Small bowel obstruction in adults, Ladd's band is an exceptional cause: a case report.

Malrotation of the gut is a congenital anomaly of foetal intestinal rotation and it's principally discovered in early childhood as acute intestinal obstruction. This condition is veritably rare and constantly silent in adults. Intestinal malrotation in adults is frequently asymptomatic and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen. Adult patients rarely present with acute midgut volvulus or internal hernias caused by Ladd's bands. We present a case of an admitted 18-year-old female with a small bowel obstruction due to an intestinal volvulus complicating intestinal malrotation in the presence of Ladd's band. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, appendicectomy, and reorientation of the small bowel on the right and the cecum and colon on the left of the abdominal cavity; the postoperative evolution was favorable. Although it is a rare pathology, it should be kept in mind in cases of patients presenting small bowel obstruction.

Perineal papilliferous syringocystadenoma: An unusual localization.

INTRODUCTION AND IMPORTANCE: Syringocystadenoma papiliferum (SCAP) is an infrequent, benign neoplasm originating from the apocrine or, less frequently, eccrine sweat glands. This condition predominantly manifests in regions such as the head, face, neck, and trunk. Notably, it is frequently associated with hamartomas of endocrine, sebaceous, or follicular origin, as well as with sebaceous nevi. CASE PRESENTATION: In the context of this study, we present a clinical case involving a 65-year-old patient who exhibited an atypical anatomical presentation of syringocystadenoma papiliferum. CLINICAL DISCUSSION: This case highlights the importance of considering SCAP as a potential diagnosis of perineal cystic masses that need a surgical excision due to the risk of malignancy transformation. CONCLUSION: The uniqueness of the case under consideration lies in the rarity of syringocystadenoma papiliferum (SCAP), the atypical perineal localization, and its occurrence at an advanced age (65 years).

Digestive cancer surgery in low-mid income countries: analysis of postoperative mortality and complications in a single-center study.

PURPOSE: This study aimed to analyze postoperative and 90-day morbidity and mortality and their risk factors in all digestive cancer curative intent resections of a single digestive surgical department in a low-mid income country. METHODS: All consecutive patients who underwent a surgical resection for digestive cancer with a curative intent between January 1, 2021, and December 31, 2021, were included. This is a retrospective analysis of a prospective cancer surgery database managed during the period. Patterns and factors associated with increased morbidity and mortality were analyzed and presented in tabular and descriptive forms. RESULTS: Seventy-six patients were included, 38 (50%) were men with a mean age of 59 years (±13.5). Forty patients (52.63%) had tumors locally advanced, staged CT3-CT4 on preoperative imagery. Thirty-three of our population (43.42%) had laparoscopic surgery (conversion rate at 12.12%). In immediate preoperative, the morbidity rate was 36.84%; among each, 7 patients (9.21%) had serious complications (>2 Clavien-Dindo grade), and mortality rate was 5.26%. At 90 days after surgery, morbidity remained the same, and mortality increased to 7.9%. Risk factors for increased morbidity and mortality were female gender, obesity, high levels of carcinoembryonic antigen, hypoalbuminemia, laparotomy approach, hand sewn anastomosis, prolonged operating time, and wide drainage (p < 0.05). CONCLUSIONS: This study provides figures on mortality and morbidity related to digestive cancer curative surgery in a low-mid income country digestive department and discusses risk factors increasing postoperative complications and death.

A colic mesothelial cyst, mimicking an appendicular mucocoele in an elderly patient: A case report and a literature review.

Benign cystic mesothelioma is a very rare and uncommon lesion, first reported by Plaut in 1928. It affects young women of reproductive age. It is usually asymptomatic or has non-specific symptoms. Diagnosis remains difficult despite the evolution of imaging, and the histopathological study is the key examination to make the diagnosis. Surgery remains the only curative treatment, regardless of significant rate of recurrence, and until today, no consensus on the therapeutic strategy is established.

Synchronous anal mucinous adenocarcinoma and anal tuberculosis presenting as chronic anal fistula: Challenging management.

Metachronous anal tuberculosis to an anal adenocarcinoma is an exceptional condition. The aim of our study was to report management of the first case of synchronized anal canal adenocarcinoma and anal canal tuberculosis and report our multidisciplinary approach. A 71-year-old man was admitted for non-healing anal fistula. Rectal examination at supine position showed an ulcerative growth at the medio-superior quadrant on a radius of 2cm from the anal verge. Digital rectal examination assessed no tumor in the anorectum. Biopsy of fistulae confirmed diagnosis of anal mucinous adenocarcinoma with coexisting anal tuberculosis. Further exploration confirmed diagnosis with no distal metastasis, no active pulmonary tuberculosis and no immunodepression. Adjuvant anti-bacillary chemotherapy was initiated 1 month prior to adjuvant radio-chemotherapy. Patient was re-admitted at the 6th week following the last dose of radio-chemotherapy for surgery. On long-term evaluation at 10 months, the patient reported absence of symptoms with weight gain. Association of both entities is rare. Chronic inflammatory damage may possibly initiate a sequence of metaplasia and dysplasia, resulting in neoplastic transformation. Anal canal adenocarcinoma treatment follows same guidelines as rectal cancer. Extra-pulmonary tuberculosis treatment follows anti-bacillary protocol with consequent side effects. Therefore, our case is a unique clinical challenge for physicians. Management decision was multidisciplinary process. Their pathophysiology relationship is yet to be understood. Moreover, each entity has defined and individual therapeutic protocols and indications. All this taken into consideration, such case presents a clinical and therapeutic challenge for physicians.

Giant gastric trichobezoar in a young female with Rapunzel syndrome: case report.

Rapunzel syndrome is an extremely rare complication of a gastric trichobezoar in. We report here the unusual case of a case of a 16 years old girl presented with severe abdominal pain and vomiting. Clinical examination revealed a malnourished girl, with presence of a mobile and sensitive abdominal mass of 20x15 cm witch filled the upper quadrant. An abdominal computed tomography scan showed a heterogeneous mass occupying the whole stomach cavity with extension into the third portion of the duodenum. A diagnostic of giant trichobezoar is suspected after further questioning reveling a trichotillomania, trichophagia and onychophagia. The removal of the trichobezoar endoscopically failed and it was possible to pull only few fibers of hair to comfort the diagnostic. She was subjected to an exploratory laparotomy. An antral gastrostomy were performed and a 25x10x7 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to psychiatry. Rapunzel syndrome is an uncommon trichobezoar, it's commonly found in young females usually with an underlying psychiatric disorder. Management requires gastrotomy. A psychiatric assessment and a long-term follow-up are advocated as a regular part of treatment to prevent recurrence.

Risk Factors for Conversion and Morbidity During Initial Experience in Laparoscopic Proctectomies: a Retrospective Study.

The aim of this study was to determine the predictable factors for conversion during laparoscopic proctectomies, and for postoperative morbidity, in order to assist in defining the best candidates of patients for initial experience in laparoscopic proctectomies for rectal adenocarcinoma. A retrospective analysis of consecutive patients who underwent laparoscopic rectal resection for rectal adenocarcinoma operated by a single surgeon, between 2005 and 2012, were performed. Predictive factors for conversion and for postoperative morbidity were analyzed using univariate and multivariate analysis. Sixty-nine patients were included. There were 35 (50.7 %) men with a median age of 53 years. Forty-seven patients had tumors located below 8 cm from the anal verge, and sphincter-preserving surgery was performed in 52 (75.4 %) patients. Thirty-four patients were operated in the early period (before 2009). Conversion rate was 17.4 %. In multivariate analysis, the independent predictive factors for conversion were time period (before 2009) (p = 0.007, Exp. 19.9; CI (95 %) 2.2-177.4) and tumors located 8 cm above the anal verge (p = 0.028, Exp. 5.23, CI (95 %) 1.2-22.8). Twenty-two patients (31.9 %) had a complicated postoperative course. Only male gender was associated with postoperative complications (p = 0.01, CI (95 %) 1.3-11.8). Our study showed that conversion rate is influenced by surgeon's experience, and height of the tumor and that male gender is a predisposing factor for a higher morbidity rate. These results suggest that women with low rectal tumors requiring colo-anal anastomosis or abdomino-perineal resection would be the best candidates for early surgeons' experience in laparoscopic proctectomies for rectal adenocarcinoma.

Impact of Conversion to Open Surgery on Early Postoperative Morbidity After Laparoscopic Resection for Rectal Adenocarcinoma: A Retrospective Study.

BACKGROUND: The impact of conversion to open surgery after a laparoscopic resection for rectal adenocarcinoma on postoperative morbidity is still unclear. Most previous studies included colon and rectal carcinomas and produced conflicting results. The aim of this study was to investigate the impact of conversion to open surgery on early postoperative morbidity in patients who underwent a laparoscopic resection for rectal adenocarcinoma. METHODS: This was a retrospective bicentric study. It included all consecutive patients who underwent a laparoscopic resection for nonmetastatic rectal adenocarcinoma between January 2005 and December 2013. The impact of conversion to open surgery on 30-day postoperative morbidity was analyzed by univariate and multivariate analyses. Risk factors for conversion were also investigated by univariate and multivariate analyses. RESULTS: One hundred thirty-one patients were included. The conversion rate was 26.7%. The global 30-day morbidity rate was 31.3% (41 patients). The conversion to open surgery was associated with higher rates of postoperative complications, anastomotic leaks, and reoperations. It was also an independent predictive factor to postoperative morbidity in the multivariate analysis (P = .01; odds ratio 2.86; 95% confidence interval [CI] 1.23-6.63), in addition to T4 tumors (P = .04; odds ratio 3.92; 95% CI 1.05-14.61). Risk factors for conversion in the multivariate analysis were T4 tumors (P = .006; odds ratio 6.09; 95% CI 1.66-22.32) and the height of the tumor (P = .025; odds ratio 2.7; 95% CI 1.13-6.43). CONCLUSIONS: This study showed that conversion to open surgery after laparoscopic proctectomy for rectal adenocarcinoma was associated with higher rates of early postoperative complications. It also showed that T4 tumors and the height of the tumor were independent factors associated with the conversion to open surgery. Reducing postoperative morbidity could be achieved by a better patient selection and a policy of early conversion.

Abdominal wall recurrence of a gastrointestinal stromal tumor: case report.

INTRODUCTION: The gastrointestinal stromal tumors (GIST) are mesenchymal tumors, most commonly affecting the stomach and small bowel. Only few cases of port-site recurrence after laparoscopic treatment have been reported. We herein report the case of a parietal recurrence on the extraction incision site, 7 years after laparoscopic surgery for small bowel GIST. CASE REPORT: A 47 years-old female patient was hospitalized in November 2007 for isolated pelvic pain. CT scan showed an intestinal tumor with a benign aspect measuring 50 mm. A laparoscopy-assisted resection was performed. Surgical exploration found a 7 cm small bowel tumor. It was extracted through a supra-pubic transversal incision without a wound protector and then resected. Histologic analysis revealed an intestinal GIST with high aggressive potential (five mitosis per field), with CD117 positive at the immunohistochemical examination. The patient had no adjuvant chemotherapy. Seven years later, the patient was readmitted for an abdominal mass at the site of the supra-pubic scar. Abdomino-pelvic CT scan showed a 10 × 7.5 cm solid mass of the abdominal wall. Percutaneous biopsies were done and the pathological analysis revealed a mesenchymal-cell tumor, positive to CD117 and DOG1 at the immunohistochemical examination. Final diagnosis was abdominal wall recurrence of GIST secondary to tumor-contamination during the first surgery. CONCLUSION: Abdominal wall recurrence of GIST after laparoscopic surgery is rarely reported. This complication should be avoided with preventive measures such as the use of extraction bags or wound protectors.

Imaging features of adrenal ganglioneuroma: a case report.

BACKGROUND: Adrenal ganglioneuroma is a rare tumor constituting 20-30% of all ganglioneuromas. It is a benign tumor and can present diagnostic problems when confused with other adrenal solid tumors. CASE PRESENTATION: We herein report a case of adrenal ganglioneuroma in a 28-year-old Arabic patient and emphasize the diagnostic role of cross-sectional imaging modalities (computed tomography and magnetic resonance imaging). CONCLUSION: Imaging of adrenal ganglioneuromas is diagnostically challenging. Differentiation between adrenal ganglioneuroma and other solid adrenal tumors can be difficult. However, some suggestive features on computed tomography and magnetic resonance imaging are helpful in achieving a correct diagnosis.

Asymptomatic intra-peritoneal rupture of hydatid cyst of the liver: case report.

BACKGROUND: Intra-peritoneal rupture of hydatid cyst is a rare complication and there is no consensus about its treatment. CASE PRESENTATION: The reported case concerns a 25 years old female patient who had been complaining for four months from a moderate pain in the right upper quadrant. No clinical or biological signs of sepsis or allergic reactions were witnessed. Ultrasound and CT examinations showed a multilocular hepatic cyst in addition to multiple unilocular cysts in the abdomen. The suspected diagnosis was hepatic and peritoneal HC and a surgical treatment was scheduled four weeks later. Surgical exploration showed a large ruptured HC on the left lobe of the liver, with daughter cysts in the peritoneal cavity. Left lobectomy of the liver with complete ablation of all daughter cysts and a wide peritoneal lavage were performed. For the three months following the surgery, Albendazole had been given to the patient. No recurrence occurred after four years of follow-up. CONCLUSION: Intra-peritoneal rupture of liver HC could be asymptomatic. This case showed that in some cases, occurrence of complications is not systematic. This suggests that urgent surgical treatment is not always mandatory in the absence of alarming signs. Well-conducted medical treatment would reduce the risk of occurrence of secondary peritoneal hydatidosis.

Risk factors for anastomotic leakage after anterior resection for rectal adenocarcinoma.

BACKGROUND: Anastomotic leakage (AL) is an important cause of morbidity after surgery for rectal cancer. AIM: to analyze the risk factors associated with anastomotic leakage after anterior resection for rectal adenocarcinoma. METHODS: We collected data from all the patients who had surgical resection with an anastomosis, for rectal adenocarcinoma at the Surgical Clinic C (Ibn Sina Hospital, Rabat, Morocco), between January 2001 and December 2010. The associations between variables and anastomotic leakage were studied using univariate and multivariate analysis. RESULTS: Our study included 130 patients. Anastomotic leakage occurred in 28 patients (21.5%). Univariate and multivariate analysis showed that the rate of anastomotic leakage was significantly higher in patients who received preoperative radiotherapy (34.2% vs. 12 %, p = 0.002 - OR 3.8 - CI 95%: 1.5 - 9.4). There was no significant difference in the rate of AL between patients with or without a protective stoma. In the group of patients with AL, the rate of reoperation was significantly lower in patients with a stoma protection (31.8% vs. 83.3%, p = 0.04). CONCLUSION: Radiotherapy is a risk factor for anastomotic leakage. The systematic design of a protective stoma in patients receiving neoadjuvant radiotherapy is advisable to reduce the rate of reoperations associated with AL.

Peritoneal echinococcosis: anatomoclinical features and surgical treatment.

BACKGROUND: Peritoneal hydatid disease is a rare and poorly known disease. We report our experience with 17 patients treated for peritoneal echinococcosis. The main objectives were to analyze and discuss the specific features of the anatomic peritoneal lesions along with their surgical treatment. METHODS: We analyzed retrospectively all patients treated in our unit for peritoneal echinococcosis between January 2001 and December 2008. Preoperative description of the lesions, and the surgical procedures were carefully reported. RESULTS: Peritoneal hydatidosis represented 6.3% of all abdominal localizations. There were 10 women (58.8%) and 7 men (41.2%). Median age was 34 years. Ten patients (58.8%) had had previous surgery for abdominal echinococcosis. Ten patients (58.8%) had synchronous abdominal localization of hydatid disease, and two patients had synchronous pulmonary localization. Sixteen patients were operated on by laparotomy. We classified the anatomic lesions into four groups: localized form (n = 6, 37.4%), disseminated form (n = 8, 50%), "hydatid carcinomatosis" (n = 3, 18.7%), hydatidoperitoneum (n = 1, 6.25%). One patient had a ruptured hydatid cyst of the left liver. We performed total cystectomies in 10 patients, partial cystectomies in 8 patients, and omentectomy in 5 patients. Two patients (12.5%) had surgical complications. One patient (6.25%) died owing to a pulmonary embolism. Anthelmintic chemotherapy was given to two patients before surgery and to nine patients postoperatively. Recurrences were seen in two patients (14.2%). CONCLUSIONS: Peritoneal echinococcosis can cause a large variety of specific and complex anatomic lesions. The disseminated form is the most common, and therefore the surgical treatment is challenging in most cases.

Intestinal subocclusion due to colonic lipoma: a case report.

Colonic lipomas are rare benign tumors infrequently met in clinical practice. Most of them are asymptomatic making frequent their fortuitous discovery. The therapeutic approach to the fortuitous discovery of a lipoma is even less clear. The treatment depends essentially on the clinical picture, on the size of the lipoma and on its location. We report the case of a 31-year old woman, which sub-occlusive accidents events revealed a lipoma of the descending colon. The diagnosis was suspected on colonoscopy and segmental colectomy was performed. The diagnosis was confirmed by histological examination. We review the literature and discuss the clinical features, diagnosis and treatment of this uncommon disease.

Spontaneous rupture of a recurrent hepatic cystadenoma.

Biliary cystadenoma is a rare cystic tumor of the middle aged woman that usually arises in the liver or occasionally in the extrahepatic bile ducts. It has a strong potential for recurrence and for malignant transformation. The lack of specific clinical and biological features hinders diagnosis before surgery. The spontaneous rupture of a hepatobiliary cystadnoma is a very rare and potentially life-threatening complication, with only two reported cases in the English literature. We report a case with spontaneous rupture of a recurrent hepatobiliary cystadenoma in a 32 year-old woman.

Primary retroperitoneal mucinous cystadenocarcinoma in a male patient: a case report.

In the literature, 51 cases of primary retroperitoneal mucinous cystadenocarcinoma have been published. We report the fourth case occurring in a male patient. The 42-year-old patient presented with multiple retroperitoneal cystic masses causing abdominal discomfort without alteration of the global clinical state. The masses were totally removed by a two-stage surgery. No other treatment has been introduced. After a follow-up of 6 months, the patient is disease-free. This rare tumor most likely arises from the mucinous metaplasia of peritoneal inclusion cysts rather than from ectopic ovarian tissue or ovarian teratomas. The occurrence of such a tumor in a male patient supports this theory. Preoperative diagnosis is mostly difficult. Clinical behavior and treatment are still controversial.