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Mature ovarian teratoma is the most frequent benign tumor in premenopausal women. It is usually asymptomatic but complications are possible such as adnexal torsion, infection, malignant transformation or cystic rupture. The latter can be spontaneous or more often occurs during surgery of excision of dermoid cyst. It can rarely result in chemical peritonitis, which is due to the irritation of the peritoneal serosa by the aseptic content of the tumour. We report the case of a patient who undrewent an emergency laparotomy for a chemical peritonitis following a spontaneous rupture of a dermoid cyst. Afterwards, she developed an acute respiratory distress syndrome that required an admission in the intensive care unit and subsequent surgery.

We report three original cases of sclerosing encapsulating peritonitis (SEP) which is a rare but severe complication of peritoneal dialysis (PD). In the report of case 1, SEP occurred in a 75-year-old diabetic patient mellitus 18 years after the arrest of PD technique recurrent infectious peritonitis. The switch to hemodialysis was associated with a chronic inflammatory state poorly explained until the discovery of SEP. For case 2, SEP started within seven months after automated PD initiation in a severe septic context leading to leg amputation in a 57-year-old unstable diabetic male. In the last case, 84-year-old woman presented SEP after several peritonitis episodes, including one due to acute pancreatitis. In all cases, SEP was confirmed by open surgery. All patients were treated by visceralysis. The outcome was favorable in two of these three patients. SEP mechanisms, risks factors, prognosis and treatment are discussed with reference to the literature.

Purpose: To assess the CT-guided transgluteal approach for percutaneous interventional image guided procedures., Materials and Methods: CT guided transgluteal approach through the greater sciatic foramen was used for diagnostic procedure (CT guided needle biopsy of presacral masses n=5) or percutaneous treatment (aspiration n=4, and drainage n=10) in 19 patients, mean age 58 years (age range 20-86)., Results: No technical failure occurred. A histological diagnostic was obtained in all diagnostic procedures. The success rate for therapeutic procedures was 87% and allowed to postpone surgery in 2 cases. In 2 patients a small pelvic hematoma occurred after catheter placement, but remained without consequence. Recurrences of collection occurred in 2 cases, one treated medically and the other surgically. Two patients suffered from transient deep pelvic pain, which resolved after catheter removal., Conclusion: CT-guided percutaneous transgluteal procedures may be successfully performed in patients who cannot undergo trans-perineal, trans-rectal or trans-vaginal approach and is a safe and effective diagnostic and therapeutic option.

Introduction: Abdominal angiostrongyliasis caused by the filiform nematode Angiostrongylus costaricensis, is an endemic disease in Central and South America. A case of necrotic eosinophilic angeitis with ileum perforation and peritonitis due to abdominal angiostrongyliasis is reported., Observation: A 32 year-old man, living in a Paris suburb, underwent segmentary resection of the ileum with end to end anastomosis for perforation with generalized peritonitis. The anatomopathological examination revealed eosinophilic necrotic lesions with thrombosis on the borders of the ileum perforation. The discovery of a section of A. costaricensis in the lumen of a nearby muscular artery initiated an epidemiological survey, revealing that the patient had visited French Guyana 2 months earlier., Discussion: Angiostrongylus costaricensis is a nematode parisiting certain forest rodents that become its permanent host. The intermediate hosts are earth molluscs or slugs of the same family. Humans are accidentally infected following ingestion of vegetables infested with L3 larvae or slugs carrying the disease. The clinical symptomatology is unspecific: prolonged fever, anorexia, and right iliac fossa pain with eosinophilia of the blood. Often benign, the progression of abdominal angiostrongylosis is punctuated by complications: occlusive syndrome, generalised peritonitis due to intestinal perforation and mass syndrome. Hemorrhage, infarct, pseudo-tumoural fibrosis and ulcers represent the surgical or macroscopic rearrangements. In the tissue, 4 lesions characterize abdominal angiostrongylosis: eosinophilic necrotic angeitis, foreign body granulomas, eosinophilia in the digestive wall, and the presence of A. costaricensis in the lumen of the vessels. There is presently no medical treatment and surgery is the only therapeutic option.

The case presented in this study illustrates the peritoneal changes observed in long-term peritoneal dialysis (PD) patients. This male patient was on peritoneal dialysis (CAPD) for seven months before and 86 months after renal transplantation. Two episodes of peritonitis occurred during that time. The patient developed symptoms (ascites, gastro-intestinal disturbances, deteriorating general condition, inflammatory syndrome) four months after starting hemodialysis, one month after ablation of the PD catheter. Other potential causes (infection, malignancy, hepatitis, etc.) of these symptoms were ruled out following an exhaustive etiological work-up. A final diagnosis of sclerosing peritonitis was made, and the patient was started on corticosteroid therapy. Both morphological and functional alterations of the peritoneal membrane associated with long term PD and the detection of such alterations in everyday practice are reviewed here, along with possible etiological factors and therapeutic measures discussed in the literature. A better understanding of the pathophysiological mecHanisms underlying these alterations would make it possible to develop preventive measures, such as more biocompatible dialysates.

Introduction: Peritoneal mesothelioma is a rare malignant neoplasm that might be linked to chronic peritoneal inflammation. As well, the association peritoneal mesothelioma-familial Mediterranean fever is uncommon., Exegesis: We report the case of a 60-year-old man who presented for 30 years with standard periodic familial Mediterranean fever accompanied by acute abdominal episodes, sensitive to colchicine. Between 1988 and 1995, acute abdominal episodes were accompanied by more and more profuse recurrent ascites, partially resolving under colchicine treatment. In 1995, the last episode was severe (with loss of weight and inability to tolerate feeding) and conducted to the patient's death due to peritoneal mesothelioma, as confirmed by the biopsy., Conclusion: Profuse and recurrent ascites is unusual in standard periodic familial Mediterranean fever. Asbestos exposure at the origin of peritoneal mesothelioma is not well documented. Furthermore, the disease clinical and paraclinical features are misleading, and the diagnosis is based on histology. The prognosis is severe, and treatment is usually disappointing. Our observation clearly demonstrates the interconnection between an unusual form of profuse and relapsing ascites that occurred in the course of a periodic disease and peritoneal mesothelioma. The potential role of recurrent peritonitis related to familial Mediterranean fever in the pathogenesis of the tumor is discussed.

Dermoid cyst is the most frequent benign ovarian tumor. Its intraperitoneal rupture may lead to a peritoneal reaction known as chemical peritonitis. It is a rare but a potentially dangerous issue. Its treatment may need one or more reoperations. We report here the case of a patient operated on in emergency for a torsion of an ovarian dermoid cyst, with peritoneal spillage of its content during coeliosurgery. The prolonged contact between the sebaceous material and the peritoneum has led to a chemical peritonitis. Two more laparoscopic interventions, associated with a systemic anti-inflammatory treatment, were necessary to relieve symptoms. We propose the following attitude to avoid this complication: (1) puncture and drainage of the cyst with a trocar; (2) extraction of the cyst in an endobag, and (3) abundant washout of the peritoneal cavity.

One case of peritoneal splenosis is reported. The diagnosis was established at surgery in a 17-year-old female patient presenting with dull abdominopelvic pain, who had undergone total splenectomy after a trauma ten years earlier. This autograft of splenic tissue must be known to be acknowledged, especially today, when the conservative treatment advocated for ruptures of the spleen may increase its incidence. The literature reports only about one hundred cases. The treatment only consists in removing the sole symptomatic nodules.

From the analysis of 28 records in the gynecological Department of the Hospital Principal in Dakar, all of them recording cases of pelviperitonitis having demanded a surgical intervention, it seems permissible to the authors to maintain the denomination, full of imagery, of "Gynecologic African Complex". They define it as appearing in a peculiar socio-economical environment (in Africa but also in the Third World) and characterised anatomically by an inflammatory pelviperitoneal syndrome presenting a large anatomic diversity. In the studied records, the authors sorted out 14 cases with an acute clinical aspect and 14 with a chronic one. These 28 cases represented 1.5% of the admissions and 5% of the operated patients in the gynecologic Department. The aspect "complex", linked with the polymorphism of the diagnosed lesions (among them 2 tubal tuberculosis, 1 peritoneal tuberculosis, 2 genital bilharziosis) and their frequent association, constitutes a surgical entity about which therapeutic tactics has to be adapted and reasonably mutilating. The concern of preservation must take into consideration future evolution of surgical consequences, genital and obstetrical future of women often young.

A case of retractile mesenteritis associated with ischaemic enteritis in a 77-year old woman is described. The clinicopathological features of retractile mesenteritis are briefly reviewed.

The physiopathology of the rare affection encapsulating peritonitis is poorly elucidated, but its etiologies are now more clearly defined. Diagnosis is usually at operation, as in the present case, a 65 year old man with known alcoholism and wearing a LeVeen type peritoneo-jugular valve, probably the cause of the peritonitis.

The authors have observed on two occasions, a diffuse peritoneal syndrome in the post-operative period after right hemi-colectomy for Crohn's disease, and interpret, in the absence of complications at the level of the anastomosis, as peritonitis due to septic lymphorrhea. According to them, it does not seem that this syndrome has the same significance as that described following appendicectomy in children.

Acute purulent post-operative peritonitis is highly severe and difficult to diagnose. Six symptoms have a real prognostic value: shock, acute renal insufficiency, respiratory failure, jaundice, acidosis and septicaemia. If more than three of these signs of severity coexist, the mortality rate reaches nearly 100%. A patient with evidence of acute diffuse post-operative peritonitis must be operated on after a short preoperative treatment to restore a situation altered by shock, renal failure and pulmonary edema. Antibiotic agent alone, though necessary, cannot bring recovery. The maintenance of high nutritional intake for excess caloric expenditure is essential. The effects of the early decision of a surgical reintervention are studied in 27 patients with only two recoveries.

From 74 observations, 55 p. 100 of which caused death by intestinal lesions, the author searches, through the symptomatology of the disease, for possible factors of prognosis. No relation between the importance of cutaneous symptoms and the appearance of intestinal symptoms has been found. There is no constancy in the chronological evolution of the lesions. The interest of laparoscopy is emphasized. No biological constant seems specific of the disease. A few modest arguments are suggestive of an auto-immune disease. In spite of a varied range of therapeutic orientations, none of them could prove to be efficient, not even heparinotherapy.

Sclerosing encapsulating peritonitis is rare in children. The clinical features are discussed and the etiology must be searched for tuberculosis. Occurrence in prepubertal girls leads to a discussion of the pathogenesis in this age group. Surgery must be conservative.

A retrospective study of 99 case-reports of patients with generalized peritonitis, including 38 postoperative cases involving peritoneum and lungs, was conducted with the aid of two files based on documented data containing 168 and 204 analytical criteria respectively. Data processing and statistical analysis alone were capable of establishing possible relationships between isolated or associated peritoneal factors and respiratory manifestations. Out of the vast quantity of data obtained by using this new approach, only factors significantly affecting pulmonary complications were retained: some relations could not be established because of the small number of patients studied. Respiratory complications were frequent (60%) and severe (58% mortality). They occurred in 96% of postoperative peritonitis cases, with 77% of deaths, and in 44% of primary peritonitis cases, with 36% of deaths. In contrast, when absent the mortality is reduced to 4%. Frequency distribution of clinical signs, pulmonary radiological images and the effects of gasometry are analyzed. Obstruction is a frequent and early symptom. The presence of bilateral diffuse lung shadows and their shunt effect are narrowly correlated with the presence of postoperative peritonitis. Respiratory complications were correlated with peritonitis criteria, particularly with age, the sub-mesocolon origin of the peritonitis, the rapidity of operative intervention, and surgical excision rather than shunt formation or suturing, and to the development of criteria of repeat abdominal or extra-abdominal surgery. Initial antibiotherapy and digestive suction have, on the contrary, no effect. Many other criteria were studied. A "profit" of patients liable to develop these complication is described, the mechanisms outlined, and the means of prevention and of rapid detection discussed, particularly the important role played by early gasometry.

A case of sclerosing encapsulating peritonitis was observed in a patient who had been treated by continuous ambulatory peritoneal dialysis for 4 years. During that period the patient had always used a lactate buffered dialysate (Dianeal solution, supplied by Travenol) and no disinfectant. Nine episodes of peritonitis occurred during the first two years of dialysis. At the end of the first year the patient had decreased ultrafiltration associated with high glucose absorption. A peritoneal biopsy performed at that time showed mesothelial alterations and desquamation. Sclerosing encapsulating peritonitis was suspected at the end of the fourth year, on the basis of changes in the glucose equilibration curve which showed that poor ultrafiltration was now associated with very slow glucose absorption. The diagnosis was confirmed at laparotomy. The authors suggest that the first stage of encapsulating peritonitis might be prolonged and severe alteration of the mesothelial layer. Dialysis should be discontinued immediately in the presence of a loss of filtration with hypermeability (type I) in order to permit normal recovery. If this is not done, loss of filtration with severe hypopermeability (type II) may develop due to multiple adhesions or to the encapsulating process.