Left-Sided Colon Cancer and Right-Sided Colon Cancer: Are They the Same Cancer or Two Different Entities?

Background Colon cancer is one of the most common cancers in the world and one of the main causes of cancer-related deaths. In Morocco, it occupies the first place among digestive cancers. Right-sided and left-sided colon cancers have different embryological, epidemiological, pathological, genetic, and clinical characteristics. This distinction leads to differences in the evolution and prognosis of the disease. This study aimed to identify epidemiological factors and clinical and pathological characteristics that can influence perioperative and prognostic outcomes in patients with right-sided colon cancer compared to those with left-sided colon cancer. Methodology We conducted a retrospective cohort study over a period of nine years from January 2012 until December 2020. We included 277 patients divided into two groups, namely, right colon cancer (group 1) (n = 99) and left colon cancer (group 2) (n = 178). Results The average age of our series was 57.4 years, with extremes ranging from 19 to 89 years old (SD = ±13.6451 years). The average age in the right colon group was 55.97 (SD = ±13.341 years). The average age in the left colon group was 58.18 (SD = ±13.69 years). The male gender had a predominance, with a sex ratio of 1.3 for both groups. Among the patients in group 2, 65% showed lymph node involvement on the CT scan, whereas only 34% of patients in group 1 displayed the same condition. The recurrence rate in the right-sided colon cancer group was 22.2% compared to 24.9% in the left-sided group. The five-year overall survival was estimated for the right-sided and left-sided colon cancer groups at 87% and 96.5%, respectively. In patients with stage III and IV cancer, overall survival was better for those who underwent surgery for left-sided colon cancer compared to those who underwent surgery for right-sided colon cancer (p = 0.029). In the case of vascular emboli or involvement of the perineural sheath, there was no significant difference in overall survival (p = 0.446 and p = 0.655, respectively). The three-month survival without recurrence was almost identical in both groups (31% for right-sided colon cancers and 30.9% for left-sided colon cancers). Age over 61 years was a predictive factor of poor prognosis in recurrence-free survival (hazard ratio = 3.245; p = 0.023). Conclusions We identified factors that can influence perioperative outcomes and prognosis in patients with right-sided colon cancer compared to those with left-sided colon cancer. Our findings suggest that age and lymph node involvement along with other factors play a role in the overall survival and recurrence outcomes of these patients. Further research is necessary to explore these differences and develop personalized treatment plans for patients with colon cancer.

[Epiploic appendagitis: a rare cause of acute abdomen]

L’appendagite épiploïque primitive est une cause rare d’abdomen aigu. Elle peut simuler le tableau clinique d’autre processus inflammatoire tels que la diverticulite ou l’appendicite. Le diagnostic repose sur le scanner. Le traitement est médical en dehors des complications.

[Voluminous colorectal foreign bodies inserted voluntarily: about a case]

L'introduction de corps étrangers (CE) est une curiosité et un tabou dans notre pays. Elle se caractérise par la gravité des complications éventuelles et les différentes possibilités thérapeutiques. Nous rapportons le cas d'un patient, ayant eu une incarcération d'un énorme objet introduit volontairement par voie anale. Il a bénéficié d'une extraction manuelle. Cette dernière permet, quand elle est possible, d'éviter la chirurgie qui s'impose en cas d'échec ou de complications.

[Acute intestinal intussusception revealing intestinal T-cell lymphoma in adults]

L'invagination intestinale aiguë est une pathologie du nourrisson et du petit enfant. Sa survenue chez l'adulte est très inhabituelle. Elle est d'étiologie diverse. Dans l'immense majorité des cas, elle est secondaire à une tumeur qui peut être bénigne ou maligne. Un lymphome T digestif révélé par invagination intestinale est une entité très rare. Nous rapportons le cas d'un patient de 43 ans, admis aux urgences du centre hospitalier universitaire Hassan II de Fès, Maroc pour une occlusion intestinale. Le scanner abdominal a montré une invagination intestinale aiguë grêlo-grêlique sur un épaississement pariétal digestif de l'anse incarcérée. Le traitement était une résection chirurgicale carcinologique à ciel ouvert. L'étude anatomopathologique et immunohistochimique de la pièce opératoire a conclu à un lymphome anaplasique à grandes cellules de type T. Après la chirurgie, une chimiothérapie est indiquée dans le but d'améliorer le pronostic et d'éviter une éventuelle rechute. L'invagination intestinale est une affection rare chez l'adulte. Elle conduit le plus souvent à la découverte d'une cause organique pouvant être tumorale. A partir de ce nouveau cas et après analyse de la littérature, nous discutons les caractéristiques cliniques, diagnostiques et les possibilités thérapeutiques de cette pathologie rare.

Transverse colon volvulus presenting as bowel obstruction: a case report

BACKGROUND

Transverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco.

CASE PRESENTATION

We report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a "U-shaped" loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function. He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis. Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies.

CONCLUSION

This case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial. It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. Prompt recognition with emergency intervention constitutes the key to a successful outcome.

[Internal hernia through the falciform ligament: a rare cause of intestinal obstruction]

Internal hernias are a rare cause of acute intestinal obstruction. Hernias through the falciform ligament is uncommon. Diagnosis is often made intraoperatively. Abdominal CT scan, performed in an emergency situation, can enable preoperative diagnosis and guide the therapeutic approach. In this respect, we here report a case whose data were collected in the Department of Visceral Surgery at the University Hospital Hassan II in Fez. The study involved a 48-year old patient, with no particular previous history, admitted to the Emergency Department with occlusion evolving over 4 days. Abdominal x-ray without treatment objectified multiple hydroaeric levels in small bowel some of which projected towards the hepatic region as well as the presence of a flat intestinal loop in continuity with distended intestinal segment. Abdominal CT scan was not performed due to altered renal function. The patient then underwent emergency surgery after stabilization of his condition and the diagnosis of internal hernias through the falciform ligament was made intraoperatively. In adults, internal hernia through the falciform ligament is a rare cause of acute intestinal obstruction in our daily practice. The diagnosis is most often made intraoperatively. It is necessary to suspect it in young patients with no history of abdominal surgery or intraperitoneal infectious process and with hydroaeric levels in the right upper quadrant.

[Gastroduodenal trichobezoar: about a case]

Le trichobézoard gastroduodénal est une affection rare, dont le diagnostic est facile en présence d'un contexte évocateur. Nous rapportons le cas d'une jeune patiente âgée de 21 ans suivie pour une schizophrénie, admise pour douleur abdominale aiguë, vomissements et masse épigastrique, le scanner abdominal a permis de faire suspecter un bézoard en objectivant des lésions hétérogènes occupant tout l'estomac, ne prenant pas le contraste et semblant indépendante de la paroi gastrique. Un traitement chirurgical a été réalisé avec exérèse du trichobézoard par gastrotomie, sans complications et un transfert en service de psychiatrie.

[Volvulus of the cecum: a rare cause of intestinal occlusion: about two cases]

Le Cæcum est, en fréquence, la deuxième partie du colon concernée par le volvulus après le sigmoïde et avant l'angle gauche et le côlon transverse. Cette affection survient sur des cæcums anormalement mobiles. Le mécanisme du volvulus est la torsion ou la bascule. Le tableau clinique est celui d'une occlusion intestinale aiguë par strangulation. L'abdomen sans préparation (ASP) et la TDM abdominale sont les examens radiologique de premier choix pour le diagnostic. Le traitement consiste en une chirurgie en urgence avec résection du cæcum et de l'iléon terminal. Nous rapportons deux cas de volvulus du cæcum admis aux urgences dans un tableau d'occlusion intestinale aiguë, le diagnostic était confirmé chez les deux patients par un scanner abdomino-pelvien et le traitement consistait en une résection iléo-colique avec rétablissement immédiate de continuité, les suites post opératoires étaient simples.

[High grade insulinoma detected in a patient with a 5-year history of severe hypoglycemias]

Les tumeurs endocrines fonctionnelles du pancréas sont des lésions rares, parmi lesquelles les insulinomes sont les plus fréquents. La majorité des patients atteints d'insulinome ont entre 30 et 60 ans et 59% d'entre eux sont des femmes. La plupart des insulinomes sont sporadiques, alors que 10% sont développés chez des patients atteints de NEM. Le diagnostic repose sur la clinique et sur le bilan biologique. Le bilan d'imagerie préopératoire (Echo-endoscopie, TDM, IRM) est essentiel localisant la tumeur dans plus de 80% des cas. Le traitement de référence est l'exérèse chirurgicale de la tumeur. Nous rapportons ici un cas d'insulinome de haut grade développé sur la face antérieure de la queue du pancréas chez une patiente de 50 ans.

[Colonic gallstone ileus: a rare cause of colonic obstruction]

Bile ileus with migration of the gallstone into the colon through cholecystocolonic fistula is rare. The diagnosis is difficult and often late. We here report the case of a 89-year old patient with a history of sigmoid diverticular disease presenting with colonic obstruction associated with bile ileus caused by migration of a large gallstone through cholecystocolonic fistula. Abdominal CT scan allowed the diagnosis. The patient underwent surgical extraction of the gallstone with sigmoidotomy followed by sigmoidostomy with subsequent recovery of the digestive continuity. The cholecystocolonic fistula wasn't identified.

[Rare complication of colonoscopy in a patient on anticoagulant: haemoperitoneum by rupture of a subcapsular hematoma of the spleen, clinical case]

La coloscopie à visée diagnostique et/ou thérapeutique est un examen invasif fréquemment pratiquée de nos jours. La perforation colique et l'hémorragie digestive en sont les principales complications. La survenue d'un hémopéritoine par rupture d'un hématome sous-capsulaire splénique est une complication extrêmement rare et potentiellement mortelle de la coloscopie. Un traumatisme splénique minime passé inaperçu et la prise d'anticoagulant en sont des facteurs favorisants. Nous présentons le cas d'une rupture d'un hématome sous-capsulaire de la rate après une coloscopie, survenue chez un patient de 70 ans porteur d'une valve mitrale mécanique sous acénocoumarol à dose hypocaogulante. La nécessité d'obtention d'une anti coagulation rapidement efficace et l'instabilité hémodynamique avaient justifiée la réalisation d'une splénectomie. L’évolution était favorable. A travers cette observation clinique nous discutons les mécanismes et les modalités de prise en charge devant cette complication.

Epigenetics could explain some Moroccan population colorectal cancers peculiarities: microsatellite instability pathway exploration

Background

Colorectal Cancers (CRC) are one of the most common malignancies in the world. Their incidence in Morocco, between 2005 and 2007, was 5.6 for 100000 inhabitants, which is very low compared to what found in developed countries. In addition, CRCs show a high frequency of rectal localizations, and occurs in a younger population in Morocco compared to what found in developed countries.

The purpose of this study is to confirm these CRC peculiarities in Morocco and try to explain them by exploring the microsatellite instability molecular pathway.

Methods

This is a prospective observational study conducted since January 2010, including 385 patients admitted in Hassan II University Hospital of Fez. We collected clinical, radiological and pathological data. We investigated the expression of mismatch repair (MMR) proteins in 214 patients and BRAF gene mutations in 159 patients.

Results

Mean age was 55.08 +/− 15.16 years. 36.5 % of patients were less than 50 years old and 49.3 % of tumors were localized in the rectum. Loss of MMR protein expression was observed in 11.2 % of cases. It was independently associated with individual or family history of cancer belonging to Hereditary Non-Polyposis Colorectal Cancer (HNPCC) spectrum (p = 0.01) and proximal localization (p = 0.02). No BRAF mutation was detected in all cases.

Conclusions

These results confirm the high occurrence of CRCs to young patients and the high frequency of rectal localizations in Moroccan population. They mostly show an absence of BRAF mutation, supposing a rarity of MLH1 promoter hypermethylation pathway, which may even partially explain the CRC peculiarities in our context.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5868184711716884

[Large intra-rectal foreign body : a case report]

L'insertion d'objets dans le rectum est peu courante dans les pays au contexte socio-culturel tels que le Maroc. Elle se caractérise par la gravité des complications éventuelles et les différentes possibilités thérapeutiques. Nous rapportons le cas d'un patient, ayant eu une incarcération d'un énorme objet introduit volontairement par voie anale, cet objet étant soigneusement façonné par le patient. Il a bénéficié d'une extraction manuelle. Cette dernière permet, quand elle est possible, d’éviter la chirurgie qui s'impose en cas d’échec ou de complications.

[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.

[Small bowel volvulus on peritoneal hydatid disease: a rare cause of obstruction]

L'hydatidose péritonéale peut être primitive, hématogène ou hétérotopique, comme elle peut être secondaire et résulte de la fissuration d'un kyste hydatique, le plus souvent hépatique. Cliniquement polymorphe, elle peut se révéler par des douleurs abdominales ou par la palpation d'une masse abdominale. Nous rapportons le cas d'une patiente chez qui l'hydatidose péritonéale était révélée par un accident occlusif: un volvulus grêlique dû à un volumineux kyste hydatique mésentérique. Le traitement de l'hydatidose péritonéale est chirurgical, couplé à un traitement médical à base d'albendazole.

Pedunculated lipoma causing colo-colonic intussusception: a rare case report

Background

Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy.

Case presentation

A 55-year old man visited our emergency department with severe abdominal pain, multiple episodes of vomiting, abdominal distension. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign, suggestive of intussusception. Surgery revealed a hard elongated mass in the right colon wihch telescoped in the transverse colon and caused colo-colonic intussusception. Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.

Conclusion

A large submucosal lipoma is a very rare cause of colon intussusception that presents as intestinal obstruction in patients without malignancy. CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall. Surgical resection remains the treatment of choice and produces an excellent prognosis.

Benign cystic mesothelioma of the peritoneum: a case report and literature review

Benign cystic mesothelioma of the peritoneum (BCM) is an uncommon lesion with some 130 cases reported since the first case described by Smith and Mennenmeyer in 1979. It is a rare intra abdominal tumor occurring predominantly in women of reproductive age. Due to the rarity of this tumor, similarity of patient presentation, and comparable features on imaging, the diagnosis of this pathology is difficult, and is based on histological findings. This tumor is known for local recurrence. It's agreed that surgery is the only effective treatment, but there are no evidence-based treatment strategies for BCM.

Traumatic appendicitis: a case report and literature review

Appendicitis and trauma may exist together, which causes an interesting debate whether trauma has led to appendicitis. We report a case of appendicitis after an abdominal trauma. Our patient developed acute appendicitis following a stab wound in the right iliac fossa. Surgical exploration confirmed the traumatic origin of appendicitis, appendectomy was performed and our patient made an excellent recovery. In non operative management of abdominal trauma, physical examinations and radiological explorations should be repeated in order to diagnose traumatic appendicitis.

[Intestinal cystic pneumatosis revealed by stenosis of a gastrointestinal anastomosis: report of a case]

La pneumatose kystique intestinale est la présence de bulles gazeuses dans la paroi et les séreuses du tube digestif. Il s'agit d'une pathologie bénigne, rare, de diagnostic radiologique et de traitement médical. Nous rapportons le cas d'un homme âgé de 42ans, opéré il y a 6ans pour une sténose du bulbe duodénal d'origine ulcéreuse, il avait bénéficié d'une gastro-entéro-anastomose avec bivagotomie tronculaire. Il a été hospitalisé pour des vomissements associés à des épigastralgies. le patient a bénéficié d'une fibroscopie oeso-gastro-duodénale qui a trouvé une stase gastrique gênant toute exploration, ce qui a conduit à la réalisation d'une tomodensitométrie abdominale qui a objectivé un énorme estomac de stase en amont d'une sténose de l'anastomose gastro jéjunale, une pneumatose kystique intestinale et un pneumopéritoine. Le patient a été opéré et l'exploration a trouvé une ascite, un volumineux estomac de stase et des adhérences entre le grêle et le colon droit, sièges de la pneumatose, provoquant un tour de spire (volvulus) de l'ancienne anastomose gastro-jéjunale. L'estomac était atone. Une gastrectomie des 2/3 emportant l'ancienne anastomose suivie d'une anastomose type Finsterer manuelle a été réalisée. Les suites post opératoires étaient simples. La pneumatose kystique intestinale est une affection bénigne, de diagnostic radiologique. Le scanner permet d’étudier la diffusion des gaz dans les séreuses digestives. Son traitement est habituellement médical alors que ses complications peuvent relever d'un traitement chirurgical comme pour notre patient.

Acute intraperitoneal rupture of hydatid cysts: a surgical experience with 14 cases

Introduction

Hydatidosis is endemic in the Mediterranean region including morrocco, the Middle and Far East, Australia, New Zealand, and South America—all areas where animal husbandry is common. Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention.

Methods

Fourteen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 5 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively.

Results

Eight of the patients were men and six were women. All of the patients had signs of peritoneal irritation. One patient (7,14%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases, intraperitoneal multiple cysts in 11 cases and heterogeneous cavity or cystic structures in the liver in 12 cases. Computed tomography showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. The ruptured cysts were located in the right lobe of the liver in seven patients, in the left lobe in six patients and in both lobes in one patients. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Partial pericystectomy and drainage was the most frequent surgical procedure. No patients died in the early postoperative period. A total of seven morbidities developed in six patients (35.3%). Median hospital stay was 08 days and median follow-up was 12 months. Intra-abdominal recurrence occurred in one case (7.7%).

Conclusions

Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. The operative procedures, either radical or conservative, should be based on the patient’s condition, the regional characteristics, and the surgeon’s experience. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.

A large gastrointestinal stromal tumor of the duodenum treated by partial duodenectomy with Roux-en-Y duodenojejunostomy: a case report

Introduction

Duodenal gastrointestinal stromal tumors are uncommon and a relatively small subset of gastrointestinal stromal tumors whose optimal surgical procedure has not been well defined. Because submucosal spread and local lymph node involvement are infrequent in gastrointestinal stromal tumors, wide margins with routine lymph node dissection may not be required. Various surgical procedures for duodenal gastrointestinal stromal tumor, pancreatoduodenectomy, pancreas-sparing duodenectomy, segmental duodenectomy, or local resection, have been described depending on the size and exact site of the lesion.

Case presentation

We present the case of a 65-year-old African woman with a giant gastrointestinal stromal tumor involving the second and third portion of the duodenum successfully treated by partial duodenectomy with duodenojejunostomy. This surgical technique is ideal when a gastrointestinal stromal tumor does not involve the ampulla because it avoids a pancreatoduodenectomy, and has not been previously described for the management of this malignancy. Duodenal gastrointestinal stromal tumor should be suspected in any patient with a duodenal wall mass.

Conclusions

Gastrointestinal stromal tumors of the duodenum should be suspected in any patient with a duodenal wall mass. Extramural growth and central ulceration with or without bleeding should alert the endoscopist to the possibility of a duodenal gastrointestinal stromal tumor diagnosis.

Squamous cell carcinoma associated anal fistulas in Crohn's disease unique case report with literature review

Squamous cell carcinoma arising from perineal fistula in patients with Crohn's disease (CD) is a rare entity, with few reported cases in the literature making its clinical characterization troublesome. The outcome is poor following operative treatment as the malignancy of chronic perineal fistula in Crohn's disease is usually overlooked and tardily diagnosed. We present a unique case of a 47-year-old man with a 20-year history of chronic perineal fistula that was diagnosed with extensive perineal squamous cell carcinoma extending down to the right thigh. Computer tomography showed locally advanced disease with inguinal and lung metastasis. Treatment was consisted of diverting colostomy and palliative care. The patient died 3 months later. The clinical data and clinicopathological features of reported cases in the literature were reviewed.

[Sequential treatment of gallstones versus surgery alone: analysis by propensity score]

Introduction

L'objectif étant de comparer, rétrospectivement, les résultats du traitement combiné séquentiel à ceux de la chirurgie ouverte chez des patients pris en charge pour lithiase vésiculaire (LV) et lithiase de la voie biliaire principale (LVBP) durant la même hospitalisation

Méthodes

L’étude a concerné 132 patients pris en charge au CHU Hassan de Fès entre Décembre 2003 et Décembre 2011. Nos patients ont été répartis sur deux groupes thérapeutiques. Le premier correspondant aux malades ayant eu une sphincterotomie endoscopique première suivie d'une cholécystectomie par voie cœlioscopique. Le deuxième incluant les malades ayant eu un traitement exclusivement chirurgical. La comparaison des deux groupes a porté sur les résultats en termes de morbi-mortalité, de séjour post opératoire et d'efficacité du traitement.

Résultats

L'appariement des deux groupes thérapeutiques a permis de retenir 64 patients. L’âge moyen a été de 54 ans ± 14 avec un sexe ratio F/H de 2. Quatorze pourcents de nos malades avaient des tares associées. L'ictère ± angiocholite a été noté chez 76,6% de nos patients. Des anomalies du bilan hépatique ont été relevées chez plus de 70% des malades. L’échographie abdominale et le scanner ont été réalisés chez 97% et 30% des malades respectivement. La médiane du séjour post opératoire a été de 2,5 jours pour le premier groupe versus 5 jours pour le deuxième. Nous avons eu un cas de décès post opératoire dans le premier groupe. Les complications post opératoires ont été à type d'un cas de fistule biliaire et 2 cas de sepsis dans le premier groupe. Deux cas de lithiase résiduelle ont été observés dans le groupe de chirurgie seule.

Conclusion

Le choix d'une stratégie de prise en charge de la lithiase biliaire devra prendre en considération le plateau technique disponible et le degré d'expertise des opérateurs. Dans l'attente d'une maîtrise parfaite du traitement de la LVBP par laparoscopie par notre jeune équipe, le traitement combiné séquentiel, nous semble une alternative thérapeutique acceptable.

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.

Adult intussusceptions caused by a lipoma in the jejunum: report of a case and review of the literature

Intussusceptions in adults is rare. Gastrointestinal lipomas are rare benign tumors and intussusceptions due to a gastrointestinal lipoma constitutes an infrequent clinical entity. Lipoma may develop as a benign tumor in all organs and rarely in large or small intestine. The present report describes a case of jejunojejunal intussusceptions in an adult with a history of colicky upper abdominal pain. Ileo-ileal invagination was diagnosed by computed tomography scan. Exploratory laparotomy revealed jejunojejunal intussusceptions secondary to a lipoma which was successfully treated with segmental intestinal resection. A review of the literature is also performed regarding this rare association revealing the diagnostic and therapeutic debates that exist. ABSTRACT (FRENCH): L'invagination chez les adultes est rare. Les lipomes gastro-intestinaux sont de rares tumeurs bénignes et l'invagination intestinale due à un lipome gastro-intestinal constitue une entité clinique trés rare. Le lipome peut se développer comme une tumeur bénigne dans tous les organes et rarement dans l'intestin grêle ou le colon. Le présent rapport décrit un cas d'invagination jéjunojéjunale chez un adulte avec une histoire de douleurs abdominales. Iléo-iléale invagination a été diagnostiquée par tomodensitométrie. Une laparotomie exploratrice a révélé l'existence d'une invagination jéjunojéjunale secondaire à un lipome qui a été traitée avec succès par une résection intestinale segmentaire. Une revue de la littérature est également effectuée au sujet de cette association rare révélant les débats diagnostiques et thérapeutiques qui existent.

[Splenic metastasis from colonic adenocarcinoma - about a case and literature review]

L'atteinte métastatique de la rate est rare et exceptionnellement isolée. En effet, elle survient généralement dans le cadre d'une atteinte multi viscérale. Les cancers les plus pourvoyeurs de métastase splénique sont les mélanomes, les carcinomes de l'ovaire, du sein et du poumon. Dans le cancer colique, l'atteinte métastatique isolée de la rate est rare, dix cas seulement ont été décrits dans la littérature jusque-là. À travers cette revue, nous décrivons un nouveau cas présentant un adénocarcinome colique avec métastase splénique métachrone, tout en discutant les aspects cliniques et les différentes approches thérapeutiques décrites dans la littérature. Nous rapportons un nouveau cas d'un patient âgé de 46ans ayant un adénocarcinome colique traité, et qui a présenté 5 ans plus tard une métastase splénique de découverte fortuite lors d'un bilan radiologique de surveillance, pour laquelle le patient a bénéficié d'une splénectomie suivie d'une chimiothérapie systémique avec une bonne évolution. Les métastases spléniques isolées des tumeurs solides sont rares, et leur diagnostic est souvent de découverte fortuite. La splénectomie totale est un moyen efficace de faire le diagnostic définitif de ces métastases et de les traiter afin de prévenir les complications et d'améliorer la survie.

Simultaneous acute appendicitis and ectopic pregnancy

The acute abdomen in pregnancy is a surgical emergency. Ectopic pregnancy and appendicitis are two causes of acute abdomen in pregnancy. Difficulties in correctly identifying the cause of the pain can be hazardous to the patient and care needs to be taken in obtaining a prompt and accurate diagnosis enabling the most appropriate management. The case presented here underlies the pathogenesis of the simultaneous existence of these two conditions in a patient.

Pancreatic transection due to blunt trauma

Blunt fractures of the pancreas are rare and serious lesions. An isolated injury to the pancreas is uncommon. Physical signs and laboratory parameters are often inaccurate, and missing the diagnosis can cause serious clinical problems. We report a case of a 28-year-old woman with blunt pancreatic trauma in whom computed tomography revealed a fracture through the tail of the pancreas. It was complicated by pseudocyst formation. She was treated surgically with good outcome. This case is a reminder that pancreatic injuries should be considered in the differential diagnosis in cases of blunt abdominal trauma. Also, the clinician should be aware that when pancreatic injuries are managed conservatively, the clinical, radiological, and laboratory parameters need to be monitored till resolution.

[Hydatid cyst of the liver ruptured into the inferior vena cava]

La rupture du kyste hydatique dans la veine cave inférieure est une complication rare et grave des kystes hydatiques hépatique. La manifestation la plus fréquente est l'embolie pulmonaire. L'hémorragie aigue intra-kystique survienne surtout en per-opératoire et elle est d’évolution dramatique. Le diagnostic est basé sur le scanner. Le traitement est chirurgical. Nous rapportons un cas clinique rare chez un patient de 38 ans, opéré en urgence pour un sepsis sur un kyste hydatique du foie comprimant la veine cave inférieur (VCI) avec thrombose partielle de cette dernière. Après évacuation du kyste, une fistulisation spontané per opératoire s'est produite dans la VCI ayant causé le décès du patient. La rupture du kyste hydatique du foie dans la VCI doit toujours être redoutée devant un kyste hydatique des segments postérieurs du foie droit (VII et VIII), comprimant la VCI avec présence en son sein d'une thrombose ou des vésicules filles. Le traitement chirurgical doit être réalisé avec prudence et toujours sous contrôle vasculaire.

Uncommon mimics of appendicitis: giant mucocele

Appendiceal mucocele is an infrequent but well recognized entity that can present with a variety of clinical syndromes or can be asymptomatic and discovered incidentally. A 55 years old patient was admitted in the emergency department for acute right lower quadrant pain. A diagnosis of appendicitis was made. At operation an appendiceal mucocele was found. An appendectomy was performed. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.

Isolated liver tuberculosis abscess in a patient without immunodeficiency: A case report

Although hepatic tuberculosis is not a rare disease entity, tubercular liver abscess (TLA) is extremely rare. It is usually associated with foci of infection either in the lung and/or gastrointestinal tract or with an immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even rarer. We report on a 28 year old man who developed an isolated tuberculous liver abscess not associated with lung involvement. Ultrasonography and computed tomography of the abdomen showed the abscess lesions in the liver but the diagnosis of tuberculosis was confirmed by histological examination of the wall of the abscess after surgical drainage. Although tuberculous liver abscess is very rare, it should be included in the differential diagnosis of abscess and unknown hepatic mass lesions.

[Peripheral primitive neuroectodermal tumor with gastric primary location: about a new case]

Abstract

Les tumeurs neuro-ectodermiques primitives ou sarcome d’Ewing sont classiquement des néoplasmes se développant aux dépends des tissus mous et des os. Les tumeurs neuro-ectodermiques primitives gastriques (pPNETs) sont extrêmement rares. Nous nous proposons, à travers le cas d’un patient, opéré pour une tumeur gastrique, d’étudier les aspects cliniques, radiologiques, anatomopathologiques et thérapeutiques des tumeurs neuro-ectodermiques primitives périphériques. A notre connaissance ce patient illustre le troisième cas de tumeur gastrique d’origine neuroectodermique décrite chez l’adulte.

[Pheochromocytoma and pregnancy - Perioperative and obstetrical management: report of one case and review of literature ]

Résumé

Colonic adenocarcinoma revealing Crohn's disease: a case report

INTRODUCTION

There is growing evidence from epidemiological studies and clinicopathological data obtained from case reports that Crohn's disease is associated with an increased risk of carcinoma of the large bowel.

CASE PRESENTATION

A 70-year-old Arabic African man with undiagnosed Crohn's disease presented with acute abdominal obstruction due to an occlusive carcinoma of the sigmoid. At laparotomy, the colonic tumor was excised with continuity restored by end-to-end anastomosis.

CONCLUSION

The risk of colonic carcinoma in Crohn's disease is increasing. Several case reports actually support the possibility that a genuine association between these two conditions exists.

Non-Hodgkin's lymphoma revealed by an ilio-colic intussusception in a Moroccan patient: a case report

Intussusceptions are rare but well-known causes of the small bowel obstruction in adults and an underlying cause is present in the majority of cases. Lymphoma's involvement of the ileum is one of the rare causes of intussusception. CT is a sensitive examination that diagnoses intussusceptions and provides an excellent pre-operative evaluation including possible extension and dissemination especially in intestinal lymphomas. The treatment is almost always surgical and the pathological study is needed for diagnostic confirmation. Authors present an unusual case of intestinal intussusception due to lymphoma of the terminal part of the ileum in a 49-year-old man. Computed tomography confirmed the diagnosis of intussusception and non-Hodgkin's lymphoma of B-cell was diagnosed by histological examination after surgical treatment. Primary intestinal lymphomas differ from gastric lymphomas in clinical features, treatment, and prognosis. They are not well characterized and the standardized concepts for their clinical diagnosis and management are absent. The aim of this rare observation is to shed light on NHL of the small bowel, its clinical and radiological diagnosis and its treatment especially in forms revealed by intussusceptions in adults.

Uncommon cause of small bowel obstruction - gallstone ileus: a case report

Gallstone ileus is an uncommon cause of small bowel obstruction. We present a case of small intestinal obstruction owing to a large gallstone in lower ileum in a 65 years old man. The diagnosis was made by computed tomography.

Gastrointestinal stromal tumors and shock

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumor of the gastrointestinal tract. Clinically, they are associated with nonspecific symptoms, but some patients can present gastrointestinal bleeding with shock. We report two cases of GIST of the small bowel, revelated by hemorrhagic shock secondary to acute bleeding, succesfully treated by emergency surgery.

Small bowel intussusception with the Meckel's diverticulum after blunt abdominal trauma: a case report

Intussusception with the Meckel's diverticulum is a rare but well-known cause of small bowel obstruction in the adult. After blunt abdominal trauma, intussusception is exceedingly rare and has been reported previously only in few cases. We present a case of a previously healthy 28-year-old man developing four days after blunt abdominal trauma signs of small bowel obstruction. Ileo-ileal intussusception was suggested by computed tomography. Exploration revealed ileo-ileal intussusception with Meckel's diverticulum. A diverticulectomy with small bowel resection was performed.

A case of gastric cancer associated to situs inversus totalis

The situs inversus is a rare congenital anomaly, which is a more or less complete inversion of the abdominal and thoracic organs. We report a case of 70 years old man, without pathological antecedents complaining about epigastric pains associated to haematemesis, and whose gastric endoscopy objectified a gastric tumor. The pulmonary x-ray and the abdominal computed tomography (CT) revealed the previously unrecognized situs inversus totalis. A subtotal gastrectomy was performed and patient had an uneventful postoperative course.

Le trichobézoard gastrique : une observation

The gastric trichobezoar is a rare disease in which diagnosis is easy in case of evocative context. Its treatment is not standardized. The authors report the case of a 9 year old girl, known to have trichophagy, presenting with a large epigastric mass. Upper endoscopy made the diagnosis of a trichobezoar. Surgical extraction was performed through gastrotomy, without complications. Psychiatric follow-up was recommended.