Primary Ewing sarcoma of the liver: Diagnosis, management, and prognosis: A case report and literature review.

Ewing's sarcoma tumors (ES) are a rare entity exceptionally localized on the liver. We report a case of an ES of the liver in a 26-year-old man who presented with abdominal pain. The diagnosis was confirmed with a histopathological examination of the left hepatectomy specimen and adjuvant chemotherapy was received.

[Abdominal wall edometriosis: about two cases]. / Endométriose de la paroi abdominale: à propos de deux cas.

Abdominal wall endometriosis is a rare disease that usually develops in association with a cesarean section scar. Although frequently identified in the skin and subcutaneous adipose tissue adjacent to the cesarean scar, intramuscular localization is possible but rare. Treatment is based on surgical excision of the lesion associated with or without hormone therapy. Wide surgical excision is the treatment of choice, but it exposes to the risk of abdominal wall hernia. We here report two cases of parietal endometriosis occurring after Pfannstiel scar for cesarean section whose data were collected at the Department of surgery in the Zaghouan Regional Hospital.

Perforated jejunal diverticulum as an unsual cause of acute abdomen: A case report.

INTRODUCTION AND IMPORTANCE: Jejunal divertica is a rare entity with an often clinically silent course. However, it may be associated to life-threatening complications such as perforation. Therefore it should be considered in every case of acute abdomen. CASE PRESENTATION: A 60-year-old female presented with a generalized abdominal pain associated with vomiting evolving for 24 h. Physical examination found an irreducible and tender hernia in the umbilical region with abdominal guarding. Laboratory test results showed a biological inflammatory syndrome. The primary diagnosis of strangulated umbilical hernia was suspected and the patient underwent an emergency laparotomy. Intra-operative examination revealed mutiple jejunal diverticula, with a perforation in one diverticulum leading to generalized peritonitis. A bowel resection and peritoneal lavage were performed with good outcome. CLINICAL DISCUSSION: Jejunal diverticula is a challenging condition with various non-specific clinical presentations. Jejunal perforation is its most feared complication. Deceitful abdominal examination among elderly patients and lack of specific signs may lead to diagnostic delay responsible for high mortality rate and poor prognosis. Adjunctive imaging modalities may be needed to help establish a prompt diagnosis and dictate management strategy. Treatment of perforated jejunal diverticulum is based on limited bowel resection associated to primary anastomosis. CONCLUSION: Jejunal diverticulitis should be kept in mind as a differential diagnosis in every case of acute abdomen. High index of clinical suspicion and eventual further radiological examinations are required to avoid misdaignosis and save patients' lives.

Focal Mass-Forming Autoimmune Pancreatitis Mimicking Pancreatic Cancer: Which strategy?

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis that predominantly affects men in their fifth and sixth decades and often presents with obstructive jaundice and pancreatic enlargement. It is relatively easily diagnosed by characteristics of diffuse swelling of parenchyma and irregular narrowing of the main pancreatic duct. However, focal mass-forming AIP is hard to distinguish from pancreatic cancer. Problematic issue : How to differentiate a focal AIP from a pancreatic cancer and avoid a heavy and unnecessary surgical treatment?. Summary of the observation : We report three cases of mass-forming autoimmune pancreatitis that were preoperatively suspected to be pancreatic cancer, and review their clinical, radiological and histological features. We emphasize on the strategy of diagnosis and we try to understand the histopathological features of this disease. Conclusion : In patients with obstructive jaundice suggestive of pancreatic carcinoma, AIP should be considered in the differential diagnosis to avoid unnecessary laparotomy or pancreatic resection. To the best of our knowledge, this report is from the rare publications to present a histopathological comparison of mass-forming AIP with the adjacent uninvolved pancreatic tissues.

Gallbladder schistosomiasis: rare but possible, a case report and review of the literature.

After Malaria, schistosomiasis remains the most important tropical disease in large parts of the world. It affects mainly the colon and the urinary tract. The hepatic involvement is significantly frequent, particularly by the mansoni species. Still one of the extremely rare locations is the gallbladder. Our case is about a 51 year old woman from Tunisia, which is no longer considered an endemic country, with no particular medical history, underwent surgery for symptomatic cholelithiasis. She had a laparoscopic cholecystectomy. Post operative period was uneventful. Histology of the gallbladder showed fibrosis in the mucosa and schistosomal ova in the wall. As a conclusion we can see that due to the lack of specific clinical and radiological signs, the diagnosis of gallbladder schistosomiasis is established only after the histological examination.

Cystic degeneration of neuro endocrine tumor of pancreas and Crohn's disease: true or coincidental association?

Pancreatic endocrine tumors (PETs) or islet cell tumors are rare lesions, the incidence of which is estimated to be less than 1 per 100,000 person-years in the general population. PETs can be divided into functional (exhibit a distinct clinical syndrome due to hormone hypersecretion) and non-functional tumors. The majority of PETs are non-functional. In spite of their rarity, cystic neoplasms of the pancreas are characterized by existing or potential malignancy that cannot be ignored during decisive process with regard to the choice of treatment. The purpose of this workis to find an association with Crohn's disease and cystic degeneration of a neuroendocrine tumor of the pancreas. Crohn's disease may affect extraintestinal organs, including the pancreas. In such cases, It seems certain that many patients diagnosed with Crohn disease (CD) are predisposed to a wider spectrum of cancers. We present a case of pancreatic cyst with no typical features of pseudocyst in the medical interview, with history of Crohn's disease, treated by caudal pancreatectomy. We tried to evaluate the clinical and morphological features of so-called cystic neoplasms associated with inflammatory bowel disease and to define their pathological characteristics.

Conservative Management of Isolated Superior Mesenteric Artery and Celiac Trunk Dissection: A Case Report and Literature Review.

Isolated arterial dissection without aortic pathology has been rarely reported in mesenteric vessels. The natural history and appropriate treatment for this disease is uncertain because of the scarcity of literature which limits the data available to the clinician, resulting in management challenges. Herein, we report a rare case of a 42-year-old Tunisian man with spontaneous dissection and aneurysmal dilatation of the Celiac Artery (CA) and the Superior Mesenteric Artery (SMA) with partial thrombosis. This case was successfully managed conservatively with heparin infusion and blood pressure control and the patient remained symptom free at 15 months follow up. This case demonstrates that conservative management may be warranted in non-complicated isolated visceral arterial dissection.

Epidemiology of nosocomial infections: About 70 cases.

Background - The infections associated with care (IAS) constitute a major public health problem by the morbi- mortality than they generate as well as by their cost to support. The prevention of these infections has become a priority for several years everywhere in the world and in the occurrence in Tunisia. Aim - The purpose of our study is to assess the prevalence of nosocomial infections as well as develop their microbiologic  profiles in the different departments of  the hospital of FSI  Marsa Tunisia and try to highlight the risk factors that can influence these infections Methods - It was a retrospective study about  patients with noscomila infection who were admitted in the different care unit of the Hospital of FSI  Marsa and this on a period of 6 years from 1 January 2009 to 31 December 2014 Results - We have identified seventy(70) patients having contracted a nososcomial infection during the period of study for 24600 hospital admission, with a prevalence rate of 0.28%. The unit of intensive care   had the highest prevalence rate (30%), followed by the general surgery unit (17.1%) and orthopaedics (15.7%). Four bacterial species accounted for almost ¾ of germs isolated: Pseudomonas aeruginosa (22.86%), Staphylococcus  ( 15.71%), Klebsiella pneumoniae (15,71 %) and Escherichia coli in 8.75% of the helth care associated infections. Conclusion - Nosocomial infections represent an important indicator of the quality of care. Serious efforts but simple, especially as regards the respect of the rules of aseptic and hand hygiene are effective to significantly reduce the occurrence of infections in hospital.

[Common bile duct distomatosis managed by coelioscopic aproach. One case report]. / Distomatose de la voie Biliaire principale traitée par voie coelioscopique. A propos d'un cas.

Biliary distomatosis is caused by a parasitis of trematode family: the fascialo hepatica. It is a rare affection in Tunisia. The diagnostic is often done in the status phase. Adult parasite stay preferentially at biliary ducts, cause obstruction and cholangitis. The authors report a case of biliary treated successfully by laparoscopic procedure.