal PH by showing incarcerated jejunal loops in a PH through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities.