•Disseminated abdominal hydatidosis is a rare presentation of hydatid disease.•Early diagnosis and surgical management are the keys to avoiding such expansion.•Conservative treatment may be ...considered in some cases given the extent of lesions.
Introductionles stomies digestives constituent l´aboutissement d´un certain nombre d´interventions chirurgicales. Elles peuvent être temporaires ou définitives. Le patient porteur de stomie se trouve ...confronté à des aléas d´ordre physique et psychologique. Il nécessite donc une adaptation aux changements et une acceptation de la situation qu´elle soit temporaire ou définitive. Le but de ce travail est d´évaluer l´impact des stomies digestives sur la qualité de vie des patients et leur retentissement professionnel.Méthodesil s´agit d´une étude rétrospective, menée de janvier 2010 à décembre 2014. Au cours de cette période 115 patients avaient eu des stomies digestives. Parmi ces patients, soixante étaient en âge d´activité professionnelle, avaient un emploi fixe et avaient repris leurs travail; ils constituent l´effectif de notre étude. Le recueil des données était réalisé par un questionnaire spécifique: le questionnaire généraliste SF-36 réalisé en post opératoire.Résultatsle score moyen pour la qualité de vie globale pour les patients stomisés était 41. Quarante patients avaient une mauvaise qualité de vie avec un score SF-36 qui était inférieur à 50. Notre étude a démontré que les patients stomisés ont éprouvé des difficultés de fonctionnement dans des situations de travail. Quarante-huit patients décrivaient une gêne directement liée à la stomie lors de l´exercice de leurs activités professionnelles. Les causes évoquées étaient d´ordre physique dans 6 cas et d´ordre psychologique dans 3 cas. Six patients étaient mutés vers des postes plus adaptés à leur situation.Conclusionl´objectif de la prise en charge des patients porteurs de stomie digestive doit être la réintégration sociale et professionnelle adéquate. Ceci ne peut se concevoir qu´en impliquant le médecin de travail, le psychologue, le stomathérapeute et les associations dans cette prise en charge.
Background. Hepatic hydatid disease is still common in Tunisia, is deemed benign disease but concerns its complications; the most frequent is the rupture in biliary ducts. The aim of the work was to ...study the results of surgical treatment of hydatid cysts of the open liver in the bile ducts and to deduce the predictive factors of postoperative complications. Methods. This was a retrospective study, done in the department of general surgery of Mongi Slim hospital, over a period of 11 years (from January 2000 to December 2013) and collecting 115 patients. Judging criteria were specific morbidity, length of postoperative stay and recurrence. Results. The median age was 43 years (62 women and 53 men). The clinic consisted of typical cholangitis episodes (6.95%), 6.95% of patients were asymptomatic. 50 radical interventions and 65 conservative interventions were performed, supplemented by treatment of the fistula as follows: Fistula blindness (43.47%), trans-fistulo-oddian drainage (3.4%), bipolar drainage (2.6%), PERDOMO (6.95%). The overall mortality was zero. The overall morbidity was 27.69% with an overall specific morality of 14.7% mainly represented by the suppuration of the CR and the external biliary fistulas. The median postoperative stay was 6 days; the recurrence rate was 1.7% with a delay of 30 months. The predictive factors of postoperative complications in bi variance were: The size of the cyst (p = 0.02), The location of a cyst in the hepatic dome (p = 0.002), Surgical treatment: radical or conservative (p = 0.02), The sex factor (p = 0.015). The multivariate study who found a significant association between sex only and postoperative complications. Conclusion. Advances in hepatobiliary surgery and anesthesia are changing the surgical attitude in favor of radical procedures with favorable consequences in terms of morbidity, length of stay and recurrence. It is believed that the surgeon’s experience is the most important factor in the success of surgical treatment. This helps to prevent complications.
Introduction. Hydatid disease is a zoonosis caused by the tapeworm Echinococcus granulosus. The liver is the most commonly involved organ, followed by lungs. The most common complications of hepatic ...hydatid cyst are rupture into the biliary tract and secondary bacterial infection. However, rupture into the retroperitoneum and the abdominal wall muscles is exceptional. Case presentation. We describe an unusual case of a 27-year-old female who was referred to our department for right flank pain for four months. Abdominal ultrasound and CT scan revealed a huge hydatid cyst in liver segment VI fistulizing to the retroperitoneum and the lateral and posterior abdominal wall muscles, causing anterior displacement of the right kidney, with two other cysts in segment II and VIII. Surgery was performed associated with perioperative antiparasitic chemotherapy. The cysts were unroofed and a resection of the protruding domes was performed. The hydatid material in the retroperitoneum and the muscles were completely evacuated by aspiration. Follow-up showed no recurrence. Discussion. Hepatic hydatid cyst rupture usually occurs into biliary tract, pleural cavity, bronchial tree and intraperitoneal cavity. Rupture into the retroperitoneum and the lateral and posterior abdominal wall muscles is exceptional. To our knowledge, this complication has never been documented before. The hydatid disease may involve insidiously for a long time to lead to such a complication. Surgery was inevitable in our case. It allowed to treat both the hydatid cyst and its complication. Conclusions. A rupture into the retroperitoneum and the abdominal wall muscles as a complication of a liver hydatid cyst is exceptional. In this presentation, we noticed that hydatid cysts can reach an extremely large size while remaining for a long time asymptomatic. We aim to highlight the significance of preventive measures and public health education to fight against the hydatid disease in endemic areas.
Solid pseudopapillary tumour (SPT) is an unusual pancreatic neoplasm which predominantly affects young women. Less than 10% of patients with SPT in the reported literature were male. In this paper, ...the authors report two new cases of SPT that occurred in two male patients aged respectively 25 and 20 years old. Abdominal computed tomography scan showed a well-defined heterogeneous mass involving respectively the tail and the body of the pancreas with peripheral calcifications in the first case. The two patients underwent distal splenopancreatectomy. Histopathological examination of the surgical specimen coupled with immunohistochemical study was compatible with solid pseudopapillary tumour. On postoperative day 8, the first patient developed abdominal wall abscess and peritoneal collection. Postoperative course was uneventful for the second patient. In summary, a large, well-encapsulated cystic mass in the pancreas of a young man should raise suspicion of solid pseudopapillary tumour.
Le prolapsus rectal est un trouble de la statique du rectum, qui réalise une invagination de la paroi rectale aboutissant à son extériorisation à travers l’anus. Il touche généralement l’enfant et le ...sujet âgé. Sa survenue chez l’adulte jeune est rare. L’étranglement du rectum prolabé est également une complication rare. Nous rapportons l’observation d’un jeune de 30 ans, opéré en urgence pour un prolapsus rectal étranglé. Il a eu une recto-sigmoïdectomie périnéale (intervention d’Altemeier) en urgence avec des suites simples.
Cystic Echinococcosis (CE) is a worldwide zoonotic infection caused by the larval stage of Echinococcus granulosus. It has a widespread distribution in the human population of Tunisia.The liver ...hydatid cysts are the most commun abdominal site. However, other rare intra cavity location, can occur. We report the case of 56 year old patient with surgical history for liver hydatid cyst. Ten years after surgery, he was presented with chronic abdominal pain and constipation. The imaging results were all in favor of a retro rectal hydatid cyst. A total resection of the hydatid cyst was executed good outcomes.
Bangladesh Journal of Infectious Diseases, December 2023;10(2):101-103
De novo autoimmune hepatitis (AIH) is a rare disorder first described in 1998. It occurs in patients who underwent liver transplantation for a different etiology. We present the case of a 56-year-old ...woman who was diagnosed with primary biliary cirrhosis and had liver transplantation for refractory pruritis. Seven years after transplantation, she presented alterations in the hepatic profile with hypertransaminasemia, elevated alkaline phosphatase and gamma-glutamyl-transferase. Her liver functions test also showed elevated IgG levels. Serum autoantibodies were negative except for antimitochondrial antibodies. Histological findings indicated features of AIH without bile duct damage or loss. She had a pretreatment AIH score of 13 points and a post treatment score of 15 points according to the International AIH Group. The patient was treated effectively with prednisolone and her liver function and globulin levels rapidly returned to normal.
AIM:To assess the role of the major risk factors for hepatocellular carcinoma(HCC) development in the western part of North Africa.METHODS:A multicenter case control study was conducted in ...Tunisia,Morocco and Algeria in collaboration with Pasteur Institutes in these countries.A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included.Prevalences of HBsAg,anti-hepatitis C virus(HCV)and diabetes were assessed.HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients.RESULTS:The mean age of patients was 62±10 years old for a 1.5 M:F sex ratio.Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg.Diabetes was detected in 18% of cases.Odd ratio(OR)and 95% confidence intervals(CI) were 32.0(15.8-65.0),7.2(3.2-16.1) and 8.0(3.1 -20.0)for anti-HCV,HBsAg and diabetes respectively.Multivariate analysis indicated that the three studied factors were independent.1b HCV genotype and D HBV genotype were predominant in HCC patients.HCV was the only risk factor significantly associated with an excess of cirrhosis(90% vs 68% for all other risk factors collectively,P=0.00168).Excessive alcohol consumption was reliably established for 19(17.6%) cases among the 108 HCC patients for whom data is available.CONCLUSION:HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa.An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.Salah Berkane,Department of Gastroenterology BologhineUniversity Hospital,Bologhine 16090,Algiers,Algeria
Ansa pancreatica is an embryologic malformation where the accessory pancreatic duct is obliterated and replaced instead by a loop merging from the main duct. It is associated with recurrent acute ...pancreatitis.
1st case
A 47-year-old male patient with a history of former alcoholism presented in the last three years five episodes of acute pancreatitis. He presented for a 6th episode. An MRCP was practiced revealing an ansa pancreatica. The patient undergoes an endoscopic sphincterotomy.
2nd case
It is a 74-year-old woman patient, who presented for a second episode of acute pancreatitis. The investigations did not reveal a gallstone disease or any metabolic abnormalities. An MRCP was performed showing an ansa pancreatica.
3rd case
A 27-year-old male admitted for acute pancreatitis. Initial abdominal ultrasound revealed gallbladder sludge along with a dilated common bile duct (CBD). The patient underwent a cholecystectomy with cholangiography. The cholangiography revealed an ansa pancreatica. The post-operative recovery was uneventful.
Ansa pancreatica, is an embryological malformation consisting of the accessory pancreatic duct obliteration, near its junction with the common duct. This portion is replaced by an S-shaped loop joining the minor papilla. That can lead to clinical manifestations, particularly acute pancreatitis. Sphincterotomy targeting the minor papilla could improve symptoms and reduce pancreatitis recurrence. In case of failure, endoscopic ligation of the ansa deformity represents a good alternative.
Through these cases, we tried to illustrate different scenarios in which we discovered an ansa pancreatica and the management of such anatomic variance.
•Ansa pancreatica is a rare anomaly.•It is an embryologic malformation, where the accessory pancreatic is obliterated, replaced instead by a loop emerging from the main duct to join the minor papilla.•It could be the etiology of recurrent acute pancreatitis.•Endoscopic sphincterotomy could be discussed as a treatment.
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