[Superior mesenteric artery syndrome in gastric cancer: a case report]. / Syndrome de la pince aorto-mésentérique sur cancer gastrique: à propos d'un cas.

Superior mesenteric artery syndrome or Wilkie syndrome is due to the compression of the third duodenum between the superior mesenteric artery and the aorta. It causes acute or chronic upper bowel occlusion. Abdominal CT scan facilitates the diagnosis. Severe malnutrition is its main etiological factor. Medical treatment can be based on aspiration of gastric contents and parenteral nutrition. If this fails, surgery is necessary. We here report the case of a 46-year-old patient, with a history of smoking, presenting with profuse postprandial bile and food vomiting. He had had weight loss of 7% over a period of 6 months. Upper GI endoscopy revealed non-stenotic antro-pyloric tumour mass. Histological examination showed poorly differentiated tubular gastric adenocarcinoma. Staging was without any peculiarity and allowed for the detection of superior mesenteric artery syndrome at an angle of 8°C. The patient received parenteral nutrition for 10 days, followed by inferior pole gastrectomy and gastrojejunal anastomosis (omega loop). The postoperative course was uneventful. Adjuvant chemotherapy was indicated.

Cystic mesenteric lymphangioma: A case report.

INTRODUCTION: Cystic lymphangioma is a benign malformative tumor. The abdominal localization is rare. The diagnosis is not easy in preoperative period. The surgery is the choice in the abdominal and symptomatic localization. PRESENTATION OF CASE: We report a 26 years old women. She consulted with left hypochondrial pain. The exam found left hyphochondrial swelling with 10 cm of diameter. The biologic screeming was normal. The ultrasound showed a multiloculated cyst which measured 130*80 mm. the CT scan showed a mesenteri cyst mass measured 15 cm. A fine needle aspiration cytology guided by abdominal ultrasound was realized and the cytology doesn't show malignant cell. A median laparotomy found a mesenteric cystic mass measured 15 cm of diameter. A resection was realized. The histologic exam membranous fibrosis cyst limited by an endothelium. CONCLUSION: Mesenteric localization of cyst lymphagioma is rare. The surgery is safe and efficiency for the treatment.

[Torsion of wandering spleen in a teenager: about a case]. / Torsion chronique d'une rate baladeuse chez un adolescent: à propos d'un cas.

Wandering or migrating spleen is a rare anomaly which is usually described in children. Complications, which include pedicle torsion, are common and can be life-threatening. We report the case of a 17 year-old patient with a long past medical history of epigastric pain suffering from wandering spleen with chronic torsion of the pedicle. The clinical picture was marked by spontaneously painful epigastric mass, evolved over the past 48 hours. Abdominal ultrasound objectified heterogeneous hypertrophied ectopic spleen in epigastric position and a subcapsular hematoma. Doppler showed a torsion of splenic pedicle which was untwisted 2 turns and a small blood stream on the splenic artery. Abdominal CT scan with contrast injection showed a lack of parenchymal enhancement of large epigastric ectopic spleen and a subcapsular hematoma. The diagnosis of wandering spleen with chronic torsion of the pedicle complicated by necrosis and subcapsular hematoma was confirmed. The patient underwent splenectomy. The postoperative course was uneventful. We here discuss the contribution of ultrasound and CT scan in the diagnosis of wandering spleen with chronic torsion of the pedicle.

Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.

INTRODUCTION: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. PATIENTS AND METHODS: We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. RESULTS: Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. CONCLUSION: The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.

INTRODUCTION: Les traumatismes du diaphragme comprennent les ruptures et les plaies du diaphragme. Leur incidence varie entre 0,8 % et 15 %. Elles sont très souvent méconnues malgré les techniques performantes d'imagerie médicale. Leur prise en charge chirurgicale reste controversée. La mortalité de cette pathologie est liée aux lésions associées. Le but de notre étude était d'apprécier l'incidence des lésions diaphragmatique dans les traumatismes thoraco-abdominaux, et de discuter les aspects épidémiologiques, diagnostiques et thérapeutiques. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective sur 21 ans allant du 1er janvier 1994 au 30 juin 2015. Cette étude a été réalisée au Service de Chirurgie Générale de l'Hôpital Aristide Le Dantec de Dakar. Etaient inclus dans cette étude tous les patients qui présentaient une lésion diaphragmatique consécutive à un traumatisme abdominal et/ou thoracique ouvert ou fermé. RÉSULTATS: Durant cette période d'étude, nous avons reçu 1535 patients victimes de traumatisme thoracique et/ou abdominal. Il s'agissait de 859 cas de contusions et 676 cas de plaies thoraciques et/ou abdominaux. Notre étude portait sur 20 cas de lésions diaphragmatiques (1,3 %). Le sex-ratio était de 4. L'âge moyen était de 33 ans. Les agressions par arme blanche représentaient 60 % (12 cas). L'incidence des lésions diaphragmatiques était de 2,6 %. La plaie cutanée était de siège thoracique dans 60 % (7 cas). La radiographie du thorax était contributive dans 45 % (9 cas). Le diagnostic de lésion diaphragmatique était préopératoire dans 45 % (9 cas). La brèche diaphragmatique siégeait à gauche dans 90 % (18 cas) et la taille moyenne était de 4,3 cm. Le geste chirurgical avait consisté en une réduction des viscères herniés et une suture du diaphragme par des points en « X ¼ dans 85 % (17 cas). Le drainage thoracique était systématique. Le taux de morbidité était de 10 % et la mortalité de 5 %. CONCLUSION: Leur diagnostic est difficile. Elles siègent le plus souvent à gauche. Leur traitement est chirurgical et la voie d'abord préférentielle est la laparotomie.