[Giant pelvic lipoma mimicking a liposarcoma]. / Lipome géant pelvien mimant un liposarcome.

Giant lipoma (GL) is a rare ubiquitous tumor. Pelvic lipoma is rare with less than 10 cases reported in the literature. The main differential diagnosis is lipoma-like well differentiated liposarcoma. We report the case of a 50-year old female patient, with a 3-month history of pelvic discomfort, presenting with a mass in the left ischiorectal fossa. Abdominopelvic CT scan showed presacral hypodense homogeneous lipomatous mass measuring 10x18 cm. MRI showed hyperintense lesion on T1 and T2 -weighted images with fine partition walls reaching the 2nd sacral vertebra. Total abdominoperineal resection was performed without rupture of tumor capsule. Anatomo-pathological examination confirmed the diagnosis of GL. This study aims to report a new case of giant presacral pelvic lipoma which extends into the left ischiorectal fossa.

[Spontaneous rupture of hydatid cyst of liver in the peritoneal cavity with intact proligerous membrane: about a case and literature review]. / Rupture spontanée d'un kyste hydatique du foie dans la cavité péritonéale avec une membrane proligère intacte: à propos d'un cas et revue de la littérature.

Rupture of hydatid cyst of liver with intact proligerous membrane is rare. We report the case of a 63 year-old female patient presenting with right hypocondrium pain without fever or jaundice. Diagnostic imaging examination showed hydatid cyst in segment IV of liver associated with pelvic cystic lesion measuring 12 cm x 06 cm. Surgical exploration revealed ruptured unilocular hydatid cyst of the liver with intact proligerous membrane and free in the peritoneal cavity. This study aims to report a new case of intraperitoneal rupture of hydatid cyst of liver with intact proligerous membrane and to highlight the diagnostic and therapeutic difficulties due to this complication.

[The POSSUM: a good scoring system for predicting mortality in elderly patients undergoing emergency surgery?] / Le POSSUM: un bon score pour prédire la mortalité du sujet âgé opéré en urgence?

INTRODUCTION: POSSUM (Physiologic and Operative Severity Score for the enumeration of Mortality and morbidity) is a scoring system for predicting mortality which is largely used in elective aortic and abdominal surgery. The aim of our study was to validate POSSUM with regards to elderly patients (> 70 years) undergoing digestive emergency surgery. We wanted to determine the optimal threshold for POSSUM, consisting of a physiological score and of an operative score for predicting mortality in this population. METHODS: This is a case-control analytic retrospective study of 291 patients aged ≥70 years undergoing digestive emergency surgery. These patients were divided into two groups each comprising 50 patients. Group "DC": patients died in the immediate postoperative period and Control group "SURV" chosen by lot. We analyzed the reliability of POSSUM in predicting mortality and morbidity. Subsequently, we created ROC curve to find the thresholds with the best sensitivity/specificity couple. RESULTS: The physiological score, operative score and mortality and morbidity rates predicted by POSSUM and mortality predicted by P-POSSUM are predictors of mortality (P < 0.0001). The threshold values for the physiological and operative score with the best sensitivity/specificity couple were 23 and 15 respectively. CONCLUSION: Predicting mortality in patients allows to target care management programs and to inform the patient and his family of the risks.

Pseudo-tumoral hepatic tuberculosis discovered after surgical resection.

Pseudo-tumoral hepatic tuberculosis is rare. It is characterized by non-specific symptoms and radiological polymorphism. Diagnosis is problematic. This article presents three cases, each clinically different from each other, that illustrate how difficult diagnosis can be. The definitive diagnosis of pseudo-tumoral hepatic tuberculosis was reached on the basis of histo-logical examination of surgical samples. Treatment of the disease based on appropriate anti-tubercular therapy generally gives a positive outcome.