Burkitt Lymphoma Mimicking an Acute Appendicitis in a 17 Years Old Boy: a Case Report.

Burkitt lymphoma belongs to the B cell non-Hodgkin tumors and is known as the fastest growing human tumor. It is mostly seen in children and young adults. Typically for this type of lymphoma is the chromosomal translocation that leads to a deregulated expression of the c-myc oncogene. Our case report describes a 17 year old patient who presents with atypical right lower quadrant pain. He underwent an explorative laparoscopy and a Burkitt lymphoma was discovered. Subsequently several imaging studies were performed to stage the disease. Intensive systemic chemotherapy is the choice of treatment. Surgery can have a role in early stages and acute complications of the tumor but frequently the role of surgery is restricted to histological biopsy.

Small bowel intussusception caused by multiple intestinal metastases from a giant cell carcinoma of the lung: a case report.

Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

Small Bowel Intussusception Caused by Multiple Intestinal Metastases from a Giant Cell Carcinoma of the Lung: a Case Report.

Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

Can a flap help the plug ? Or vice versa ? Proposing a combined sphincter-sparing anal fistula repair.

BACKGROUND: To evaluate the results of a combination of fistulectomy with a rectal advancement flap and an anal fistula plug in the treatment of transsphincteric anal fistulas. METHODS: All patients with a transsphincteric fistula and a limited number of anterior intersphincteric fistulas in female patients were registered from July 1(st), 2010 until November 30(th), 2012. All operations were performed by one surgeon (CdG). Patient data and results (healing, continence) were collected in a prospective database. RESULTS: 28 patients were treated with a healing rate of 75% after one procedure. Four out of seven patients who failed to heal underwent a redo anal fistula plug and rectal advancement flap. Three of them were cured. Cumulative healing rate was 86% after two procedures. There were four minor complications. Mean postoperative Wexner score was 0.62. CONCLUSIONS: Combination of anal fistula plug and rectal advancement flap in treating transsphincteric anal fistulas can result in good healing rates with minimal incontinence.

Revisiting the role of herniography in the preoperative work-up of groin hernias?

INTRODUCTION: The diagnosis of groin hernia is based on clinical symptoms and physical examination. In the case of equivocal clinical findings, patients are often referred for subsequent diagnostic imaging. Accurate detection is important to minimize the inherent risk of complications or to avoid unnecessary surgery. Although herniography has been reported as a save and highly accurate procedure, it has not gained widespread acceptance in the diagnostic work-up of groin hernias. METHODS: We retrospectively analysed 157 patients who underwent herniography in our department, which is to date the third largest study reporting on this technique. The diagnostic value of herniography was investigated--with laparascopic surgical findings serving as a gold standard--in comparison to clinical symptoms, physical examination and ultrasound. RESULTS: Herniography showed a substantial agreement with the surgical findings, but only a slight to fair agreement was found between surgery and clinical symptoms and examination. Poor agreement was found between sonographic and surgical findings. CONCLUSION: Based on the presented data and previously reported studies, we can conclude that herniography is a safe technique with a high accuracy to detect groin hernias in patients with equivocal clinical presentation, whereas ultrasound has a wide range in reported sensitivity. Clinicians and surgeons should take this into account when referring patients for subsequent imaging.

Incisional surgical site infections after colorectal surgery: time to appraise its true incidence.

BACKGROUND: Surgical site infections (SSI) are the leading cause of complications in surgical patients. For colorectal surgery the reported incidence of SSI varies between 10 and 15%. This incidence however, has been challenged recently. In this study, we evaluated the incidence of incisional SSI after colorectal surgery in our department. METHODS: We performed a retrospective analysis of 115 non-laparoscopic colorectal resections between July 1st 2004 and July 31st 2005. After exclusion, 101 patients were retained. Demographic, clinical and operative variables were collected. Univariable and multivariable analysis were performed to identify risk factors for the development of incisional SSI. RESULTS: 21 SSI were diagnosed (20.7%). Seventeen cases were incisional SSI (16.8%). Multivariable analysis identified longer operation time (p = 0.014), pre-operative obstructive lung disease (p = 0.02) and fewer postoperative days on TPN (p = 0.04) as independent predictors of incisional SSI. CONCLUSION: In comparison with recent publications, the incidence of SSI in our series was higher compared to what is generally reported.

Transmesosigmoid hernia: report of a case and review of the literature.

We report a case of a transmesosigmoid hernia in a 6 weeks postpartum woman. We found 14 previous reports of this rare type of internal hernia. Our patient presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiographic examination were not diagnostic. An early laparoscopy was performed and a herniation of a small intestine loop through a hole in the sigmoid mesocolon was seen. The hernia was reduced and the defect in the sigmoid mesocolon was closed laparoscopically. The small intestine was viable and enterectomy could be avoided. The role of laparoscopy and potential causes of this type of hernia are discussed.

Laparoscopic inguinal hernia repair: review of 6 years experience.

Since 6 years, the totally extraperitoneal laparoscopic hernia repair has become our procedure of choice to manage inguinal hernia in adult patients, especially for bilateral hernias and recurrences after classical anterior repair. Between March 1993 and March 1999, 976 patients underwent 1259 hernia repairs by an endoscopic total extraperitoneal approach. A large polypropylene prosthesis (15 x 15 cm) is placed and covers all potential defects. Follow-up on patients ranged from 6 to 79 months (mean, 39 months). Per- and postoperative morbidity and complications were acceptable (8.4%) and included conversion to open surgery (0.4%), bleedings (0.3%), urinary retention (4.2%), seromas (2.7%), neuralgias (0.2%), vague persistent groin discomfort (0.4%), orchitis (0.08%) and sigmoido-cutaneous fistula (0.08%). Recurrence rate so far is 0.1%. This retrospective study shows that the totally extraperitoneal repair for inguinal hernia should have a promising future because of low morbidity and low recurrence rate.

Focal transmural necrosis of the gallbladder with bleeding resulting in a massive haemoperitoneum.

A case of massive haemoperitoneum as a complication of focal transmural necrosis of the gallbladder with bleeding during acute cholecystitis is reported. Urgent laparotomy and cholecystectomy was performed to secure an adequate haemostasis. A review of the literature confirmed that this condition is a very rare complication of acute cholecystitis. Only 44 similar cases have been reported between 1858 and 1996. In our case, bleeding was caused by the edges of a necrotic zone in the gallbladder wall.

Duodenal transection in a battered child: a case report.

A case of severe duodenal injury following child abuse is presented. Perforating duodenal injuries are seldom seen after blunt abdominal trauma. A high energy force directed to the center of the upper abdomen may result in disruption of the duodenum. Early diagnosis and appropriate treatment are necessary to improve the outcome. Most children indeed are seen too late and in septic shock because of neglect.

Laparoscopic repair of a Morgagni hernia.

The authors present a case of laparoscopic repair of a symptomatic Morgagni hernia in an adult patient. The indication for surgery was based on symptoms of dyspnea and sensation of thoracic tightness. A tension-free closure of the defect using a Marlex mesh was carried out. Recovery was quick and uneventful. One year after surgery, no complaints were noticed. Aetiology, diagnosis and treatment are discussed.

[VDD mode single electrode cardiac stimulation: indications, results and limitations of the method]. / La stimulation cardiaque en mode VDD à sonde unique: indications, résultats et limites de la méthode.

UNLABELLED: Several authors have reported the single atrioventricular (AV) electrode, comprising an atrial dipole floating in the right atrium, to be a system capable of providing results which are just as satisfactory as those of conventional systems (DDD). Between August 1992 and March 1995, a VDD single electrode pacemaker was implanted in 65 patients (mean age: 73 years +/- 17.2). The indication for implantation was isolated high degree AVB with no apparent sinus dysfunction. Four pacemakers were used: Vitatron (n = 24), Intermedics (n = 23), Medico (n = 13), Biotronik (n = 5). Intraoperative atrial endocavitary recording was 1.8 mV +/- 0.74. 17 patients died from a cause unrelated to pacemaker dysfunction. 4 patients were lost to follow-up. The remaining 44 patients were reviewed in our centre with a mean follow-up of 14.5 months +/- 7 months. Seven pacemakers (16%) were reprogrammed in VVI or VVI (R) mode, because of permanent atrial fibrillation in 3 cases, complete loss of atrial reception in 2 cases and late onset sinus dysfunction in 1 case. In the 41 patients in sinus atrial rhythm, the atrioventricular synchronization rate was greater than 90% in 88% of patients, equal to 76.3% in 2.4% of patients and atrioventricular synchronization was impossible in 9.6% of cases. CONCLUSION: The overall results of our preliminary experience of VDD mode single electrode pacemaker are moderate. The poor results essentially concerned patients with paroxysmal atrial arrhythmias prior to pacing.

Cystic lymphangioma of the pancreas: an unusual cause of the acute surgical abdomen.

Cystic lymphangioma of the pancreas is a rare tumour. The authors report on a case of cystic lymphangioma of the pancreas in a 6-year-old boy, presenting an acute abdomen. These tumours are benign and must be differentiated from other cystic abdominal lesions. Histological diagnosis is required in all cases. Treatment consists in a complete resection of the tumour. In most cases a tumorectomy is sufficient, although sometimes pancreatic resection might be necessary.

The totally extraperitoneal laparoscopic hernia repair. Preliminary results.

BACKGROUND: The totally extraperitoneal laparoscopic hernia repair has become our procedure of choice to manage inguinal hernia in adult patients since March 1993. This technique was developed in an attempt to diminish postoperative pain, shorten the convalescence period and equal the recurrence figures of the classical tension-free repair. METHODS: A complete extraperitoneal dissection is performed. A large Marlex prosthesis (15 x 15 cm) is placed and covers all potential defects. RESULTS: A consecutive series of 195 hernias in 158 patients is proposed. The minimum follow-up in our series is at least 6 months. Morbidity is low and so far, no recurrences have been seen. CONCLUSIONS: The totally extraperitoneal laparoscopic approach for repairing inguinal hernia should have a promising future, because the same principles as the classical tension-free repair are followed. Preliminary results are promising. Further studies, even randomized prospective trials and fair reports of complications, will determine the future of laparoscopic hernia surgery.

Strangulation: a late presentation of right-sided diaphragmatic rupture.

A case of late presentation of a right-sided diaphragmatic rupture due to blunt chest trauma is presented. The patient suffered from strangulation of a herniated segment of small bowel into the chest. Chest radiography suggested diaphragmatic rupture, computed tomography and sonography established the correct preoperative diagnosis. The prevalence, mechanism of injury and possible complications are reviewed. The value of chest radiography and other imaging techniques is discussed.

Small bowel obstruction after laparoscopic inguinal hernia repair: a case report.

The authors present a case of intestinal obstruction after a transabdominal laparoscopic hernia repair, due to bowel entrapment through a not perfectly closed peritoneum. With the tremendous success of laparoscopic cholecystectomy, a laparoscopic approach to inguinal hernias seemed feasible and logical. The transabdominal preperitoneal and the totally extraperitoneal hernia repair, both using a prosthesis, are based on the same principles as the classical tension-free repair. The authors have experience with both new procedures. The case report illustrates a major complication after a transabdominal laparoscopic repair in a consecutive series of 40 patients. This was the reason why the transabdominal approach in our department is replaced by the totally extraperitoneal approach.

Laparoscopic antireflux surgery. What is real progress?

OBJECTIVE: The authors aim to substantiate, with objective arguments, potential advantages of laparoscopic versus open antireflux surgery in the light of the recent crude experience of the Louvain Medical School Hospital. METHODS: Seventy-two consecutive patients with disabling gastroesophageal reflux disease ([GERD], n = 56), symptomatic hiatal hernia without GERD (n = 5), or unsatisfactory outcome after unsuccessful antireflux procedure (n = 11) were operated on by laparotomy (n = 28), laparoscopy (n = 39), or thoracotomy (n = 5). The antireflux procedure was a subdiaphragmatic Nissen fundoplication (n = 60), an intrathoracic Nissen fundoplication (short esophagus, n = 3), a subdiaphragmatic 240 degrees fundoplication (severe motility disorders, n = 3), a Lortat-Jacob repair (hiatal hernia without GERD, n = 5), and a duodenal diversion (delayed gastric emptying, n = 1). RESULTS: Major postoperative morbidity included two pulmonary embolisms (one laparoscopy patient and one laparotomy patient), and one hemothorax (one thoracotomy patient). Mean hospital stay was 6.4 days for laparoscopy, 7.8 days for laparotomy, and 12.5 days for thoracotomy. Postoperative morphine consumption (patient-controlled analgesia) averaged 47 mg/48 hrs (laparoscopy) versus 46 mg/48 hrs (laparotomy with primary antireflux surgery) (p > 0.05). Although 93% of the laparoscopy patients returned to work within 3 weeks after surgery, 92% of the laparotomy and thoracotomy patients resumed their activity after more than 6 weeks. At follow-up, 87.5% of the patients were asymptomatic or had inconsequential symptoms, 9.8% had disabling side effects, and 2.7% had persistent or recurring esophageal symptoms. There were four parietal herniations, i.e., one incisional hernia and one recurrence of a repaired umbilical hernia in the laparotomy group, and two herniations of the wrap into the chest--probably related to a premature return to manual work--in the laparoscopy group. Three laparoscopy patients were dissatisfied with the esthetics of their scars. Lower esophageal sphincter pressure and esophageal acid exposure in the laparoscopy patients who were investigated were normal in 100% and 95%, respectively. CONCLUSIONS: Laparoscopy is a good approach for achieving successful antireflux surgery in selected cases. However, its fails to substantially reduce postoperative complication rate and discomfort, duration of the hospital stay, and the risk of esthetic sequela. Early return to work is questionable for manual workers. The subdiaphragmatic Nissen fundoplication is not an all-purpose antireflux procedure.