[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases]. / La gangrène périnéoscrotale: profil épidémiologique et aspects thérapeutiques. À propos de 45 cas.

Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases.

Adult intussusception caused by an inflammatory fibroid ileal polyp.

BACKGROUND: Inflammatory fibroid polyps (IFPs) are rare benign lesions of uncertain origin that may occur in various parts of the gastrointestinal tract that originate from the sub mucosa located in different sites of the digestive tract. They are commonly located in the stomach and small bowel. It is one of the probable diagnoses that should be considered in obstructive tumors of the small intestine causing invagination. METHODS: A case of IFP is presented, causing intestinal invagination in an 39-year-old female patient, admitted with abdominal distension and pain. RESULT: Computerised tomography imaging (CT) demonstrated intussusception of the small bowel. Exploratory laparotomy revealed a bowel intussusception. An ileo-ileal anastomosis was performed after resection of the tumoral segment. Histology of the resected small bowel revealed an inflammatory fibroid polyp. CONCLUSIONS: intussusception secondary to IFPs of the small intestine are difficult to diagnose without recognition of its clinical and pathological characteristics. CT is useful in confirming an anatomical abnormality, histological examination establishes the final diagnosis of IFPs.

[Sigmoid volvulus, a rare complication of pregnancy]. / Volvulus du sigmoïde, une complication rare de la grossesse.

Sigmoid volvulus complicating pregnancy is a rare complication with less than 80 cases reported in literature. We report the case of a young pregnant woman, admitted for sigmoid volvulus. The sigmoid volvulus was resected and Bouilly-Volkmann's colostomy was performed. According to this case and depending on the literature, the authors discuss the diagnostic and therapeutic modalities proposed for this rare entity.

[Appendicular mucocele caused by carcinoid tumor during pregnancy]. / Mucocèle de l'appendice sur tumeur carcinoïde pendant la grossesse.

Mucocele of the appendix secondary to appendicular carcinoid tumour is a rare entity. It occurs exceptionally during pregnancy. The interaction between carcinoid tumour or mucocele of the appendix and pregnancy is not yet elucidated. Prognosis depends on the size of the carcinoid tumour and its regional invasion. We report a case of appendicular mucocele caused by a carcinoid tumour in a 36-year-old pregnant woman who had been admitted because of acute appendicitis. Pathological examination of the appendicectomy specimen revealed a carcinoid tumour measuring 2 cm. Right hemicolectomy was performed two weeks after delivery with good evolution. According to this case and depending on the literature, the authors discuss the diagnosis and the therapeutic modalities proposed for this rare entity.

A Rare Internal Herniation in Adult: Meckel's Diverticulum.

Intestinal obstruction due to Meckel's diverticulum is the most common presentation in adults. There are various mechanisms by which it can cause intestinal obstruction such as volvulus of small intestine around a fibrous band extending from Meckel's diverticulum to umbilicus, intussusception, and Littre's hernia. We report the case of a young adult operated on emergency for acute intestinal obstruction. The CT scan suggested a nonspecific internal herniation. Surgical exploration confirmed a rare type of obstruction due to Meckel's diverticulum.

Mesenteric appendicitis strangulating small bowel: an exceptional internal herniation.

Primitive internal hernias are a rare cause of intestinal obstruction. They are often paraduodenal even transmesocolic, but only rarely transomental. We present a rare case of an internal abdominal hernia in a young man. The small bowel was strangulated by an intra mesenteric appendicitis. This hernia was revealed by abdominal pain, nausea and vomiting. Plain X-ray of the abdomen showed dilated jejunal and ileal loops with multiple air-fluid levels. The diagnosis of appendicitis was suggested by ultrasound but the internal hernia was found only upon surgical exploration. An appendicectomy and adhesiolysis were performed. The patient recovered fully after 3 days, and had an uneventful postoperative course. The authors discuss the possible cause of this rare intestinal obstruction.

Transmesocolic internal herniation: a rare case of small bowel obstruction, "the Marrakesh hernia".

Internal hernias, including paraduodenal (traditionally the most common), pericecal, foramen of Winslow, and intersigmoid hernias, account for approximately 0.5-5.8% of all cases of intestinal obstruction and are associated with a high mortality rate, exceeding 50% in some series. We report an extremely rare case of an internal abdominal hernia, through the right mesocolon, in a young woman with a right colon with no peritoneal fixation. This hernia was revealing by abdominal pain, nausea, and vomiting. The diagnosis of internal hernia was suggested by computed tomography (CT), but the exact type of internal hernia was confirmed by surgical exploration. The postoperative course was uneventful and the patient fully recovered after 3 days. The patient is free from symptoms and from recurrence, after 12 months of follow-up.

[Linitis plastica of the digestive tract. A case with involvement of the stomach and rectum]. / La linite plastique digestive. A propos d'un cas de localisation gastrique et rectale.

The digestive linitis plastica is a special form of the little differentiate adenocarcinoma that can reach all the segments of the digestive tube, if the gastric localization is the most frequent, the double gastric and rectal localization is rare (7%) either is simultaneous or successive. The pathologic examination arrives only at the diagnostic of the digestive linitis without biasing against its primitive and secondary character. We report a case of this association in order to focus the importance of search and difficulty of the histologic diagnosis. Mis H.N., aged of 69 years old was hospitalized because she was reached of subocclusive syndrome, the rectal touch, found a circumferential marrowing with indurated basis at 7 cm of the anal margin, the gastroduodenal transit and the high digestive fibroscopy were evokating of a total plastic linitis. The gastric biopsy confirmed the diagnosis by the presence of cells ou kitten ring. The patients died during the hospitalization, the pathologic study of the postmortem rectal swab showed the existence of a rectal linitis. The discovery of a gastric linitis makes necessary a systematic, endoscopic and radiologic complete physical examination in order to discover other digestive localizations, this darkens singularly the prognosis and complicates the therapeutic attitude.