[Non operative management of blunt splenic trauma in adults]. / Traitement non-opératoire des traumatismes fermés de la rate chez l'adulte.

Nonoperative management of blunt splenic injury allows preservation of the immune function of the spleen while avoiding unnecessary laparotomy. The aim of our study was to evaluate the feasibility and the results of conservative management of adult blunt splenic trauma in the context of a developing country. Nonoperative management was proposed for 52 out of 62 patients with blunt splenic trauma treated at the Casablanca University Hospital, Morocco. Motor vehicle-road accidents (88%) were the most common etiology. Multiple trauma was present in 79% of the cases. 15% of the cases had hemodynamic instability. Ultrasonography was performed in 52 patients; it showed splenic contusion in 45 patients and subcapsular hematoma in 7 patients. CT scan showed splenic contusion in 11 patients. Four cases ultimately required operative management with one death. Of the remaining 48 patients, 45 had an uneventful course with observation, but there were two deaths in the observation group.

[Spontaneous diaphragm rupture during delivery. Case report]. / Rupture spontanée du diaphragme pendant l'accouchement. A propos d'un cas.

We report a case of spontaneous diaphragm rupture during delivery in a 42-year-old woman. The patient presented at surgical emergency department with abdominal pains, vomiting and dyspnea, three days after full-term delivery. The X-ray of the chest and computed tomography showed symptoms of a left diaphragmatic rupture. Laparotomy confirmed the diaphragmatic rupture with herniation of portion of the stomach in the left pleural cavity. Spontaneous diaphragmatic rupture during delivery is uncommon and would result from a sudden sharp rise in the intra-abdominal pressure during the second stage of labor, exacerbated by application of external pressure to the uterine fundus or the upper abdomen. Diaphragmatic rupture during labor is a serious but rare complication that requires emergency surgery to prevent visceral perforation and cardiorespiratory failure. To prevent this complication, the delivery conditions should be improved.

[Hypoglycemic coma revealing a solitary fibrous tumor of the pleura]. / Coma hypoglycémique révélant une tumeur fibreuse solitaire de la plèvre.

INTRODUCTION: Solitary fibrous tumor of the pleura (TFSP) is rare. When associated with hypoglycemia it is commonly referred to as Doege-Potter syndrome. CASE: A 51-year-old man was hospitalized for recurrent near-syncope associated with hypoglycemia. Clinical examination and then thoracic imaging clearly showed anomalies that corresponded to a mass occupying the entire left hemithorax. After resection, histological analysis diagnosed a fibrous tumor of the pleura. DISCUSSION: Solitary fibrous tumors of the pleura are observed most often in patients aged 50 and 70 years. Hypoglycemia is rare, occurring in approximately 4% of cases. It is explained by the abnormal secretion of a type-II insulin-like growth factor. This tumor is treated by complete surgical excision.

[Colonic actinomycosis: report of a case and review of the literature]. / Actinomycose colique: à propos d'un cas et revue de la littérature.

Actinomycosis is a chronic granulomatosis infection caused by a Gram positive anaerobic bacteria, Actinomyces. Abdominal localizations are rare and simulated a malignant process. The difficulties of diagnosis are usually leading to surgical resection. We report a colonic actinomycosis case of a 62-year-old woman with a abdominal tumor and diagnosed after surgical resection.

[Solitary fibrous mediastinal tumor. A case report]. / Tumeur fibreuse solitaire du médiastin. A propos d'un cas.

Solitary fibrous tumor is a rare tumor, generally located in the pleura. Recently, new sites have been described in the literature, particularly involving the peritoneum and mediastinum, as wekk as te-the bronchopulmonary and orbital regions. The diagnosis is established at pathology, but in some cases may be difficult to differentiate from other tumors. We report the case of a 60-year-old women who had undergone surgery 25 years ago for right pulmonary hydatid cyst and who presented inspiratory dyspnea and dry cough for four months. Physical examination revealed a right cervical tumefaction in the supraclavian region. The AP chest x-ray disclosed an opacity in the right laterotracheal upper cervicomediastinal zone laminating the trachea which was displaced to the left. Thoracic computerized tomography showed a tissular process in the superior and middle mediastinum. Surgical tumor resection was performed and pathology confirmed the diagnosis of solitary fibrous tumor. The postoperative period was uneventful. Frequency of the mediastinal localisation is the same in men and women. The tumor generally develops between the 5th and 7th decades, and is most often asymptomatic. Fortuitous discovery is the rule. The clinical course is unforeseeable.

[Primary retroperitoneal tumors in adults: report of 11 cases]. / Les tumeurs rétropéritonéales primitives de l'adulte: à propos de 11 cas.

The primitive retroperitoneal tumors are tumors which diagnosis isolate and thus the prognosis is poor. The authors assess the resectability of these tumors and the therapeutic results. We performed a retrospective study during 5 years, 11 patients were reviewed, in the unit of visceral surgical emergency of UHC Ibn-Rochd in Casablanca. The median age was 44 years old. The revealing signs were pains (67%), abdominal mass (54%), and compressive signs in 78%. The diagnosis was based on the computerized tomography in 10 cases (90%), the ultrasound sonography in 3 cases, and the IVU in 3 cases when it was necessary. The treatment was surgical in all cases. The resection was curative in 58%, 1 patient received chemotherapy. Histologically, the mesenchymatous variety was the most frequent (68%) and almost malignant (80%), the ectodermic origin was noted in 3 cases, and the vestigial in 1 case. The long-term follow-up was characterized by recurrence in 4 cases and 3 patients were lost to follow-up. The prognosis of the primitive retroperitoneal tumors is poor, because of a late diagnosis, and the malignant, and recurrent potential of these tumors.

[Leiomyosarcoma of the inferior vena cava: a new case report]. / Léiomyosarcome de la veine cave inférieure: à propos d'une nouvelle observation.

We report on a new case of leiomyosarcoma of the inferior vena cava presenting as an abdominal mass. With the help of review of the literature, the value of modern imaging techniques is recalled. The treatment is exclusively surgical. The prognosis is poor due almost to the diagnosis delay.

[Abdominal stab wound injury with omentum evisceration]. / Plaies abdominales avec épiplocèle.

INTRODUCTION: The abdominal stab wound with omentum evisceration, represent 4 to 20% of abdominal injuries. It causes a problem of therapeutic indication between selective and mandatory laparotomy. The goal of this work is to give some answers to this dilemma. MATERIAL AND METHODS: A retrospective study from 1992 to 2000, concerning 75 patients presenting an omentum evisceration. Where there were 71 men et four women, the mean age was 25 years old. All the abdominal injuries are exclusively by the stab wound. These 75 patients were divided into three groups: group I: 24 patients (32) were immediately operated ahead of the existence of severity elements; group II: 18 (24%) patients had an isolated omentum evisceration without any elements of severity were operated immediately; group III: 33 (44%) were placed under clinical, radiological and ultrasound control. RESULTS: We have found four cases of negative laparotomy (16,7%) in group I, and 14 (77,8%) in group II. Five secondary laparotomies (15%) were performed in group III. Among the 51 patients (Group II and Group III) nine (17%) had visceral injuries... In all of the three groups, there was a high frequency of intestinal organs injuries, there was no mortality and 12% of morbidity. CONCLUSION: The isolated omentum evisceration is a penetrating injury of the abdominal wall but not synonym with visceral injuries, the interventionists authors had a high rate of negative laparotomy. However the selective authors in the asymptomatic patients under clinic examination appears logical: we believe that the laparoscopic diagnostic and therapeutic in doubtful cases can resolve this problem.

[Pulmonary hamartoma: a case with a predominant leiomyomatous component]. / Hamartome pulmonaire. A propos d'un cas à composante léiomyomateuse prédominante.

We report a case of leiomyomatous pulmonary hamartoma observed in a 61-year-old patient who presented with chest pain. The chest x-ray visualized a benign opacity of the upper right lobe. Hamartoma is the most frequent benign bronchopulmonary tumor. Surgical resection is required. Imaging provides the diagnosis. Conservative surgery is generally possible. Prognosis is favorable.

[Hydatid cyst of thoracic soft tissues]. / Kyste hydatique des parties molles thoraciques.

Hydatid cysts are uncommon in thoracic soft tissue. We report a case of hydatid cyst which had developed within the lattissimus dorsi presenting as a left parietal scapular mass diagnosed by ultrasound and CT scan, which remains the preferred primary examination for the investigation of masses of this type. We discuss the various possible clinical and paraclinical contexts and recommend total pericystectomy of a closed cyst as the best treatment for this kind of cyst.

[Hydatid cyst of the adrenal gland. A case report]. / Kyste hydatique de la surrénale. A propos d'un cas.

The hydatid cyst of the adrenal gland is still an exceptional localization. Only eleven cases have been described in the literature. A new case of isolate suprarenal hydatidosis is reported in one 28 years old patient, that the signs consisted in pains of the right flank and vomiting. The diagnosis has been based on the imagery, particularly the computed tomography associated to the hydatid serology, confirmed during the operation and by the pathologic examination of the resected piece. The treatment consisted in a simple cystectomy with conservancy of the gland, the operative sequelae have been simple. The interest of this cases lies in the rare feature of this hydatid localization that the diagnosis is difficult. Among the various suggested surgical methods, the simple resection of the cyst is still the best treatment that permits to keep the gland.

[Perforated duodenal ulcer: laparoscopic treatment of perforation and ulcerous disease]. / Ulcère duodénal perforé: traitement coelioscopique de la perforation et de la maladie ulcéreuse.

STUDY AIM: The aim of this retrospective study was to report a continuous series of 44 perforated duodenal peptic ulcers operated on through laparoscopic approach with curative treatment of the peptic ulcer disease for socioeconomic purpose. PATIENTS AND METHOD: From February 1995 to May 1996, 44 patients were operated on laparoscopically. There were 42 men and two women (mean age: 36 years). All patients had peritonitis with pneumoperitoneum in 68%. Duodenal peptic ulcer was known in 12 patients and antecedent of episodic epigastric pain were present in 27. Four trocads were used. The diagnosis was confirmed by abdominal exploration and peritoneal lavage was performed with physiological serum. RESULTS: The procedures were: suture of perforated ulcer associated with posterior vagotomy and anterior seromyotomy (n = 6), with troncular vagotomy and pyloroplasty (n = 24) and single suture (n = 1). A conversion into laparotomy was necessary in 13 patients (29.5%). There was no mediastinitis, no postoperative death. Peritonitis by leakage occurred in two patients who were reoperated by laparotomy; mean duration of hospital stay was 5.5 days. With a one-year follow-up, all patients were in good condition, free of pain. CONCLUSION: With laparoscopic surgery, diagnosis of peptic ulcer perforation was confirmed, peritoneal lavage was perfectly done, duodenal perforation was sutured and surgical treatment of the peptic ulcer disease was performed, which is important in poor countries.

[Pancreatitis of hydatid origin]. / Pancréatite d'origine hydatique.

INTRODUCTION: Hydatic cysts of the liver are known to rupture into the biliary tree, but acute pancreatitis is an uncommon consequence. CASE REPORT: A 30-year-old woman who had undergone cholecystectomy 8 years earlier for gall bladder stones was hospitalized because of acute abdominal pain. Acute pancreatitis was diagnosed. Abdominal sonography showed a hydatic cyst. Fifteen days after admission after normalization of the amylasemia, surgical cure was successful. DISCUSSION: This case demonstrates that hepatic material can migrate via the main bile duct and provoke acute pancreatitis. Fistula drainage via the Oddi sphincter can be successful.

Aetiology of burn injuries in childhood in Casablanca, Morocco: epidemiological data and preventive aspects.

A retrospective epidemiological study is reported concerning burn injuries in 775 children hospitalized at the unit of burn care of Casablanca between 1985 and 1993. The mean age was 3 years and 8 months; 69.9 per cent of the patients were below 5 years old. The male to female ratio was 1.43 to 1.0. The most common agents were scalding liquids (69.1 per cent) followed by flames (15.2 per cent). The authors underline through this report that preventive measures depend closely on the regional, environmental and sociocultural specificity.

[Penetrating injuries of the abdomen. Results of two classical and selective attitudes in the management of 249 wounds]. / Les plaies pénétrantes de l'abdomen. Résultats des 2 attitudes classique et sélective dans la prise en charge de 249 plaies.

The systematic surgical exploration of each abdominal penetrating wound allows an exact out-come of lesions and an adequate treatment without delay. But these advantages are made upon a possibly 30% negative laparotomy. The selective attitude in the management of these abdominal's wounds has permitted to decrease this rate to 5% with a risk of secondary operation for non primary detected lesions in 5%. Our attitude toward 249 penetrative abdominal's wounds was classic and selectable respectively from 86 to 89 and 90 to 93. The results has confirmed the literature's date and especially has shown no significant difference between the two attitude concerning the morbidity and the mortality.

[Hydatid cyst of the liver. Treatment by resection of the cyst wall. Our experience apropos of a series of 495 cases]. / Kyste hydatique du foie. Traitement par résection du dôme saillant. Notre expérience à propos d'une série de 495 cas.

From January 1976 to December 1990, 495 cases of hydatid cyst of the liver were treated by resection of the cyst wall. The mean age of the patients was 42 years with a female predominance (71% of cases). Confirmation of the diagnosis was essentially based on ultrasonography. At operation, the hydatid cysts were located in the right lobe of the liver in 83% of cases. The hepatic dome (segments VII + VIII) was involved in 52% of cases. After resection of the cyst wall, biliary tract lesions required common bile duct drainage with a Kehr drain in 50 cases, transcystic drainage in 22 cases and cysto-biliary disconnection in 22 cases. In every case, drainage of the residual cyst cavity was performed by a two-way catheter. Seven deaths were recorded in this series, including one from anaphylactic shock associated with intracystic injection of formalin, 3 from bronchopulmonary complications, 2 from subphrenic abscesses and 1 after surgical revision for evisceration on the 5th day. The postoperative morbidity and, consequently, the hospital stay depended on the condition of the pericystic tissues. The mean hospital stay was 12 days in the case of soft pericystic tissues and 32 days in the case of fibrotic and calcified pericystic tissues. Due to the benign nature of hydatid cysts of the liver, the authors emphasise the value of resection of the cyst wall which carries a lower operative risk and which can be performed by most surgeons.

[Heller's operation in the treatment of idiopathic megaesophagus. Apropos of 25 cases]. / L'opération de Heller dans le traitement du mégaoesophage idiopathique. A propos de vingt-cinq cas.

The authors report 25 cases of idiopathic mega-oesophagus treated by Heller's myotomy via an abdominal incision with prevention of gastro-oesophageal reflux by means of Toupet, Dor or Nissen procedures. The results, with a follow-up of 2 to 13 years, were considered to be good in 82% of cases with 2 moderate results (9%) and two failures (9%). The authors consider Heller's operation to be the operation of choice in preference to forced dilatations.