Fortuitous discovery of an early neuroendocrine tumor during appendicular peritonitis

Introduction

Materials and methods

Results

Conclusion

•

Neuroendocrine tumors of the small bowel are rare but represent the most frequent histological type at this level.

•

Their incidence is increasing thanks to the evolution of diagnostic means.

•

These tumors are most often diagnosed incidentally during the workup of aspecific digestive disorders or during hormonal hypersecretion syndrome or rarely by a complication.

Early Discovery Of Small Bowel Adenocarcinoma In a Patient Admitted For 4 Acute Intestinal Intussusception case report

Introduction

Malignant tumours of the small bowel are uncommon in clinical practice. Adenocarcinoma is the most common of these tumours, accounting for approximately 35–45% of all tumours. It may occur sporadically, in association with familial adenomatous polyposis coli or Peutz-Jeghers syndrome or hereditary non-polyposis colorectal cancer, or in association with chronic inflammatory bowel changes (such as Crohn's disease or celiac disease).

Materials and methods

We report a case of Early Discovery Of Small Bowel Adenocarcinoma In A Patient Admitted For 4 Acute Intestinal Intussusception in the department of Emergency visceral surgery P35 of the ibn rochd hospital in casablanca.

Results

Our patient was admitted to the emergency room for sub-occlusive syndrome with generalized abdominal pain of chronic appearance dating back to one month before his admission With Abdominal and pelvic ultrasound showed: intestinal parietal thickening and minimal ascites (peritoneal and/or intestinal tuberculosis? Crohn's disease)

The patient underwent an abdominal-pelvic CT scan which showed: Presence of diffuse small bowel thickening, involving several small intestines and the colonic angle with intestinal invaginations (at least 3) suspecting an inflammatory or tumoral origin? To be compared with histological data and infiltration of the mesenteric fat in the sub-umbilical region with a peritoneal effusion in the Douglas. the patient was operated on in the emergency room, approached by laparotomy and found on exploration: Presence of 3 invaginations in the small intestine located at 20cm and 90cm from the Duodenojejunal Angle (DIA) as well as at 25cm from the Last part of the small intestine (DAI), with Presence of a colonic invagination at the level of the left colonic angle. the patient underwent 3 small bowel resections and one segmental colonic resection including segmental small bowel resections: the 1st one of 30 cm taking away an invagination of the small intestine at 20cm from the ADJ, the 2nd one taking away 60cm of invaginated located at 90cm from the ADJ the 3rd one taking away 20cm of invaginated located at 25cm from the DAI and a 4th resection taking away an invagination of the left colonic angle with 3 Anastomosis of the T-T small intestine and a transverse Colostomy in Bouilley Volkman.

On examination by the anapathomopathologist: consistent with a small bowel tumour: well-differentiated intestinal adenocarcinoma on degenerated adenomatous polyps measuring 2.5cm and 1.7cm with an estimated 10% mucinous component with no vascular emboli and no peri-nervous sheathing. TNM stage p: pT2 with healthy resection margins in the left colon: Presence of a tubular adenoma with low grade dysplasia.

Conclusion

The most common symptoms of adenocarcinoma of the small bowel are obstruction, overt or covert bleeding, weight loss and jaundice. Because the small bowel has long been relatively inaccessible to routine endoscopy, the diagnosis of small bowel adenocarcinoma was often delayed for several months after the onset of symptoms. Therefore, in case of suspicion of this type of cancer, a thorough evaluation should be undertaken. Nowadays, endoscopy of the small bowel is widely available, allowing an earlier non-invasive diagnosis.

•

Acute Intestinal Intussusception as a cause of intestinal obstruction is often a diagnostic challenge mimicking a wide spectrum of diseases.

•

Malignant tumours of the small bowel are uncommon in clinical practice. Adenocarcinoma is the most common of these tumours.

•

Its diagnosis is still very difficult.

•

The treatment of Acute Intestinal Intussusception is in most cases surgical.

•

The diagnosis of Acute Intestinal Intussusception is histological.

Circular Mini-Incision in the Left Iliac Fossa Followed by Purse-String Closure as a Minimally Invasive Approach for the Sigmoid Volvulus: A Technical Note

Introduction: Volvulus of the sigmoid is a common cause of intestinal obstruction in Morocco. It is a serious condition with substantial mortality. Initial endoscopic decompression followed by resection of the redundant colon via laparotomy or laparoscopy is the procedure of choice. Exteriorization of the sigmoid colon through a linear skin incision in the left iliac fossa has been described as an alternative approach for the classic midline incision, with or without laparoscopic assistance, with acceptable results.

Methods: We describe herein a novel, minimally invasive approach for fit patients with non-complicated volvulus sigmoid. This approach consists of a skin-disk incision in the left iliac fossa, exteriorization of the redundant colon, and resection with or without primary anastomosis, followed by a purse-string closure.

Results: A 65-year-old patient with no prior notable medical history, presented to the emergency department with his first episode of sigmoid volvulus. A skin-disk incision was made in the left iliac fossa, exteriorization of the sigmoid was done easily through the incision, and resection and manual anastomosis were done. The closure was made in a purse-string fashion. Recovery was uneventful and the patient was discharged home on the fourth postoperative day. No wound infection was noted and the cosmetic result was satisfactory.

Conclusion: Left iliac skin-disk incision followed by a purse-string closure is an option for approaching the abdomen in the case of sigmoid volvulus. It has been demonstrated that this technique helps reduce wound-related complications in patients undergoing stoma reversal. Authors suggest that cosmetic results are better and the incidence of surgical site infection can be lower with this technique as compared to the classic linear skin incision. Results, however, should be confirmed by larger studies.

Value of Alvarado scoring system in diagnosis of acute appendicitis

Introduction

Methods

Results

Conclusion

•

Acute appendicitis is one of the most common causes of acute abdomen in surgical patients.

•

Various scoring systems are used for decision making in appendicitis.

•

Alvarado score remains the most popular scoring system.

Mesenteric lipoma with small bowel volvulus: A rare cause of upper gastrointestinal obstruction (a case report and literature review)

Introduction

Small bowel volvulus due to mesenteric lipoma is a rare clinical entity. It poses both a diagnostic and therapeutic challenge. Small bowel mesenteric lipoma is a rare cause of small bowel obstruction. We present the case of a patient admitted to our emergency department for a small bowel volvulus due to a mesenteric lipoma with small intestine obstruction.

Patient and method

A 61 years old man, with diabetes since 25 years with antidiabetics oral medication, vaccinated against Covid 19 (two doses) who presented with peri-umbilical pain for two months, constipation and melaena, complicated 3 days before his admission by obstructive symptoms and vomiting with apyrexia and overall health state alteration. The physical examination noticed abdomen distension and the abdominal CT scan revealed a large fatty mass of the hypochondrium and left flank, roughly oval with regular borders, well limited measuring 124 × 86 mm of height of 126 mm thought to be a liposarcoma. The patient underwent enbloc resection of 20 cm of small bowel with the mass and end to end anastomosis of the ileo-ileum. The postoperative course was uneventful and he was been discharged from hospital on day 5.

Discussion

Mesenteric lipomas are diagnosed incidentally after laparoscopy or laparatomy. Ultrasound shows a well defined homogenous echogenic mass, and so can distinguish it from a mesenteric cyst. Computed Tomography (CT) is the standard imaging of diagnosis and shows homogenous tumor of adipose tissue. The treatment is surgery and the prognosis is better.

Conclusion

The mesenteric is an uncommon location of lipoma. When there is small bowel obstruction with intra-abdominal mass, the mesenteric lipoma could be recalled.

•

Mesenteric lipoma is rare.

•

Small bowel volvulus due to lipoma is a rare clinical entity.

•

The diagnosis and management

•

Although they are benign, the mesenteric lipomas discovered must be treated.

Small bowel adenocarcinoma a rare cause of upper gastrointestinal obstruction (a case report and literature review)

INTRODUCTION

Small bowel adenocarcinoma is a rare but increasing disease. It poses both a diagnostic and therapeutic challange. Small bowel adenocarcinoma is a rare cause of small bowel obstruction. We present the case of a patient admitted to our emergency department for a bowel obstruction due to a mass of the jejunum and whose anatomopathological diagnosis was adenocarcinoma.

PATIENT AND METHOD

It is a 62-year-old woman with unparticular history, admitted to the emergency of visceral surgery of Ibn Rochd University Hospital for subocclusive syndrome evolving for one year, with early postprandial vomiting becoming stenosing two months ago. The abdominal CT scan showed thickening jejunal wall of 46 mm with upstream distension. She underwent a segmental bowel resection of 50 cm of small bowel with 3 cm stenotic mass located at 40 cm from the duodenojejunal angle. The pathophysiology revealed an invasive liberkhunian adenocarcinoma. The postoperative follow-up was simple, feeding allowed at D4 with discharge allowed at D6 and functional improvement at the time of the control performed three months after the intervention.

DISCUSSION

Small bowel adenocarcinoma is rare and represents only 1-3% of all gastrointestinal cancers. The incidence of SBA is 24 to 66 times lower than that of colorectal cancer (CRC). Due to its non-specific clinical manifestation and less accessible location, SBA is diagnosed at an advanced stage, and often at specimen analysis. The treatment is resection and the overall survival is increased when diagnostic is early made.

CONCLUSION

Small bowel adenocarcinoma is a rare but increasing cause of gastrointestinal malignancy, being both a diagnostic and therapeutic challenge. In front of the occlusive syndrome of small bowel appearance, adenocarcinoma must be ruled out.

Total colectomy in Vascular Ehlers Danlos syndrome a case report and literature review

Introduction

Ehlers Danlos syndromes (EDS) are a group of genetic disorders, characterized by skin hyperelasticity, joint hyperlaxity and tissue weakness. Vascular EDS is rare and is differs from other types of EDS by an inconsistent acrogenic morphotype and the occurrence of severe digestive and vascular complications, which can be lifethreatening.

Case presentation

We report the case of a 27-year-old man with a type IV vascular Ehlers-Danlos syndrome revealed by a colonic perforation after appendectomy for peritonitis secondary to appendicitis. The etiology of the perforation remained a challenge till a genetic research was carried out for COL3A1 gene mutation, which was positive in favor of vascular Ehlers Danlos disease. Then, a totalization of the colectomy with ileorectal anastomosis was performed.

Discussion

Vascular Ehlers Danlos syndrome (VEDS) is due to qualitative and quantitative abnormalities in the synthesis of type III collagen, which is a major constituent of the vessel wall, skin, joint capsules, uterus and gastrointestinal tract, particularly the colon. Colonic perforation, particularly sigmoidal perforation, is the most frequent complication in SEDV and most often precedes the molecular diagnosis. Colonic perforations are uncommon. The Hartmann procedure is a well-established surgical treatment modality, especially for emergency surgery. Given the iterative risk of colonic perforation and anastomotic leakage, preventive treatment by total colectomy with ileo-rectal anastomosis or definitive ileostomy is recommended by several authors.

Conclusion

SEDV is a rare pathology with a difficult diagnosis. However, it should be keeped in mind when there is any spontaneous colonic perforation in the young people.

•

Ehlers danlos syndromes are a group of genetic disorders of the connective tissue.

•

Life expectancy is reduced due to spontaneous vascular rupture or colonic perforation.

•

Colonic perforations are uncommon. They occur in the context of diverticulitis in adults.

•

The diagnosis is difficult because of the rarity of the pathology and the inaccessibility of genetic tests.

•

The surgical management of colonic perforations in ehlers danlos syndromes is not codified.

Fournier's gangrene: Seven years of experience in the emergencies service of visceral surgery at Ibn Rochd University Hospital Center

Introduction

This work aims to describe and discuss the epidemiological, clinical, therapeutic and evolution of Fournier's gangrene.

Materials and methods

Case series with retrospective data collection of patients treated for Fournier's gangrene between January 2010 and March 2017. The main etiologies, risk factors, postoperative complications outcomes and long term follow up results were analyzed.

Results

Eight four (84) patients were recruited. The average age of our patients was 49 years (with limits of 20–76), the male gender dominates our series (83.33%) with a sex ratio of 5 M/1W, the most frequently found risk factor was diabetes mellitus (37%). The most common etiology was anal abscesses (32%). The average time to consultation was 8 days (limits ranges from 3 to 30 days). All patients were admitted at a necrosis stage (100%). Anemia was identified in 85% of cases. The low platelets were noticed in 44.03% of cases. Hypoalbuminemia was found in 93% of cases. All patients (100%) benefited resuscitation initially and antibiotic therapy on their admission. They received emergency surgical debridement with a cleansing stoma. The average length of hospital stay was 13 days and complications occurred in 33% of cases. The mortality rate was 7.14%.

Conclusion

Fournier's gangrene is a medico-surgical emergency with a high morbidity and mortality rate. Early diagnosis as well as antibiotic therapy and the quality of debridement save the patients.

•

Fournier's gangrene is a rare but severe disease.

•

The diagnosis and treatment delay and lesions extension increase mortality.

•

The treatment is multidisciplinary.

•

Early diagnosis and treatment improve prognosis.

•

Tobacco intoxication is suspected to be risk factor.

[Strangulated hernia below the umbilicus containing the liver: a case report]

Herniation of liver segments through defects in the anterior abdominal wall is rare. To our knowledge, only three cases have been described in the literature. This study reports the case of a 84-year-old man presenting to the emergency department with strangulated hernia of the linea alba showing dullness to percussion with protrusion of a sensitive and firm mass. Laboratory test results were normal. Abdominal CT scan showed herniation of liver segment through the linea alba with calculous cholecystitis. The patient underwent retrograde cholecystectomy with subhepatic Redon drain and repair of the herniation by overlapping suture, associated with two subcutaneous vacuum suction Redon drains. The post-operative suite was simple and the patient was discharged on the second post-operative day. Six months after surgery, our patient was healthy. Herniation of liver segments through defects in the anterior abdominal wall is rare. Patients usually show little evidence if clinical signs. Abdominal CT scan is essential to assess the viability of parenchymal liver cells. Patients´ management is studied on a case-by-case basis, it can be surgical or non-surgical. Herniation of liver segments is rare; few cases have been reported in the literature and, in these cases, patients showed little evidence of clinical signs. CT scan is essential to assess the viability of parenchymal liver cells.

Bartholin's gland abscess a rare cause of rectovaginal fistula: A case report and literature review

Introduction

Rectovaginal fistula (RVF) is an abnormal communication between the vagina and the rectum. RVFs caused by Bartholin's gland infection are very rare. We present the case of recurrent rectovaginal fistula complicating a bartholin's gland abcess successfully treated with a Martius flap. The aim of this work is to demonstrate the possibility of complication of bartholin's gland infection by a rectovaginal fistula and the efficacy of Martius flap procedure for recurrent RVF of the low third part of the vagina.

Observation

It is a 30-year-old woman admitted to our department for recurrent RVF due to an abscess of the Bartholin's glands. She was previously treated with a vaginal advancement flap which failed with persistence of the fistula and its symptoms. The patient underwent a RVF repair by Martius flap with complete healing of the fistula.

Discussion

Rectovaginal fistula is a complex pathology with psycho-social, individual, family, religious and ethno-environmental repercussions. Its main aetiologies are obstetric, rectal surgery. Several techniques including the vaginal or anal advancement flap and the Martius flap are used for the treatment of rectovaginal fistulas. For recurrent fistulas, the Martius flap seems to be the most indicated with better results.

Conclusion

Rectovaginal fistula remain a challenge for surgeons and have major psycho-socio-economic repercussions for the patient. The complication of Bartholin's gland infection by rectovaginal fistula is rare. The Martius flap technique is the method of choice for recurrent rectovaginal fistulas of the lower third of the vagina or in association with other pathologies.

•

Recovaginal fistula is a challenge for surgeons.

•

The rectovaginale fistula due to Bartholin’s gland abcess is very rare

•

Care must be taken during the management of this pathology which affetcs 2% of women during their life for avoiding that complication

•

The Martius flap is the method of choice for the treatment of rectovaginale fistula of the low third inferior part of the vagina

A Fatal Case of Strangulated Pericecal Hernia

Pericecal hernia, a subtype of internal hernia, is a rare and unusual cause of small-bowel obstruction (SBO). We report the case of a pericecal hernia in an 80-year-old woman who presented to the emergency department with symptoms of SBO. She experienced colicky diffuse abdominal pain associated with vomiting and obstipation for over five days. Abdominal examination showed rebound tenderness in the right iliac fossa without any mass palpation. Computed tomography noted a "sac-like" structure in the right iliac fossa with dilated and ischemic small-bowel loops within. Exploratory laparotomy showed strangulated pericecal hernia and non-viable small bowel loops in the inferior ileocecal recess. Extensive resection and defect repair followed by small-bowel end-to-end primary anastomosis was made. After two days of ICU admission, patient died from septic shock. This case report highlights the need for prompt diagnosis, followed by surgical intervention to lower mortality of SBO of internal hernia origin, especially in cases where no previous surgery is noted.

Strangulated Spiegel hernia: About a case and literature review

The anterolateral abdominal Hernias are a frequent reason for consultation; Spiegel's hernia is a rare spontaneous abdominal anterolateral hernia (0.12% of abdominal hernias) for patients between 40 and 70 years old, There are risk factors such as intra-abdominal hyperpressure secondary to morbid obesity, multiple pregnancies and chronic cough. The surgery is the standard treatment; whether by raphy or prosthetic mesch. We report the case of a 42 year old male admitted to the emergency room for an occlusion syndrome due to the strangulated spiegel hernia with caecal and appendicular contents.

Post-traumatic diaphragmatic rupture with pericardial denudation: A case report

INTRODUCTION

Post-traumatic diaphragmatic rupture is a lesion of variable severity. It is a rare and difficult to diagnose pathology, it has been found in 0.4% of all traumatized patients and in 1.9% of blunt traumas. It can be associated with abdominal andthoracic lesions, particularly cardiac, which can be life-threatening.

MATERIALS AND METHODS

Our work is a retrospective case report with a descriptive aim concerning a patient operated for a post-traumatic diaphragmatic rupture within the department of general surgery of CHU Ibn Rochd Casablanca. This work has been reported in line with the SCARE 2020 criteria (17).

CASE PRESENTATION

A 60-year-old patient was admitted to the visceral surgical emergency department following a work accident (crushing between two carts) causing a thoraco-abdominal impact point trauma without initial loss of consciousness, nor externalized digestive hemorrhage or associated signs, but with a general condition alteration. The patient was conscious, dyspneic with a blood pressure of 100/50 mmHg and afebrile. Physical examination showed diffuse abdominal sensibility. The thoraco-abdomino-pelvic CT scan revealed the presence of a left thoracic hernia with gastric, colic and epiploic contents through a lateral defect of the left diaphragmatic dome. The decision was to directly send the patient to the operating room. Exploration found a large left diaphragmatic breach of 20 cm, a denudation of the pericardia, a medium-abundant hemoperitoneum and a hematoma of the right mesocolon. The procedure consisted of right hemicolectomy with ileocolic anastomosis, treatment of a diaphragmatic breach with a 2-silk raphia, thoracic drainage with a Joly drain, pericardial drainage with a Joly drain, pre-anastomotic drainage with 2 delbet slides, drainage of the Douglas and left subthreshold with 2 Salem catheters. The post-operative follow-up was simple.

DISCUSSION

Diaphragmatic rupture is a rare and difficult to diagnose condition. Traumatic diaphragmatic rupture (TDR) was found in 0.4% of all traumatized patients and in 1.9% of blunt trauma. Associated lesions of the spleen, liver and/or lungs were found in more than 30% of cases, with an overall mortality rate of 26.8% (1). Pericardial rupture following blunt chest trauma is rare and associated with a high mortality rate ranging from 30% to 64% (9). The physiopathology of this type of injury is not well understood, but the most accepted hypothesis describes an increase in intra-abdominal pressure due to a blunt creating a sufficiently high-pressure gradient between the chest and the abdomen to cause a diaphragmatic rupture. The common clinical symptoms of a diaphragmatic rupture are a marked respiratory distress and diffuse abdominal pain but it can be asymptomatic. Medical imaging exams visualize the ascended organs but it's more difficult to visualize the rupture itself. The chest X-ray is currently the first examination to be requested (4) and also helps in the diagnosis of injuries and diaphragm rupture (13). Surgical treatment includes the reduction of any visceral hernia, repair of the diaphragm and restoration of circulation, breathing and digestive functions. Laparotomy is generally used because of the complete exploration of the abdominal viscera, although it is easier to reduce herniated tissue and repair the diaphragm.

CONCLUSION

Diaphragmatic rupture with denudation of the heart is rare with poor prognosis and requires emergency surgery with close postoperative monitoring in the intensive care setting.

SUMMARY

Post-traumatic diaphragmatic rupture is a lesion of variable severity. It is a rare and difficult to diagnose pathology, it has been found in 0.4% of all traumatized patients and in 1.9% of blunt traumas. The lesions are more frequent in the left diaphragmatic dome compared to the right one, and exceptionally bilateral. Pericardial rupture following blunt chest trauma is rare and associated to a high mortality rate. It is often unrecognized and goes unnoticed in the acute phase. The most common clinical symptoms of diaphragmatic ruptures are respiratory distress and diffuse abdominal pain, as it can be asymptomatic. Its diagnosis is essentially radiological using CT scan, and requires emergency surgical treatment as soon as the diagnosis is suspected, in order to avoid the dreaded complications. Traumatic diaphragmatic rupture remains a diagnostic and therapeutic challenge. We report the case of a patient who presented a post-traumatic diaphragmatic rupture with pericardial damage operated in the visceral emergency department at the Ibn Rochd Hospital c in Casablanca, Morocco.

Ischemic volvulus of the transverse colon caused by intestinal malrotation: A case report

Introduction

Congenital Intestinal malrotation is a complex disorder caused by incomplete or abnormal rotation of the intestine during fetal development. Volvulus of the transverse colon secondary to intestinal malrotation is a rare cause of acute abdomen in adults. It has a high risk of mortality, hence the need for an urgent diagnosis and surgical intervention.

Case report

We report an unusual case of volvulus of the transverse colon caused by intestinal malrotation. A 21-year-old women presented abdominal pain with nausea and vomiting. On clinical examination, the abdomen was tympanic to percussion with peritoneal sensitivity. The abdominal X-ray revealed a massive obstruction of the distended large intestine with a “U-shaped” loop. He underwent an exploratory laparotomy that revealed the diagnosis of transverse colon volvulus with intestinal malrotation. His condition was treated surgically by transverse colectomy with colostomy. The patient died on the second day following a hemodynamic instability.

Conclusion

Transverse colonic volvulus is a rare entity with a high mortality, so it requires urgent diagnosis and surgical intervention.

•

Volvulus of the transverse colon secondary to intestinal malrotation is a rare cause of an acute abdomen in adults.

•

Volvulus of the transverse colon has a high risk of mortality, so it requires urgent diagnosis and surgical intervention.

•

The diagnosis of the volvulus of the transverse colon before surgery is rarely observed, it's most often made intraoperatively.

•

The choice of a procedure depends on the general condition of the patient.

Fish bone perforation of the small bowel: A case report

INTRODUCTION

Fish bone is one of the most common accidently ingested foreign bodies. Normally, it is eliminated from the gastrointestinal (GI) system without any symptomatology, only 1% of the cases will develop a perforation of the GI tract requiring surgical intervention.

PRESENTATION OF CASE

A 70-year-old man, presented with a 48h evolving abdominal pain, important abdominal distension, nausea, vomiting, and a last bowel movement reported 2 days ago, The abdomino-pelvic CT-scan objectified a distension of the terminal ileum measured at 30mm, The exploration revealed a sharp foreign body,at the 15 proximal centimeters of the terminal ileum, which penetrated through the wall of the ileum. The foreign body was removed and we noticed that it is a fish bone. The patient recovered well.

DISCUSSION

Clinical manifestations are determined by the location of the perforation and the preoperative diagnosis is always difficult to reach. Computed tomography (CT) scan is the indicated method to identify ingested foreign bodies and surgery is the treatment of choice.

CONCLUSION

Delay in diagnosis and treatment can be associated with significant morbidity and mortality.

Acute pancreatitis associated with Cushing syndrome - A case report and literature review

INTRODUCTION

Cushing's syndrome (CS) is a rare and severe disease. Acute pancreatitis is the leading cause of hospitalization. The association of the two disease is rare and uncommon. We report the case of a 37-year-old woman admitted in our service for acute pancreatitis and whose Cushing syndrome was diagnosed during hospiatilisation. The aim of this work is to try to understand the influence of de Cushing in acute pancreatitis and to establish a causative relationship between the two diseases.

OBSERVATION

It is a 37-year-old woman with a history of corticosteroid intake for six months, stopped three months ago who consulted for epigastralgia and vomiting. The physical exam found epigastric sensitivity with Cushing syndrome symptoms. A CT scan revealed acute edematous-interstitial pancreatitis stage E of Balthazar classification. 24 h free cortisol of 95 μg/24 h and cortisolemia of 3.4 μg/dl. The patient was treated symptomatically and referred after to endocrinology service for further treatment.

CONCLUSION

The association with acute pancreatitis and CS is rare and uncommon. Although detailed studies and evidence are lacking, it can therefore be inferred that CS is one of the risk factors for the onset of acute pancreatitis. The medical treatment and management of acute pancreatitis in those patients do not differ from other pancreatitis of any etiologies.

Gastrointestinal manifestations related to infection with SARS-COV-2: Appendicular syndrome (A case report)

INTRODUCTION

The clinical symptomatology of SARS-CoV-2 disease may manifest as an appendicular syndrome. The abdominal CT scan can be used to rule out or confirm the diagnosis of acute appendicitis and a chest CT scan can make the diagnosis of SARS-CoV-2 infection.

OBSERVATION

We report the observation of a 30-year-old patient, with no particular pathological history, who presented with appendicular syndrome without extra-digestive signs, and especially, without respiratory syndrome. The CRP was at 35mg/l. A thoracoabdominal CT scan was requested to detect an eventual appendicitis. With three straight frosted glass areas on the thoracic area suggesting COVID 19 infectious pneumopathy, a PCR was requested to detect a positive SARS-CoV-2 viral RNA, then the patient was appendectomized. Post-operative follow-up was simple and the patient was transferred to a department dedicated to covid-19-positive patients for further management.

CONCLUSION

CT scan is necessary before considering emergency surgery for acute appendicitis because it can change the patient's management circuit.

Lactococcus lactis ssp lactis a rare cause of liver abscesses: A case report and literature review

•

Lactococcus lactis is a rare cause of liver abscesses.

•

Lactococcus lactis ssp lactis can cause liver abcesses in immunocompetent people.

•

The exposition to unpasteurized dairy products may lead to liver abcess due to L. lactis ssp lactis.

•

Young and immunocompetent people can develop liver abscesses, even for bacteria considered as non-pathogenic.

•

Antibiotics and percutaneous drainage are the first line for treatment of liver abscesses and have improved the death rate.

Introduction

We present a liver abscess due to Lactococcus lactis ssp lactis.

Case presentation

It is a 27-year-old male patient without history who presented the right hypochondrium pain over 10 days. The physical examination noted right hypochondrium pain and hépatomegally. The ultrasound showed hepatomegaly with liver abcess for the segments IV and V as well as VII and VIII measuring 13 × 8 cm and 7.6 × 4.3 cm respectively. A computed tomography (CT) revealed an abscess for segments IV and V and VI and VII measuring respectively 107 × 89 mm and 55 × 50 mm. He underwent a surgical drainage after a radiologic drainage and antibiotherapy failure with success.

Discussion

Liver abscesses are rare; affect men over 60 years with co-morbidities and those due to L. Lactis ssp lactis are exceptional. Their prevalence is 0.29–1.47% in series of autopsies and 0.008 to 0.16% in hospitalized patients. The most frequently found germs are gram-negative bacilli (40–60%) and anaerobic bacteria (40–50%). Ultrasound and CT scan make the diagnosis in 90% of cases and orients to the etiology. Percutaneous drainage is the first line for treatment, surgical drainage is reserved for percutaneous drainage failures.

Conclusion

Liver abscess due to Lactococcus lactis ssp lactis is very rare. The clinic, diagnostic methods and treatment of this abscess are identical to other abscesses due to other etiologies. The antibiotics and percutaneous drainage of abscesses have improved the death rate from 40% to 10%–25%.

Pneumatosis cystoides intestinalis with pneumoperitoneum secondary to stenosing pyloro-duodenal peptic ulcer: Case series of three patients and literature review

•

Pneumatosis cystoides intestinalis (PCI) is a rare condition which can be associated to pneumoperitoneum without gastro-intestinal perforation.

•

PCI is most often secondary to various diseases and the stenosing peptic ulcer is one of them.

•

Careful correlation of the clinical presentation with corroborating biological tests should determine whether a conservative medical approach or emergency surgical exploration is appropriate.

•

Knowledge of this pathology is important to avoid unnecessary exploratory laparotomy.

Introduction

Pneumatosis cystoides intestinalis (PCI) is a rare condition, which can affect the entire gastro-intestinal tract. It can be idiopathic or most often secondary to various diseases. The causes remain multiple and the stenosing peptic ulcer is one of them. We report three case reports of pneumatosis cystoides with pneumoperitoneum intestinalis secondary to stenosing pyloro-duodenal peptic ulcer.

Case presentation

We report a case series of three patients with PCI that presented to the emergency department with a reassuring clinical picture with the discovery in imaging of a pneumoperitoneum. All our patients presented with a pyloro-duodenal stenosis secondary to a complicated peptic ulcer, one of which was treated surgically and the other two endoscopically.

Discussion

The objective of this report is to provide an update on pneumatosis cystoides intestinalis secondary to stenosing pyloro-duodenal peptic ulcer, by specifying its etiopathogenic, diagnostic and therapeutic characteristics.

Conclusion

Knowledge of this pathology is necessary in order to avoid unnecessary abusive surgery.

Acute colonic occlusion over endometriosis: About a case

The gastrointestinal tract is the most common site of extra pelvic endometriosis, with the rectum and sigmoid colon being the most frequently affected areas. Its diagnosis is still very difficult, especially when it manifests itself as an acute occlusion. We report the case of a patient admitted to the emergency room for an occlusive syndrome on a sigmoid process and who was operated on with colorectal resection and it was the anatomopathological examination that led to the diagnosis of endometriosis.

Sub-acute transverse colon volvulus an exceptional cause of large bowel obstruction: Case report

Introduction

The sub-acute form of transverse colon volvulus manifests with signs and symptoms of large bowel obstruction. The diagnosis is most often done intraoperatively. We report a rare case of transverse colon volvulus in a 65-year-old female patient with no particular pathological or surgical history.

Case presentation

Sub-acute transverse colon volvulus in an elderly woman with no pathological or surgical history. Manifested with signs and symptoms of colonic obstruction. Surgically treated by a two-stage procedure with good postoperative outcomes.

Discussion

The transverse colon volvulus represents only 2-4% of all colonic volvulus. We discuss the diagnostic and therapeutic approach of our case of transverse colon volvulus through a literature review.

Conclusion

Transverse colon volvulus should be considered as a differential diagnosis in the face of large bowel obstruction. Early diagnosis and treatment improve the prognosis.

Phytobezoar: An unusual cause of small bowel obstruction

Phytobezoars are concretions of indigested fruit and vegetables fibers in the gastrointestinal tract. The past of gastric surgery is most common risk factor of phytobezoar. We present the case of a 39-year-old female was admitted to the emergency department and who presented with small bowel obstruction due to phytobezoar, her past medical history was marqued by truncal vagotomy and simple suture recurrent perforated gastric ulcer 15 years earlier. Her postoperative recovery was uneventful.

Primary appendiceal Burkitt's lymphoma presenting as acute appendicitis: An extremely rare case report and review of the literatture

Primary lymphomas of appendix are extremely rare tumors. The incidence is 0.015% out of all gastrointestinal lymphomas; furthermore, limited data is available in literature. The appendiceal neoplasms are most commonly presented as acute appendicitis followed intestinal obstruction, intussusception or perforation. We present a case of a 22 year-old male patient who presented with acute appenditis and underwent emergency laparotomy. On abdominal exploration, swollen and enlarged appendix measured 3cm was present for which appendectomy were performed. The histopathological examination of appendectomy specimen revealed a Burkitt's Lymphoma. The patient received R-COPADEM protocol of chemotherapy. Primary gastrointestinal lymphoma is a extremely rare neoplasm without guidelines for therapy.

•

Burkitt lymphoma is an aggressive non-hodgkin b-cell lymphoma.

•

The occurrence of primary Burkitt's lymphoma of appendix is extremely rare.

•

The appendiceal neoplasms are most commonly presented as acute appendicitis.

•

The diagnosis of kimura disease is confirmed by surgical biopsy.

•

The diagnostic of Burkitt's lymphoma was only made after histopathological examination, so should be done.

•

The surgery and chemotheray constitue a best traitement for burkitt's lymphoma of appendix presenting as acute appendicitis.

Nutcracker syndrome due to aorto-mesenteric compression in adults: Case report and literature review

•

Nutcracker syndrome is characterized by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, resulting in an obstruction of blood flow from the left renal vein into the inferior vena cava due to extrinsic compression.

•

The management of nutcracker syndrome depends on the clinical presentation and severity of hypertension in the left renal vein, ranging from simple monitoring to nephrectomy.

•

Surgical techniques used for the treatment of patients with severe symptoms.

Nutcracker syndrome is a rare entity that corresponds to an abdominal pain following compression of the left renal vein during its passage between the aorta and the superior mesenteric artery, with a peak prevalence in adults between 20 and 30 years old, The typical clinical presentation includes hematuria, orthostatic proteinuria with or without flank pain. doppler ultrasound has a sensitivity of 78% and specificity of 100%, Both CT and MRI can show the compression of the left renal vein between the aorta and the superior mesenteric artery.

We report the case of a young patient admitted to the emergency room for abdominal pain mainly localized in the left hypochondrium, with microscopic hematuria, a CT scan was performed showing a reduced aorto mesenteric angle with a compression of the left renal vein and collateralization of venous circulation of left gonadal vein.

Ansa pancreatica: a rare cause of acute recurrent pancreatitis

Acute pancreatitis is an inflammation of the pancreas that can be caused in rare situations by ansa pancreatica, it is a rare anatomic variation of the pancreatic ducts. It is a communication between the main pancreatic duct (Wirsung) and the accessory pancreatic duct (Santorini). We report a case of the patient, in a 44-year-old, non-alcoholic, hospitalized for acute pancreatitis stage C of Baltazar. A magnetic resonance Cholangiopancreatography (MRCP) was performed which showed a gallstone and ansa pancreatica, than an endoscopic retrograde cholangiopancreatography (ERCP) revealed an ansa pancreatica with a common bile duct clear, a sphincterotomy of the major papilla was performed. It is still not clear whether the presence of these two pathologies is a coincidence or if the ansa pancreatica is the cause of acute pancreatitis. New studies are necessary to clarify these points.

Polysplenia with agenesis of the dorsal pancreas and preduodenal portal vein, about a case

PURPOSE OF THE STUDY

Polysplenia is a complex polymalformative syndrome that is frequently accompanied by an inconsistent spectrum of visceral and vascular anatomical abnormalities and is extremely undiscovered in adulthood. The objective of this article is to limit the intraoperative risks generated by the lack of knowledge of these anatomical variations by insisting on the inconstancy of all these variations and the perfect knowledge of the reference anatomy and the exploration of the anatomical variations in imaging before the surgery.

PATIENT AND METHODS

The patient was 50-year-old who was hospitalized in our department for gastric adenocarcinoma. During her extension assessment, a polysplenia syndrome was accidentally discovered on the scan images, which showed an exceptional association between preduodenal portal vein, agenesis of the dorsal pancreas, and polysplenia.

CONCLUSION

There are neither specific clinical symptoms of the polysplenia syndrome, nor any biological sign; hence, the interest of recognizing this pathology is to avoid diagnostic errors, but also to guide the surgeon during the surgical act performed.

Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) and its receptor PROKR2 are associated to human colorectal cancer progression and peritoneal carcinomatosis

BACKGROUND

The highest risk factor for mortality among malignant tumors is metastasis. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an angiogenic factor which biological activity is mediated via two G protein-coupled receptors, prokineticin receptor1 (PROKR1) and PROKR2. Recent studies suggested that EG-VEGF expression is deregulated in multiple cancers including colorectal cancer (CRC).

METHODS

Using distinctive CRC and peritoneal carcinomatosis (PC) cohorts and a corresponding control cohort, we determined the circulating levels of EG-VEGF and its in situ expression, and that of its related receptors.

RESULTS

Circulating EG-VEGF levels were significantly increased in patients with metastatic PC compared to CRC and control patients (p< 0.05). Furthermore, according to clinicopathologic examinations, local EG-VEGF expression correlated with higher tumor and nodal stages (p< 0.001) of CRC. EG-VEGF and PROKR2 were highly expressed in colorectal primary lesions compared to positive controls. PROKR1 expression was lower and did not change in tumor specimens. Also, EG-VEGF and its receptor PROKR2 were differentially expressed in the colorectal primary lesions and in the control groups.

CONCLUSION

Altogether these findings suggest that EG-VEGF/receptors system might be an important actor in the CRC progression into PC and might be involved in the ability of tumor cells to invade other organs. Circulating EG-VEGF could be proposed as a prognostic marker in human CRC and its progression into PC.

[Descriptive epidemiology of peritoneal carcinosis of gastrointestinal origin at the Ibn Rochd University Hospital, Casablanca (2008-2010)]

Introduction

La carcinose péritonéale est une diffusion inéluctablement terminale chez les patients atteints de cancers abdominaux. C'est le signe d'une maladie avancée ou d'une ré-évolution le plus souvent associée à un pronostic sombre. Environ deux tiers de l'ensemble des carcinoses péritonéales sont d'origine digestive et un tiers d'origine non digestive.

Méthodes

Il s'agit d'une étude rétrospective descriptive menée entre janvier 2008 et décembre 2010, dans le but de dresser le profil épidémiologique et les facteurs de risques de la carcinose péritonéale d'origine digestive au Centre Hospitalier Universitaire de Casablanca.

Résultats

Quarante-sept cas de carcinose péritonéale d'origine digestive ont été recensées (22 femmes, 25 hommes) ce qui représente une prévalence de 6.19% et un nombre moyen de 15.6 cas par an. L'âge était le facteur de risque essentiel dans notre série avec un âge moyen de 55.55 ans ±12.32. Les antécédents familiaux présentaient aussi un facteur de risque à prendre en considération.

Conclusion

A travers notre étude, nous avons conclus que les principaux facteurs de risque de la carcinose péritonéale d'origine digestive au Centre Hospitalier Universitaire Ibn Rochd Casablanca, sont l'âge et les antécédents familiaux.

Hepatic fascioliasis presenting with bile duct obstruction: a case report

Fascioliasis is a zoonotic infection caused by a liver trematode: fasciola hepatica; which commonly affects cattle and sheep, humans are accidental hosts. Several cases have been reported in the literature worldwide with a large geographical distribution. We present a case of bile duct obstruction due to a hepatic fascioliasis, successfully treated with both a combined surgical and medical approaches. A high index of suspicion should be kept in mind for all cases of obstructive jaundice, especially in areas in which human fascioliasis infection is repeatedly reported.

[Gastric trichobezoar: about a case]

Le trichobézoard est une affection rare, le plus souvent asymptomatique, mais de diagnostic facile par la fibroscopie œsogastroduodénale. Le traitement est le plus souvent chirurgical. On rapporte une observation d’un trichobézoard gastrique chez une fillette de 16 ans, qui a été extrait par gastrotomie, sans complications. Une prise en charge psychiatrique a été faite.

[Retroperitoneal paraganglioma: report of a case and literature review]

Les paragangliomes rétropéritonéaux non fonctionnels sont des tumeurs rares. Ils sont définis comme des tumeurs chromaffines extra- surrénaliennes et représentent environ 1/5^ème des tumeurs chromaffines. Ils sont souvent asymptomatiques et peuvent atteindre des dimensions importantes. Nous rapportons l'observation d'une patiente âgée de 34 ans opérée pour une tumeur rétropéritonéale géante et dont l'examen anapath a conclu à un paragangliome. Les formes malignes, plus fréquentes que les formes bénignes, présentent un envahissement locorégional et métastasent tardivement. La prise en charge des paragangliomes doit être multidisciplinaire mais seul le traitement chirurgical est curatif. Il n'existe par contre pas de consensus sur l'utilité des thérapeutiques complémentaires qui peuvent néanmoins constituer un appoint à titre symptomatique. Les paragangliomes présentent un caractère génétique dans 25% des cas. Une enquête génétique doit être systématiquement proposée.

Post-operative transmesosigmoid hernia causing small bowel obstruction: a case report

Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Transmesosigmoid hernia is rare type among others mesosigmoid hernia was rarely reported in the literature. We report the case of a 44-year-old male who presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiography examination were suggested intestinal obstruction due to postoperative adhesion. The diagnosis of small bowel obstruction due to internal hernia was confirmed by laparotomy exploration. The herniated loop was reduced successfully and the defect was approximated with interrupted sutures. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This case report highlight difficulty and importance of high index of suspicion considering an internal hernia as a cause of small bowel obstruction in individuals of all age groups with or without a previous history of abdominal surgery.

Spontaneous perforation of Meckel's diverticulum: a case report and review of literature

Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

[Ileosigmoid knot: report of 2 cases]

Le nœud iléosigmoïdien ou l’ileosigmoid knot (ISK), est une entité clinique exceptionnelle, c’est une urgence chirurgicale caractérisée par une strangulation du grêle en formant un nœud autour de la base du colon sigmoïde avec risque de nécrose rapide du grêle et du colon. Nous rapportons deux cas dans le service des urgences chirurgicales viscérales du CHU Ibn Rochd de Casablanca ; chez lesquels le diagnostic d’ISK n’a été posé qu’en peropératoire. A travers ces 2 cas et une revue de la littérature nous allons définir les aspects diagnostiques, thérapeutiques et pronostiques de cette entité clinique rare.

[Non operative management of blunt splenic trauma in adults]

Nonoperative management of blunt splenic injury allows preservation of the immune function of the spleen while avoiding unnecessary laparotomy. The aim of our study was to evaluate the feasibility and the results of conservative management of adult blunt splenic trauma in the context of a developing country. Nonoperative management was proposed for 52 out of 62 patients with blunt splenic trauma treated at the Casablanca University Hospital, Morocco. Motor vehicle-road accidents (88%) were the most common etiology. Multiple trauma was present in 79% of the cases. 15% of the cases had hemodynamic instability. Ultrasonography was performed in 52 patients; it showed splenic contusion in 45 patients and subcapsular hematoma in 7 patients. CT scan showed splenic contusion in 11 patients. Four cases ultimately required operative management with one death. Of the remaining 48 patients, 45 had an uneventful course with observation, but there were two deaths in the observation group.

[Intra-uterine fetal death by knife: case report]

INTRODUCTION

Opened injuries by knife are rare in pregnant women and are responsible of foetal death in most cases.

OBSERVATION AND COMMENTARY

We report a case of a 27-years woman, in her 8th months of pregnancy, victim of three knife punchs in her right iliac fossa. An emmergent laparotomy revealed deep wounds in the uterus and its right vascular pedicles, and a right external iliac artery lesion. Hysterectomy was performed and the extracted fetus was dead. He had two wounds in skull and back. Foetal death is common in opened knife injuries especially at the end of pregnancy. On one hand, the fetus has an abdominal situation that expose him to penetrating lesions. On the other hand, the uterus is richly vascularized during this period of pregnancy, thus any uterine or pedicular wound could result in a maternal hemorrhagic shock and hence a poor foetal and maternal prognosis.

CONCLUSION

Knife injuries in pregnant women could compromise the foetal prognosis. Managmanent should be early and requires a close collaboration between resuscitators, obstetricians and vascular surgeons.

[Splenectomy in hematologic diseases. A study of 70 cases]

The aim of this work was to report our own clinical experience and to compare it our results with those already published. This is a retrospective study of 70 splenectomies performed for hematologic diseases at the service des urgences viscerales of Ibn Rochd teaching hospital of Casablanca, between 1996 and 2001. The study included 70 patients. Splenectomy was performed for therapeutic reasons by laparotomy in 56 cases (80%) and bym laparoscopy in 14 cases (20%). The post-operative after-effects were mild in 81.4%. A patient died, however of pulmonary embolism. Splenectomy is an important tool in the management of patients suffering from hemolytic anemia, auto-immune thrombopenic purpura and other hemolytic anemias. Management by a multidisciplinary team is required to prevent a maximum of long and short-term post-operative complications and to offer the offer the best conditions for a successful splenectomy.

[Hydatid cyst of the pancreas. Report of a case]

A 49 years old woman was admitted to the hospital for abdominal pain with vomiting. At the examination, there was a deep and hard epigastric mass. The diagnosis of pancreatic cyst was established by ultrasonography and CT Scan. The hydatid cyst was recognized before surgery on the basis of the epidemiological data and the existence of calcified shell. The treatment consisted in the resection of the protruding dome with epiplooplasty. The postoperative evolution was simple. From this observation and reported data, complications and treatment of this uncommon localization were discussed.

The lung and Waldenström's macroglobulinemia

We encountered a 47-year-old woman with Waldenström's macroglobulinemia (WM) manifested as lung involvement and endobronchial disease, without many of the other features common to the disease. In addition to the unusual aspects of this case, we review the clinical features of other reported cases of pulmonary involvement in WM.

[Pyloroduodenal stenosis of ulcer origin. Apropos of 260 cases]

This study is about 260 cases of ulcerous pyloroduodenal stenosis operated on in 10 years among 1209 ulcers (21.5%). Males are by far dominating with a rate of 83.55%, the average of age was 45 years. 20% of our patients have presented a complication anterior or contemporary to the stenosis (perforation or hemorrhage). Clinical context is obvious and upper gastro intestinal series has made diagnosis in 92% of cases fibroscopy has been done in only 30.8% of cases. Surgical treatment has consisted in a troncular vagotomy in 252 cases. (98.2%), transduction de "dont" 34.5% of whom underwent a gastroduodenostomy 25.8%, gastrojejunostomy, 18.2% a pyloroplasty and in 21.4% an inferior polar gastrectomy. There were 3 fundic vagotomies (1.17%) associated to a gastro duodenostomy in 2 cases and to dilatation in one case e deplored 3 deaths related to surgery (1.1%) long follow up was marked by 3 ulcerous relapses and 2 stenosis.