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1.
Pan Afr Med J ; 34: 45, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762912

RESUMO

Hemocholecyst is defined as a hemorrhage into the gallbladder. It is a rare complication of anticoagulant therapies which can progress to spontaneous rupture of the gallbladder with hemorrhagic shock. We report the case of a 75-year old hypertensive, dyslipidemic man with hypertensive heart disease initially hospitalized for left hemiplegia. The patient received antiplatelet and anticoagulant therapy with low molecular weight heparin (LMWH) as prevention strategy. After 5 days of treatment the patient developed hemocholecyst and hemoperitoneum, confirmed by angio-abdominal computerized tomography scan in emergency assessment. The patient underwent cholecystectomy, hemostasis of the gallbladder fossa and evacuation of the hemoperitoneum.


Assuntos
Anticoagulantes/efeitos adversos , Colecistectomia/métodos , Doenças da Vesícula Biliar/diagnóstico por imagem , Hemoperitônio/diagnóstico por imagem , Idoso , Anticoagulantes/administração & dosagem , Doenças da Vesícula Biliar/induzido quimicamente , Doenças da Vesícula Biliar/terapia , Hemoperitônio/induzido quimicamente , Hemoperitônio/terapia , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Ruptura Espontânea , Tomografia Computadorizada por Raios X
2.
Pan Afr Med J ; 34: 63, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762927

RESUMO

Bleeding during pregnancy may not be due to obstetric causes. Pregnancy is a predisposing factor for some disorders due to physiological changes. These obstetric bleedings are rare but are responsible for high materno-fetal mortality. Prognosis depends on the speed of diagnosis as well as on multidisciplinary management. Splenic artery aneurysm (SAA) rupture during pregnancy is rare with a dreadful prognosis. Common clinical signs including abdominal pain associated with hypotension and anemia are very misleading for the obstetrician who usually suspects retroplacental hematoma or uterine rupture. We report the case of a pregnant patient requiring emergency laparotomy due to the detection of splenic artery aneurysm rupture on imaging test.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Aneurisma Roto/cirurgia , Feminino , Humanos , Laparotomia/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
3.
Arch Iran Med ; 21(4): 180-182, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29693409

RESUMO

Isolated macro-nodular liver tuberculosis is a very rare condition. It may mimic primitive or secondary tumors of the liver. This could delay or mislead the therapeutic management. An immunocompetent 48-year-old man with a history of non-metastatic seminoma was treated with right orchidectomy followed by 20 Gy radiotherapy. The discovery, 8 months later, of a 2 cm nodule of the hepatic dome evoked a liver metastasis. Percutaneous biopsy was not feasible. Wedge resection was performed whereas medical treatment would have sufficed, as pathologic examination of the resected specimen showed a macro-nodular hepatic tuberculosis. The patient received anti-tuberculosis drugs for 9 months. The diagnosis of isolated macro-nodular liver tuberculosis is frequently misleading, particularly in immunocompetent and paucisymptomatic patients. Thus percutaneous biopsy is mandatory for diagnosis and also prior to any major surgeries.


Assuntos
Fígado/patologia , Seminoma/patologia , Neoplasias Testiculares/patologia , Tuberculose Hepática/diagnóstico , Antituberculosos/uso terapêutico , Biópsia , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas , Masculino , Pessoa de Meia-Idade , Seminoma/terapia , Neoplasias Testiculares/terapia , Tomografia Computadorizada por Raios X , Tuberculose Hepática/tratamento farmacológico
4.
Indian J Surg ; 77(Suppl 2): 515-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26730056

RESUMO

Hydatid disease is a parasitic infection caused by Echinococcus granulosus. Splenic involvement is rare even in endemic areas. The aim of this study is to specify epidemiologic features, diagnostic tools, and therapeutic modalities of this uncommon entity. This is a retrospective study of 21 patients operated on for a splenic hydatid cyst between January 1996 and December 2011. The mean age was 43.8 years (range 15-72 years). Sixteen patients (76.2 %) had symptoms related to a splenic location of hydatid disease. While splenic hydatid disease was solitary in 8 patients (38.1 %), other locations were present in 13 patients (61.9 %), mainly in the liver. Most splenic cysts were type I (39.3 %) or III (42.8 %). Nine patients (42.8 %) underwent resection of the protruding dome with one postoperative complication (suppuration of residual cavity). Total and partial splenectomies were performed in nine and three patients, respectively, without any complication. No death was noted. After a mean follow-up period of 36 months (range 2-108 months), no recurrence was observed. Splenic hydatid cyst is a rare location. The diagnostic is usually easy, based on serology and imaging. The surgery is the mainstay of treatment. The type of surgical procedure depends on size, number, and location of the cyst. Total splenectomy is more effective but may have high morbidity and mortality and must be reserved to specific situations. Conservative procedure is safer but could increase the rate of recurrence and postoperative collection. Puncture aspiration injection reaspiration could be proposed for small cyst in inoperable patients.

5.
Tunis Med ; 92(7): 482-7, 2014 Jul.
Artigo em Francês | MEDLINE | ID: mdl-25775288

RESUMO

BACKGROUND: The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. AIM: reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. METHODS: A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. RESULTS: Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. CONCLUSION: Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.


Assuntos
Colostomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos
6.
Tunis Med ; 91(10): 565-72, 2013 Oct.
Artigo em Francês | MEDLINE | ID: mdl-24281995

RESUMO

BACKGROUND: Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. AIMS: Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. METHODS: An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. RESULTS: Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose (evidence level 2, grade recommendation B). Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt , a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% (level evidence 4, recommendation grade C). PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression (evidence level 2, recommendation grade B). The cecostomy is more effective and safer than conventional colostomy (level of evidence 4, recommendation grade C). The cecostomy is highly effective in colonic decompression but associated with a high mortality (level of evidence 4, recommendation grade C). CONCLUSION: Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression.


Assuntos
Pseudo-Obstrução do Colo/terapia , Doença Aguda , Cecostomia/estatística & dados numéricos , Pseudo-Obstrução do Colo/complicações , Pseudo-Obstrução do Colo/epidemiologia , Colonoscopia/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/terapia , Resultado do Tratamento
7.
Updates Surg ; 64(4): 311-4, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21983876

RESUMO

The pancreatic teratoma is a congenital tumor which results from abnormal embryonic development of totipotent cells. The preoperative diagnosis is challenging. We report, to our knowledge, the 26th case in a 64-year-old man in whom the diagnosis was made preoperatively on imaging.


Assuntos
Pâncreas/patologia , Pancreatectomia/métodos , Neoplasias Pancreáticas/diagnóstico , Teratoma/diagnóstico , Diagnóstico Diferencial , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Teratoma/cirurgia , Tomografia Computadorizada por Raios X
9.
Tunis Med ; 85(7): 610-3, 2007 Jul.
Artigo em Francês | MEDLINE | ID: mdl-18064998

RESUMO

UNLABELLED: THE AIM of this work was to study the clinical and therapeutic features of this affection. CASE REPORT: Our retrospective study concerned two cases of hyperlipemic pancreatitis treated during 6 years from 1998 to 2003. The incidence of this affection was 1.42%. Our patients were respectively a man aged 32 years without any significant history and a pregnant woman aged 24 years with a positive history of dyslipidemia. Clinical, biologic and radiological data didn't differ from those of other causes of acute pancreatitis. The hyperlipemic origin was confirmed by a lactescent serum and a rate of triglycerides greater than 10 g/l. The course was characterized by the recurrence of pancreatitis related to the increased triglycerid serum level over 10 g/l. Plasmapheresis and administration of heparin and/or insulin seem to be efficient in reducing the serum level of triglyceride and in improving the course. Hygieno-dietary measures and hypolipemiant treatment were necessary for the level of triglyceirdes in serum below 10 g/l. We in the absence of comolicatons, surgery seemed umnecessry in the two cases. CONCLUSION: the clinical pattern of acute hyperlipemic pancreatitis doesn't include any specific elements, but its treatment and prevention must take into account the associated hyperlipidemia.


Assuntos
Hiperlipidemias/complicações , Pancreatite/etiologia , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Gravidez , Complicações na Gravidez/etiologia , Estudos Retrospectivos
10.
Tunis Med ; 85(8): 697-701, 2007 Aug.
Artigo em Francês | MEDLINE | ID: mdl-18254295

RESUMO

Many authors suggest the role of hepatitis C virus (HCV) infection in the pathology of B-cell non Hodgkin's lymphomas; this is based on epidemiological, physiopathological and therapeutic arguments. The frequency of the association with hepatitis C virus infection is variable in the different study (1 to 30%). We report two cases of hepatitis C virus infection in association with non Hodgkin's lymphomas. The first case presented a low grad splenic and nodal non-Hodgkin's lymphoma associated with hepatitis C virus infection and complicated by hepato-cellular carcinoma. The second case presented a high grad nodal non-Hodgkin's lymphoma associated with HCV infection. Our cases report confirms the hypothesis of a key role of hepatitis C virus in the pathogenesis of B-cell lymphoproliferative disorders and in particular the non-Hodgkin's lymphoma. Although of several hypothesis concerning the ethiopathogenic mechanisms of this association, new studies will necessary to improve the real mechanism of this association


Assuntos
Hepatite C Crônica/complicações , Linfoma de Células B/complicações , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Tunis Med ; 82(2): 245-8, 2004 Feb.
Artigo em Francês | MEDLINE | ID: mdl-15185605

RESUMO

We report a case of hepatic artery aneurysm suggested by the appearance of epigastric mass. The diagnosis was confirmed by doppler sonography and helical CT. Surgical excision of the aneurysm without vascular reconstruction was carried out.


Assuntos
Aneurisma/patologia , Artéria Hepática/patologia , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Humanos , Ultrassonografia Doppler
12.
Tunis Med ; 82(12): 1116-20, 2004 Dec.
Artigo em Francês | MEDLINE | ID: mdl-15822515

RESUMO

Peripartum pubic symphysis separation is a rare complication of delivery, but the incidence seems to be under-estimated. We report three cases of pubic syphysis separation identified in a two-year period. All cases occurred following spontaneous non operative vaginal deliveries. The underlying etiology and pathophysiology has not been fully elucidated. Thus, prevention is difficult. Conservative therapy usually results in a complete recovery within many weeks.


Assuntos
Complicações do Trabalho de Parto , Sínfise Pubiana/lesões , Adulto , Repouso em Cama , Fixadores Externos , Feminino , Seguimentos , Humanos , Recém-Nascido , Dor/etiologia , Gravidez , Fatores de Tempo , Caminhada
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