[Evaluation of small bowel involvement in Crohn's disease by small- bowel videocapsule endoscopy: a prospective comparative study with computed-tomography enteroclysis and small bowel radiography]. / Évaluation de l'atteinte du grêle de la maladie de Crohn par vidéocapsule endoscopique : étude prospective et comparative avec le transit du grêle et l'entéroscanner.

BACKGROUND: Small-bowel videocapsule endoscopy (VCE) is a new technique in evaluation of intestinal involvement in several pathologies. Crohn's disease affects principally terminal ileum. Small bowel involvement in Crohn's disease is not well estimated by endoscopic and radiologic conventional techniques. AIMS: To evaluate the performances of VCE in detection of asymptomatic proximal small bowel lesions in consecutive patients with Crohn's disease with terminal ileal involvement, to compare the results of VCE to small bowel radiography and CT-enteroclysis and to determine the therapeutic impact of VCE in these patients. METHODS: A prospective study which included Crohn's disease patients with distal ileal involvement, based on radiological or endoscopic findings. We performed in all patients small bowel radiography, CT enteroclysis and VCE. Proximal involvement was characterized by presence of aphtoid, superficial or deep ulcerations in the jejunum or the proximal ileum. RESULTS: We studied 20 patients (12 men, mean age 31.6 years). VCE confirmed the distal ileal involvement in all patients. Significative proximal lesions was observed in nine patients (jejunum only: one case, jejunum and ileum: six cases and proximal ileum: two cases), in most cases aphtoid or superficial lesions. Deep ulcerations were observed in two patients. Small bowel radiography showed proximal ileal lesions in only two patients, and CT-enteroclysis in only one patient. Treatment by azathioprine was prescribed in two patients with severe and extended small bowel lesions in VCE examination. CONCLUSION: VCE is more accurate than radiologic techniques in detection of small bowel lesions in Crohn's disease. In cases of severe and extended small bowel involvement, VCE can conduct to changes of therapeutic approach.

[Difficulty in diagnosing pseudotumoral autoimmune pancreatitis: two cases]. / Difficultés diagnostiques de la pancréatite auto-immune pseudotumorale: à propos de deux cas.

BACKGROUND: In recent years, autoimmune pancreatitis (AIP) has been increasingly recognized. The diagnosis of AIP is based on a series of clinical, biological and radiological criteria. In imaging, it may appear as two different forms: a diffuse form by destroying channels and pseudotumoral lesions that can cause inadequate resections. AIM: To report two new cases of pseudotumoral autoimmune pancreatitis CASES REPORT: We report two cases of pseudotumoral autoimmune pancreatitis, with different clinical, biological and radiologic features. The diagnosis was established easily in one case and after surgery in a 2nd case. CONCLUSION: Our two cases underline the difficulties still encountered in the diagnosis of AIP.

[A case of an acute pancreatitis after endoscopic band ligation of esophageal varices: a strong association or an unusual complication?]. / Pancréatite aiguë au décours d'une séance de ligature elastique de varices oesophagiennes: une association fortuite ou une complication inhabituelle?

BACKGROUND: Endoscopic band ligation is considered as the gold standard of treatment for oesophageal varices. Fewer and often mild complications can occur. AIM: To report and to discuss an association between oesophageal variceal endoscopic band ligation and actue pancreatitis. CASE REPORT: We report the original case of a patient with cirrhosis and who had presented an acute pancreatitis 3 days after oesophageal variceal endoscopic band ligation. Common aetiologies of acute pancreatitis was eliminated. The evolution was favourable without specific treatment. CONCLUSION: In the absence of similar case reports, the association between oesophageal variceal endoscopic band ligation and acute pancreatitis observed in our patient remains rather fortuitous even though experimental studies can explain these association.

Chondrosarcoma of sinonasal cavity: a case report and brief literature review.

BACKGROUND: Chondrosarcomas are slow-growing malignant tumors that usually arise from cartilaginous structures. It may occur in the head and neck region with a predilection for the maxillofacial skeleton, where it has been reported to occur particularly in the mandible and maxilla. Chondrosarcoma of the sinonasal tract is very rare. AIM: Report a new case CASE: We present the case of a 43-year-old man presenting with an incidental finding of a chondrosarcoma of the maxillary and ethmoid sinus with nasal extension. The tumor was completely resected using a transnasal endoscopic approach. Treatment has followed by a radiation therapy and the patient was considered free of disease at her 5 years follow-up. CONCLUSION: Surgery is the mainstay treatment of chondrosarcomas. In selected patients, complete resection can be achieved using transnasal endoscopic approach.

[Internal herniation through the falciform ligament revealed by acute intestinal obstruction]. / Hernie interne du ligament falciforme révélée par une occlusion intestinale aiguë

INTRODUCTION: Internal hernias are a rare cause of acute intestinal obstruction. Herniation through the falciform ligament is rare and often diagnosed only during surgery. Abdominal computed tomography (CT), performed on an emergency basis, can help to diagnose this obstruction before surgery and select a therapeutic approach. CASE: A 60-year-old man was hospitalized on an emergency basis for symptoms that had been developing for 3 days, including tympanites and epigastric pain (torsion), associated with vomiting and the cessation of both feces and flatus. Abdominal radiography showed multiple levels of air-fluid levels in the small bowel, some projecting towards the liver area, as well as the presence of a flat intestinal loop continuous with a distended small-bowel segment. Abdominal CT suggested a diagnosis of small-bowel herniation and obstruction, very probably through the falciform ligament. The patient then underwent emergency surgery after a brief resuscitation. Intraoperative exploration confirmed the diagnosis of internal hernia through the falciform ligament. The postoperative course was without problems. DISCUSSION: Abdominal CT is the examination of choice in cases of a "new" acute intestinal obstruction. It makes it possible to diagnose the mechanism of the occlusion and especially the cause, especially for an internal hernia through the falciform ligament. It thus guides the choice of emergency surgical procedure and of appropriate approach. Once diagnosed, emergency surgery is essential to free the intestinal loop, with or without intestinal resection as a function of vitality.

Budd-Chiari syndrome secondary to hepatic echinococcosis.

OBJECTIVES: Hydatid cyst of liver is a parasitosis which is an endemic state in Tunisia and is a very rare cause of Budd-Chiari syndrome. The purpose of this study was to report the clinical features, radiological investigations and therapeutic management. PATIENTS AND METHODS: A retrospective analysis of 12 patients who underwent surgery for Budd-Chiari syndrome secondary to hepatic echinococcosis between January 1990 and December 2004 was performed. RESULTS: The series included ten females and two males with a mean age of 36 years. Budd-Chiari syndrome was subacute in 75% of cases. Ultrasound showed a compression of hepatic veins by cysts with a mean diameter of 13 cm situated in at least two hepatic segments. US Doppler and CT-scan of the liver provided the diagnosis in all cases. Laparotomy was performed in all cases. Operative mortality was 8% and morbidity 66% due to biliary fistula and deep abscess formation. Hepatic vein outflow was successfully re-established in four patients. CONCLUSION: Budd-Chiari syndrome is a rare but severe complication of hydatid cyst of the liver. Early diagnosis is necessary to improve prognosis.

A misleading renal tumour.

Hydatid cyst of the kidney is uncommon and still constitutes about 3% of cases of hydatid disease. The diagnosis can be made by ultrasonbography, Ct-scan and in some difficult cases by MRI. We report a case of a renal hydatid cyst in a 47-year-old man mimicking at imaging, even at MRI, a hypovascular renal tumour.

[Spontaneous intrahepatic porto-cava shunt associated with chronic pericarditis. A case report]. / Shunt porto cave intrahépatique spontané associé à une péricardite constrictive. A propos d'un cas.

INTRODUCTION: Spontaneous intrahepatic portosystemic shunts are rare vascular anomalies that consist of a communication between the portal system and the systemic venous circulation. We report a case of a porto-caval shunt associated with chronic pericarditis. CASE REPORT: A 47-year-old patient with post pericarditis cirrhosis and without encephalopathy and hypoglycaemia. The shunt was tubular in its initial segment and aneurismal just before joining the vena cava. DISCUSSION: Spontaneous intrahepatic portosystemic shunt is a rare anomaly. Diagnosis can be made by Doppler ultrasound and helical CT.

[Phlegmonous appendicitis revealed by pyogenic liver abscesses]. / Abces bacteriens du foie revelant une appendicite phlegmoneuse.

BACKGROUND: Pyogenic liver abscesses are rare and severe. Early diagnosis and treatment lead to a better prognosis. Biliary cause of liver abscesses is the most frequent. Portal origin is secondary to a portal bactremia. Appendicitis was the most cause of portal infection, but actually, diverticulitis is most common. AIM: the aim of this study was to report a new case of pyogenic liver abscesses secondary to phlegmonous appendicitis. CASE REPORT: We report a case of 47 years old man presented with fever and weight loss without abdominal pain. Laboratory investigations show signs of inflammation with high leukocyte and neutrophile rates. The diagnosis of liver abscesses was made on abdominal ultrasound and tomodensitometry witch shows also an inflammatory appendix. The outcome was good after antibiotics associated with percutaneous drainage of abscesses and laparoscopic appendectomy witch found a phlegmonous appendix. One month later, the CT scan showed a markedly decrease of the size of the abscesses.

[Rupture of hydatid cyst of the liver into the duodenum. A case report]. / Kyste hydatique du foie rompu dans le duodénum. A propos d'un cas.

BACKGROUND: Rupture of hydatid cyst in the digestive tract is a rare complication even in endemic areas. AIM: Authors report a case of a hydatid cyst of the left hepatic lobe ruptured in the duodenum CASE: was discovered at the occasion of epigastric pain and vomiting. Ct-scan revealed presence of air in a calcified hydatid cyst of the left liver lobe and a fistulous tract between the cyst and the duodenum. Endoscopy confirmed the diagnosis by the visualisation of a fistulous orifice of the anterior aspect of the first duodenum with a protrusion of hydatid membrane. Patient was treated surgically and had a partial cysto-pericystectomy and suture of duodenum.

[Cystic lymphangioma of the adrenal gland, from radiologic diagnosis to laparoscopic treatment. A case report]. / Lymphangiome kystique de la surrénale, du diagnostic radiologique au traitement laparoscopique. A propos d'une observation.

BACKGROUND: Cystic lymphangioma of the adrenal gland is a rare tumor, which is often asymptomatic. Pre-operative diagnosis is difficult. Echography and CT scan are essential exploratory techniques. Surgical exploration is usually indicated due to uncertain diagnosis. AIM: Report of a new case CASE: We report a new case of cystic lymphangioma of the left adrenal gland, in a 30 year-old female, treated with a laparoscopic excision and confirmed by anatomopathologic features.

Colonic perforation complicating percutaneous nephrolithotomy.

A case of colonic perforation complicating percutaneous nephrolithotomy in a 64-year-old woman is reported. Nonoperative management was successful with the creation of a controlled colocutaneous fistula by pulling the nephrostomy tube back from the kidney to the colon and the use of an elemental diet and antibiotics. Internal urinary drainage was not necessary.

Intraprostatic hydatid cyst: an unusual presentation.

A case of intraprostatic cyst is reported. The patient presented with a completely evacuated hydatid cyst of the prostate. The intraprostatic cystic cavity that was communicating with the urethra developed urinary stones. The patient had transurethral resection of the prostate, the stones in the cyst were pushed into the bladder and fragmented using a ballistic lithotripter. Pathological examination concluded to a prostatic hydatid cyst that had evacuated through the urethra and was complicated by stone formation within the residual cavity. Postoperative course was uneventful and follow-up did not show evidence of recurrence. This is the first case of hydatid cyst of the prostate to present as an intraprostatic stone pouch.

Hydatid cyst of the adrenal gland: a clinical study of six cases.

Hydatid cyst of the adrenal gland (HCAG) is an exceptional occurrence. We report our experience of six cases of HCAG and discuss the diagnosis and treatment of this hydatid localization. We retrospectively reviewed and analyzed the clinical files of six patients admitted to our institution from January 1990 to December 2000 for HCAG. Patients varied in age from 24-59 years. They were five males and one female. One patient had a history of pulmonary hydatidosis treated surgically 10 years previously. Five patients presented with lumbar pain and one patient had bouts of hypertension, headache, and palpitation. Physical examination was normal except in one patient who was hypertensive. Preoperative diagnosis was highly suggested by ultrasonography. CT scan performed in all cases clearly showed the relationship of the cyst with adjacent organs. Serology tests were positive in two cases. One patient had elevated urine VMA and was operated on with the diagnosis of cystic phaeochromocytoma. All six patients were operated on and had either an adrenalectomy (two cases) or partial pericystectomy (four cases). In one case, partial pericystectomy was conducted through a retroperitoneal laparoscopic approach. The hydatid nature of the cyst was confirmed pathologically. All patients had a smooth postoperative course with no cystic recurrence on follow-up. The diagnosis of HCAG is based mainly on ultrasonography and CT scan. Surgery with either partial or total excision of the cyst, with or without preservation of the adrenal gland, is the treatment of choice.

[Solitary fibrous tumor of the pancreas. A case report]. / Tumeur fibreuse solitaire du pancréas. A propos d'un cas.

Solitary fibrous tumour (SFT), a rare mesenchymal neoplasm usually arising from the pleura, may also occur in many other extra pleural sites. It has exceptionally been described in the pancreas. This report describes the case of a benign SFT of the pancreas occurring in a 41-year-old man who presented with a solid epigastric mass. Pathological and immunohistochemical findings are presented. Imaging features on ultrasonography, CT, MRI, and arteriography are widely detailed. Surgical resection of the tumour was performed, and the patient died from postoperative complications.

Adrenal cystic phaeochromocytoma: a case report.

Cystic phaeochromocytoma is a rare occurrence. We report a case of a 42-year-old woman who presented with the cardinal symptoms of phaeochromocytoma with elevated serum catecholamine levels. Radiological investigations showed a cystic mass in the right adrenal. Right adrenalectomy through a subcosal incision was performed and pathological examination concluded to a cystic phaeochromocytoma. We discuss the pathophysiology of such cyst formation as well as differential diagnoses.

[Endometriosis with urinary manifestation. A case report]. / Endométriose à manifestation urinaire. A propos d'une observation.

Endometriosis is an ectopic implantation of endometrial tissue. Authors report a case of a 33 year-old infertile women who presented a deep pelvic endometriosis infiltrating the right ureter with left ovarian endometrioma suspected by the ultrasonography and confirmed with MRI. The patient was treated with Gn-RH analogues with relief of symptoms and normalisation of the upper urinary tract.

[Gastrointestinal stromal tumours: clinical and therapeutic features. A report of 25 cases]. / Les tumeurs stromales gastrointestinales: aspects cliniques et thérapeutiques à propos de 25 cas.

AIM: To evaluate the epidemiological clinical features and herapeutic results of gastrointestinal stromal tumour (GIST). PATIENTS AND METHOD: This retrospective study concerned 25 cases of gastrointestinal stromal tumour from January 1993 to December 2002. All patients have been operated and the diagnosis of GIST has been confirmed by histological and immunohistochemical study of pieces of resection or biopsies. RESULTS: Population include II men and 13 women with a mean age of 64 years. Symptomatology was dominated by abdominal pain (54% of cases) and the digestive haemorrhage (46% of cases). A palpable mass has been found in 29% of cases. The tumour was gastric in 17 cases, small intestinal in 6 cases, colic in 1 case and rectal in 1 case. A double gastric localization and small intestinal was found in 1 case. The mean tumour size was 8 cm (1 to 30 cm). A tumour resection has been achieved in 23 cases (96%), extended to neighbourhood organs in 2 cases. The morbidity was 12.5% and there was no operative mortality. Histologically, tumour was of low grade in 10 cases, high grade in 10 cases and unclassified in 5 cases. With a median follow up of 27 months (2 to 108), we observed 4 cases of loco-regional recurrence. Overall survival at 2 years was 74% for the whole population and 35% for the high grade. Independent prognostic factors recovered were the degree of malignancy (p = 0.01) and the local recurrence (p = 0.01). CONCLUSION: The treatment of the GIST is surgical. lymphadenectomy is superfluous. The new oral chemotherapies that inhibits Tyrosine Kinase seems to be promising.