[Larrey or Morgagni hernias treated by laparoscopy]. / Hernies de la fente de Larrey, ou hernies de Morgagni, traitées par laparoscopie.

INTRODUCTION: Diaphragmatic hernia or Morgagni-Larrey hernia is a rare entity. Its treatment is surgical and hence raises the question of the surgical approach. OBSERVATIONS: Two patients underwent laparoscopic surgery for Morgagni-Larrey hernia. The first, aged 17 exhibited a chromosomic abnormality (trisomie 21). The second was 18 years old. Both patients underwent surgery by laparoscopy. In both cases, the surgical act performed was resection of the hernia and closure of the orifice with separate sutures. Their post-surgical courses were uneventful, even two years later. COMMENTS: In the age of mini-invasive surgery, laparoscopy is an excellent alternative to laparotomy in this benign pathology.

[Perineo-scrotal gangrene: apropos of 31 cases]. / La gangrène périnéo-scrotale: à propos de 31 cas.

Fournier's gangrene is a fascitis of the perineum and of the external genitalia. It is a serious infection with rapid evolution and a severe prognosis. It is also unpredictable towards the necrosis. It concerns a series of 31 cases of the perineal scrotal gangrene supervised in the department of surgical visceral emergency of the Ibn Rochd University hospital of Casablanca between 1992 and 2000. In this investigation, the male predominance is important and the mean age is 49 years. The diagnostic delay is 12 days. The symptomatology was dominated by edema and erythema signs, fever and pain. The skin necrosis was seated in the perineum and the scrotum. A septic shock was noticed in six patients and a condition of deep coma in two other patients. Etiology of gangrene was of coloproctologic origin in 15 cases and of urogenital origin in five patients. The bacteriological parietal swabs was positive in 11 cases. The therapeutic take-in-charge consisted of urgent measures of reanimation for six patients. The likely wide spectrum antibiotic therapy consisting of a triple association (beta lactam antibiotic, nitrite-imidazole compound and aminoglycoside) with a secondary adaptation that was recommended for all patients. All the patient underwent surgical debridement of the necrotic tissue with incisions and drainage of the involved areas of the of all the operated-on patients, 26 had colostomy, five among them had both colostomy and cystostomy. The overall evolution was favorable except in eight cases of death. In all, the authors insist on the positive diagnosis as well as the early take-in-charge of the disease to avoid complications of local or general order and recommended the preventive treatment with the precocious treatment of the causing infection.

[Scrotal reconstruction after necrotizing cellulitis of the perineum and external genital organs. Apropos of 21 cases]. / La reconstruction scrotal après cellulite nécrosante du périnée et des organes génitaux externes. A propos de vingt et un cas.

The author report twenty one cases of tissue reconstruction defects secondary to necrotizing cellulitis of perineum and external genital organs, treated at the burns and plastic surgery unit of CHU Ibn Rochd of Casablanca, between 1992 and 1994. Depending on the extent of the defect, the techniques used were gracilis musculocutaneous flap in 8 cases, thigh fasciocutaneous flap in 7 cases, groin flap in 4 cases, simple skin sutures and skin grafts in one case, respectively. The morphological results were satisfactory. The mean hospital stay after reconstruction was 15 days.

[Non-traumatic perforation of the small intestine]. / Les perforations non traumatiques du grêle.

An overview of a series of patients treated for peritonitis over the last 5 years showed that in 64 cases (6.8%) the infection was due to a non traumatic perforation of small intestine. The predominant aetiology was typhoid fever (39 cases), other causes for the peritonitis were perforation of an abdominal diastasis (10 cases) or a Meckel's diverticulum (8 cases), and perforation due to an acute ileitis (2 cases), a non Hodgkins malignant lymphoma (2 cases), a necrotizing enteritis (2 cases) and a jejunal tuberculoma (1 case). The surgical attitude to be adopted for repair of the perforated loop is dependent on the aetiology and the degree of peritoneal sepsis. Enterostomy should be performed as a safety measure in patients with perforation due to typhoid fever.

[Penetrating abdominal wounds. Apropos of 330 cases]. / Plaies pénétrantes de l'abdomen. A propos de 330 cas.

Penetrating abdominal wounds are frequent and serious. 330 cases have been treated in the Department of Emergencies and visceral Surgery at Averroes Hospital of Casablanca from 1980 to 1990. The predominance of male sex is noted, and these wounds are always the result of aggression by white arm. All patients have been operated, the white laparotomy rate is of 36%. The classic interventionist attitude is still recommended in spite of this high rate, because our present conditions can't permit us a rigorous watching. According to abdominal lesions, the different interventions are reviewed, and their indications are detailed.

[Volvulus of the sigmoid. Review of 38 cases]. / Le volvulus du sigmoïde. A propos de 38 cas.

A retrospective study of 38 cases of sigmoid volvulus is reported. The relative frequency of this pathology among young people in Morocco is noted. In 82% of cases diagnosis was without difficulty; and in two cases an associated small bowel volvulus was found. When deciding on the therapeutic approach it is essential to differentiate between cases in which the sigmoid colon is necrotic and those in which the changes are reversible. In the latter, the authors recommend a non surgical reduction (using flatus tube or better: colonoscopy with elective surgery performed at later date. If initial reduction proves impossible, colonic resection with colostomy appears to give the best results.