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.

[Intra-uterine fetal death by knife: case report]. / Mort foetale intra-utérine par arme blanche (à propos d'un cas).

INTRODUCTION: Opened injuries by knife are rare in pregnant women and are responsible of foetal death in most cases. OBSERVATION AND COMMENTARY: We report a case of a 27-years woman, in her 8th months of pregnancy, victim of three knife punchs in her right iliac fossa. An emmergent laparotomy revealed deep wounds in the uterus and its right vascular pedicles, and a right external iliac artery lesion. Hysterectomy was performed and the extracted fetus was dead. He had two wounds in skull and back. Foetal death is common in opened knife injuries especially at the end of pregnancy. On one hand, the fetus has an abdominal situation that expose him to penetrating lesions. On the other hand, the uterus is richly vascularized during this period of pregnancy, thus any uterine or pedicular wound could result in a maternal hemorrhagic shock and hence a poor foetal and maternal prognosis. CONCLUSION: Knife injuries in pregnant women could compromise the foetal prognosis. Managmanent should be early and requires a close collaboration between resuscitators, obstetricians and vascular surgeons.

[Splenectomy in hematologic diseases. A study of 70 cases]. / La splenectomie dans les maladies hematologiques. A propos de 70 cas.

The aim of this work was to report our own clinical experience and to compare it our results with those already published. This is a retrospective study of 70 splenectomies performed for hematologic diseases at the service des urgences viscerales of Ibn Rochd teaching hospital of Casablanca, between 1996 and 2001. The study included 70 patients. Splenectomy was performed for therapeutic reasons by laparotomy in 56 cases (80%) and bym laparoscopy in 14 cases (20%). The post-operative after-effects were mild in 81.4%. A patient died, however of pulmonary embolism. Splenectomy is an important tool in the management of patients suffering from hemolytic anemia, auto-immune thrombopenic purpura and other hemolytic anemias. Management by a multidisciplinary team is required to prevent a maximum of long and short-term post-operative complications and to offer the offer the best conditions for a successful splenectomy.

[Pancreaticogastric anastomosis after pancreatic resection. About 40 cases]. / Anastomose pancreatico gastrique apres resection pancreatique. A propos de 40 cas.

The risk of pancreaticojejunal anastomosis fistulization represents the main factor of mortality and morbidity after pancreatic resection. The pancreatogastrostomy represents a technical alternative that can be achieved easily. The purpose of our study is to report our experience of this technique and to analyse respectively 40 pancreactogastric anastomosis after 29 cephalic duodenopancreatectomies and 11 corporeocaudal pancreatectomies. The operative sequelae have been characterized by 5 cases (12.5%) of digestive hemorrhages, 3 cases (7.5%) of pancreatic fistula, 3 cases (7.5%) of intra-abdominal bleeding and a lymphorrhagia (2.5%). The operative mortality rate was about 5% (2 cases). These results are similar to the results reported in the literature by the users of this technique.