[Extrathoracic solitary shwannoma of the intercostal nerve: a rare localization]

Le shwannome thoracique solitaire est une tumeur nerveuse bénigne. La localisation est le plus souvent intra-thoracique au niveau du médiastin postérieur. Nous rapportons l'observation d'un schwannome solitaire du nerf intercostal de développement extra-thoracique imitant une tumeur sous-cutanée du thorax. La biopsie-exérèse nous a permis d’établir le diagnostic histologique. Après un recul de 14 mois aucune récidive n'a été notée. Le diagnostic de schwannome doit être suspecté devant toute tumeur sous cutanée du thorax. La certitude diagnostique est histologique. L'exérèse totale est le seul garant d'une guérison sans récidive.

Fournier's gangrene: our experience with 50 patients and analysis of factors affecting mortality

INTRODUCTION

Fournier's gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier's gangrene and to identify risk factors that affect mortality.

METHODS

The medical records of 50 patients with Fournier's gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality.

RESULTS

Ten males and five females were enrolled in the study. The mean age was 54 years (range 23-81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality.

CONCLUSIONS

Fournier's gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices.

Perianal abscesses due to ingested foreign bodies

The clinical presentation of perianal abscesses due to foreign bodies (FBs) impacted in the anal canal mimics common causes of acute anal pain. The diagnosis can be established by digital rectal examination and/or proctoscopy, but may miss the presence of an FB. Incision and drainage of the abscess, along with removal of the FB, results in immediate pain relief and cure. Impacted FB must not be overlooked as an unusual cause of perianal abscess. One case of perianal abscesses due to FB impacted in the anal canal is reported.

[Enterocutaneous fistula caused by strangulated groin hernia: five cases in Morocco]

The purpose of this report is to describe 5 cases of strangulated hernia discovered in patients presenting with enterocutaneous fistula. Most patients were women with small femoral hernias.

Torsion of a wandering spleen

Wandering spleen is a rare condition defined as a mobile spleen only attached with its pedicle. It can be complicated by a volvulus, which is a surgical abdominal emergency. Preventing infarction is the aim of a prompt surgery that can preserve the spleen and then proceed to splenopexy. We report a rare case of torsion of a wandering spleen associated with a dolichosigmoοd.