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INTRODUCTION AND IMPORTANCE: Diaphragmatic hydatid cyst is a misdiagnosed condition. The challenge is to suspect this rare entity on nonspecific clinical features and to localize the cyst on imaging in order to determine the surgical approach. Surgery is the only curative treatment and confirmation is set on pathology examination. CASE PRESENTATION: We present the case of a twenty-six-year-old patient, with no medical history, who complained of recurrent right thoracic pains rebel to opioids. All radiological items lead to suspect a diaphragmatic hydatid cyst. Surgery permitted a complete resection of the cyst and a total relief of the pains. CLINICAL DISCUSSION: The diagnosis of diaphragmatic hydatid cyst is a real challenge. Several diagnoses can be evoked such as hydatid disease depending from the liver, cystic lymphangioma or neural intercostal benign tumor. The phrenic origin of the cyst can only be identified through surgery. However, it is very important to clearly characterize the lesion to well conduct surgical approach. CONCLUSION: It is important for surgeons to suspect diaphragmatic hydatid cysts despite its rarity. CT-scan and MRI are helpful tools to localize the disease and to conduct the surgical procedure. Final diagnosis is only set on pathology examination after curative surgery.

The study of the sound propagation in duct systems containing a porous material is important because they are used in many industrial applications. The acoustic behavior of this kind of ducts which are supposed two-port systems can be modeled by many matrices like the reflection, transmission, mobility, transfer and scattering matrices. In this work, Theoretical and experimental methods are used to evaluate the acoustic performance of duct systems containing one or two porous materials. To reach this goal, the Transmission coefficient was calculated by determining transfer and scattering matrices. The comparison between theoretical and experimental results shows a good agreement between results with some differences due to the no respect of the hypothesis of the rigidity of the duct. A parametric study allowed estimating the more influent parameters on the acoustic behavior of duct systems containing porous materials.

The World Health Organization declared on March 11, 2020 that the COVID-19 epidemic has become a pandemic. In Tunisia, the Ministry of Health has recommended enhanced preventive hygiene measures to contain and limit the spread of the virus. Following the entry of Tunisia into phase 4 of the COVID-19 epidemic, the Tunisian Association of Surgery proposed recommendations related to surgical activity. Surgical emergencies must be treated urgently and without delay. Non-tumor pathologies which require surgery in an elective situation and for which the risk of aggravation or complication is considered low shoud be postponed. For digestive tumor pathology, and apart from complicated forms, neoadjuvant treatment is highly recommended in the context of multidisciplinary concertation staff.

Acoustic absorber based on perforated plate and air cavity presents a fundamental liner used in many acoustic applications as a liner applied at the wall of duct systems to reduce noise. The use of this kind of absorber in form of multilayer is generally used to improve their acoustic performance and the attenuation capacity is increased. Such absorber has an acoustic performance varying with their intrinsic and geometrical proprieties (perforation rate and the thickness of the plate, cavity length, etc…). To quantify and qualify the acoustic performance of these absorbers an acoustic indicator can be used which is the acoustic absorption coefficient. In this paper, the transfer matrix method is used to compute this coefficient in the case of the presence of plane wave. For this, several cases of multilayer configurations of multilayer configurations containing two and three layer are studied and investigated. After that, and for each studied configuration, a parametric study of the influence of the multilayer materials parameters on this coefficient for various configurations is carried on to deduce the more influent parameters on the acoustic performance of this kind of absorber.

Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques. A thirty-year-old woman was referred to our emergency unit for acute pancreatitis. The CT-scan findings revealed a liver hydatid cyst ruptured in the biliary tract and daughter vesicles within were found, responsible for C-grade acute pancreatitis. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative cholangiogram that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence. Cysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct., Highlights • Acute pancreatitis revealed by liver hydatid cyst ruptured in the biliary tracts is a scarce condition. • The management of this uncommon disease is challenging and includes a combination of surgical and endoscopic approaches. • Endoscopic treatment is an interesting tool in acute phase and delay morbid open surgery. • Open surgery is the standard treatment and remains the only procedure to eradicate the hydatid disease.

Resume Les cystadenomes sont des tumeurs benignes frequentes du pancreas dont le risque est une transformation maligne en cystadenocarcinome. La complication la plus frequente est la pancreatite aigue. Nous presentons une complication unique du cystadenome mucineux : la rupture retroperitoneale associee a une pancreatite aigue. Apres stabilisation en soins intensifs, l’intervention chirurgicale trouve une masse kystique de la queue du pancreas avec rupture retroperitoneale. Une splenopancreatectomie est realisee. Les suites operatoires sont simples. Il n’y a pas de signes de recidive a trois ans de suivi.

Mucinous cystadenomas are the most frequent cystic benign tumors of the pancreas. They are characterized by a malignant potential. Acute pancreatitis is their most common complication. This manuscript reports a unique complication of mucinous cystadenomas of the pancreas: retroperitoneal rupture associated to acute pancreatitis. After resuscitation, the patient underwent surgery. A cystic mass of the pancreas tail with retroperitoneal rupture was found. Splenopancreatectomy was performed. Outcomes were straightforward. After 3 years of follow-up, no signs of recurrence are highlighted.

Sclerosing encapsulating peritonitis (SEP) is a rare and little known pathological entity. It is a chronic fibro-inflammatory disease of the peritoneum, resulting in the formation of a thick fibrous membrane, which engages partially or totally the abdominal organs. Clinical and radiological signs make the diagnosis difficult to establish preoperatively. We present two original observations of SEP illustrating different clinical presentations, diagnostic and therapeutic means. His diagnosis requires a peritoneal biopsy. The treatment is not completely established. Surgical treatment is difficult, involving viscerolysis and multiple incisions of the fibrous membrane. Despite the current progress in therapeutic management, the prognosis remains pejorative, with significant mortality.

This Staphylococcus epidermidis has been discovered as the most frequent germ detected during indwelling medical devices infection. This fact is well attached with the ability of this bacterium to form structured layered population known as biofilm. Inside S. epidermidis biofilm, bacterial cells present more different behavior than in their planktonic counterpart. This paper describes the thriving application of Petri net theory for modeling of interaction between different regulations actors leading S. epidermidis to switch from Planctonik to Biofilm. Indeed this biologic system is very sensible and has dangerous effect. We propose Agent Petri Nets model to describe and analyze the process of formation of Biofilm molecule. This model presents a formal framework based on Multi Agents system characteristics.

Laparoscopic gastric band (LAGB) has gained popularity among the surgical community since its first description in the early 90'. Actually, it is the third most practiced bariatric procedure in the world. The mean advantage of LAGB is a low rate of early postoperative morbidity. These satisfactory early results are in complete opposition with relatively high long term morbidity and a high rate of weight loss failure.Long term morbidity, weight loss and life quality index after LAGB were analyzed.Data of patients eligible for LAGB between January 2005 and November 2016 in the surgical department of La Rabta teaching hospital were retrospectively analyzed. Weight loss curves, long term complications and quality of life were evaluated.Between 2004 and 2008, 28 patients had LAGB. Mean preoperative BMI was 44.6 Kg/m². No immediate complications occurred. Mean EWL were 39% and 37% respectively after 24 and 60 months. EWL was above 50% in only 4 patients. Coming to long term morbidity, 10 (35%) patients had complications. Reintervention rate was 39%. The gastric band was removed in 9 (32%) patients. Mean quality of life BAROS score was 4.21.Judging for its long term morbidity with a high reintervention rate, the LAGB raises the question of its valuable position as a surgical procedure against morbid obesity.

Nodular lymphoid hyperplasia (NLH) of the gastrointestinal (GI) tract is a rare condition in adults. It is usually asymptomatic. Few complications have been described. We report an unusual clinical presentation of focal lymphoid hyperplasia of the GI.A 23-year-old female patient presented with a fistulizingdisease of the terminal ileum and the caecum complicated with an abscess of the lower right quadrant if the abdomen. CT-guided drainage with antibiotic therapy failed to control the abscess. Thus, surgery was undertaken and ileocaecal resection was performed. Focal lymphoid hyperplasia was confirmed by the pathology of the specimen.NLH is an uncommon condition in adults. To the best of our knowledge, no previous cases have been reported with fistulizing NLH. The management should follow the same algorithm as fistulizing ileitis. Surgery is indicated only in cases of complicated disease after the failure of medical treatment.

A four bending test is used to simulate the mechanical solicitation subjected by the steel slabs during the rolling sequence in a temperature range between 900°C and 650°C. The review by SEM of the surface of the specimens deformed provides additional information on the cracking of the oxide band, on the type of failure and the different faults. It is shown that the temperatures of formation of the oxide layer and mechanical solicitation have a significant influence on the behavior of the system steelcalamine. Oxide coatings obtained under wet atmosphere have a behavior more plastic than those obtained under dry atmosphere.

Mucinous cystadenomas are benign tumors with malignant potential. They are often revealed by non-specific abdominal pain, jaundice or an episode of acute pancreatitis. We here report an exceptional case of mucinous cystadenoma doubly complicated by acute pancreatitis and retroperitoneal rupture. The study involved a 30-year old non-weighted female patient, presenting with epigastric pain associated with left hypochondrium evolving over the last three months and which had intensified without fever or jaundice in the last 3 days. Clinical examination showed impingement on palpation of the epigastrium and of the left hypochondrium. There was no palpable mass. Laboratory tests were without abnormalities, except for lipasemia that was 8-times the upper normal. Abdominal CT scan showed bi-loculated cystic mass in the pancreas tail, measuring 111 mm * 73 mm, with a thin wall and a fluid content, associated with an infiltration of the left perirenal fascia. MRI (Panel A) showed mucinous cystadenoma with retroperitoneal rupture. The caudal portion of the main pancreatic duct was slightly dilated and communicated with the pancreatic cyst. The patient underwent surgery via bi-sub-costal approach. A cystic mass in the pancreas tail with retroperitoneal rupture associated with acute pancreatitis (outflow of necrotic content from left anterior prerenal space) was found. Caudal splenopancreatectomy was performed (Panel B). The postoperative course was uneventful. The anatomo-pathological examination of the surgical specimen showed pancreatic mucinous cystadenoma with low-grade dysplasia.

Introduction L’appendicite aigue représente l’urgence chirurgicale la plus fréquente aux urgences. Son diagnostic est avant tout clinique. Cependant, sa présentation clinique parfois trompeuse ainsi que le large éventail de diagnostics différentiels sont fréquemment sources d’erreurs diagnostiques et de retard de prise en charge. Afin de pallier à ces difficultés diagnostiques, de réduire le nombre d’examens complémentaires et d’actes chirurgicaux abusifs, plusieurs scores cliniques ont été ainsi développés, dont le score d’Alvarado. L’objectif de cette étude était d’appliquer ce score à une population de patients adultes venant consulter pour douleurs de la fosse iliaque droite afin d’évaluer ses performances ainsi que ses limites. Méthodes Il s’agissait d’une étude prospective qui a inclus tous les malades âgés de plus de 15 ans se présentant pour douleur de la fosse iliaque droite. Le diagnostic final d'appendicite aigue a été confirmé par examen anatomo-pathologique pour les patients opérés et infirmé lorsque la symptomatologie des patients avait totalement régressé en l'absence de tout traitement. Résultats Notre étude a inclus 106 patients. Chez les patients dont le score d'Alvarado était inférieur à 4, le diagnostic d'appendicite aigüe n'a jamais été retenu. Les meilleures sensibilités et spécificités ont été retrouvées pour une valeur seuil de 8 pour le score d'Alvarado. Ainsi, avec une bonne sensibilité (81,25%) et une valeur prédictive positive correcte (74,28%), notre étude a démontré que le score d’Alvarado pouvait apporter un bénéfice dans le diagnostic d'appendicite aigüe. Le groupe de patient avec un score strictement inférieur à 4 est considéré comme à faible risque. Les patients dont le score d'Alvarado était strictement supérieur à 6 nécessiteraient une hospitalisation afin, soit d'être opérer d'emblée, soit de compléter par un examen d'imagerie et une surveillance. Le groupe de patient ayant un score compris entre 4 et 6 (limites incluses), reste un groupe où le doute diagnostic est présent et où les examens complémentaires d'imagerie ont un apport certain. Conclusion L’utilisation du score d'Alvarado dans nos urgences permet de rationaliser la prise en charge et d’orienter le diagnostic en limitant la prescription d’explorations radiologiques, le coût de la prise en charge et les actes chirurgicaux abusifs.

Ileo-cecal resection is the most performed procedure in Cohn’s disease. In the last decades, the laparoscopic approach became the gold standard. The dissection can be lateral to median or median to lateral. In non-malignant diseases as it is the case for Crohn’s disease, the most performed dissection approach is the lateral to median. Herein, we describe a technique performed in our department: the total retro-mesenteric approach. The procedure requires 4 trocars with a 10- to 12-mm median suprapubic trocar. The telescope is placed in this trocar. The dissection will begin with the opening of the mesentery root creating a retro-mesenteric tunnel. This dissection gives a direct visualization of the duodenum, of the ureter and the gonadic vessels which guarantees a safe procedure considering the importance of the inflammation in this disease. At the end of the retro-mesenteric step, the right colon is only attached to the Toldt’s fascia. The transection of the mesentery is done next to the bowel wall leaving at the end the choice to the surgeon to perform an extra- or endocorporeal anastomosis. This retro-mesenteric approach has been used in our department since 2004. Until May 2013, 89 patients underwent laparoscopic resection for Crohn’s disease with a mean operative time of 130 min, a morbidity rate of 6 % and a laparoconversion rate of 13.6 %. We describe the total retro-mesenteric approach in the ileo-cecal resection for Crohn’s disease. The approach is considered to be safe allowing the surgeon to perform a dissection far from the inflammatory site and allowing a visual identification of the duodenum and the right ureter. The morbidity of the procedure is equivalent to the other dissection techniques.

Resume Le foie et les voies biliaires sont une localisation exceptionnelle de la tuberculose (TBC). La symptomatologie clinique n’est pas specifique. Les trois aspects decrits a l’imagerie sont les formes macronodulaires, micronodulaires et canaliculaires qui sont les plus rares.

The laparoscopic approach is becoming the gold standard in the surgical treatment of primary Crohn's disease. The aim of this study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease.We conducted a non-randomized, comparative, retrospective analysis of a prospective database from 1998 to 2010. The remaining 129 patients were divided into two groups: laparoscopic-assisted group (Group L; n=64) and conventional group (Group C; n=65). There were no differences between the two groups as regards preoperative patient characteristics. Complications were graded according to the Clavien-Dindo classification.One hundred and seventeen (90.7%) patients had no complications. Out of 12 patients (9.3%) with complications, four (3.1%) had Grade I, six (4.7%) had Grade II and two (1.6%) had Grade III. There were no postoperative deaths (Grade V). Operating time was longer in Group L compared with Group C (P0.001). Bowel function returned more quickly in the laparoscopic group in terms of return of bowel movements (P=0.018) and resumption of a regular diet (P=0.06). The mean length of stay was significantly shorter in the laparoscopic group (P=0.001). The mean follow-up was 26 months in Group L versus 34 months in Group C (P=0.06). During follow-up, six patients presented with small bowel obstruction in Group C, which was not statistically different from Group L (3 patients) (P=0.25). During the follow-up period, there have been no recurrences of Crohn's disease in the laparoscopic group while 11 patients (16.9%) have developed a recurrence in the conventional group (P=0.001).Laparoscopic-assisted ileocolectomy for primary Crohn's disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn's disease should be considered as the preferred operative approach for primary resections.

Volvulus is a rare cause of intestinal obstruction. The main types of colonic volvulus are sigmoid volvulus and cecal volvulus. The simultaneous occurrence of cecal and sigmoid colon volvulus is extremely unusual. To our knowledge, few reports on simultaneous sigmoid and cecum colon have been published to date. We are reporting a case of a synchronous volvulus of ceacum and sigmoid colon.

Pancreas divisum (PD) is a common congenital anomaly of the pancreas, which results from an abnormal fusion between the ventral and dorsal pancreatic ducts during fetal development. Association with Intraductal papillary mucinous neoplasm (IPMN) is extremely rare. The treatment of this entity will depend both on the malignant potential of IPMN and on the symptoms related to pancreas divisum. We report a rare case of Intraductal papillary mucinous carcinoma of the pancreas associated with pancreas divisum, one of the most difficult situations which the surgeon can be confronted to in his practice.

Introduction La maladie de Crohn se complique rarement d’abces intra-abdominaux. Cette complication pose d’une part un probleme de diagnostic positif et d’autre part un probleme de strategie therapeutique vis-a-vis de l’abces mais egalement de la maladie en cause.

Gastric adenocarcinoma in young patients is considered as a cancer among the old. Its occurrence among the youth is rather rare and reputed to be of a bad prognosis.

Resume L’adenocarcinome gastrique est considere comme un cancer du sujet âge. Sa survenue chez le sujet jeune est rare et reputee etre de mauvais pronostic.

Le megaduodenum est une affection rare. Elle pourrait etre idiopathique ou secondaire a une myopathie ou neuropathie viscerale. Les manifestations cliniques sont variables allant de la latence totale a la pseudo-obstruction severe. Des infections urinaires recidivantes sont frequentes. Le diagnostic est aisement realise par les explorations radiologiques et manometriques revelant une atteinte motrice oesophagienne, grelique et anorectale. Le traitement chirurgical pose des problemes techniques specifiques lies a la presence du confluent biliopancreatique (dont l’atteinte est possible) et de la tete du pancreas. Le but de ce travail est de decrire les manifestations cliniques, les anomalies radiologiques et manometriques observees au cours du megaduodenum et de discuter les modalites therapeutiques. Nous rapportons l’observation de deux patients: le premier, âge de 27 ans, opere pour stenose digestive haute dans un autre centre ou une dilatation gastrique importante a ete constatee avec un pylore permeable, il a ete realise une anastomose laterolaterale entre le deuxieme duodenum et la premiere anse jejunale. Le patient a ete readmis dans notre service quatre ans plus tard pour recidive de la meme symptomatologie. En peroperatoire, l’ancienne anastomose duodenojejunale etait permeable. Une diversion duodenale totale a ete effectuee. Le second patient est âge de 22 ans, avec notion de deces a la premiere annee dans la fratrie. Ce cas est associe a des troubles ophtalmologiques, a une dysmorphie faciale et a un endobrachyoesophage. Le patient a beneficie d’une diversion duodenale totale avec des resultats satisfaisants, le caryotype sanguin chromosomique n’a pas montre d’anomalies.

Echinococcosis/hydatidosis caused by Echinococcus granulosus has a widespread distribution in the human population of Tunisia, particularly in the north-west and centre-west of the country. In a recent study, the morphological features, fertility and viability of hydatid cysts that had been excised from patients in Tunis were explored, and the E. granulosus strain or genotype involved in each case was identified from morphology of the protoscolex hooks and the results of molecular genotyping. The hepatic cysts investigated came from 41 patients [31 women and 10 men, with a mean (S.E.) age of 43.41 (14.25) years] who were treated for cystic echinococcosis, by surgery but rarely with chemotherapy, at the La Rabta Hospital in Tunis, in the 12 months ending in June 2008. Most (56%) of these patients originated from rural areas in endemic governorates. Of the 60 hepatic cysts that were studied, 38.3% were located in the right lobe of the liver and 35.0% each involved both hepatic lobes. Almost a third (31.7%) of the excised cysts were degenerating, with the rest considered viable and either multivesicular (38.3%) or univesicular (30.0%). Almost all (93.3%) of the cysts were categorized as fertile, with a mean protoscolex viability of 21.8%. Protoscolex viability was relatively high in the viable univesicular cysts with a visible cyst wall and in the multivesicular and multiseptate cysts with daughter cysts, and lowest in the cysts that appeared to be solid calcified masses. The observed variation in protoscolex viability with cyst type, in cysts excised from patients before any chemotherapy, supports the cyst classification recommended by the World Health Organization but could also be compatible with the imaging-based 'Gharbi' classification. The results of the molecular genotyping showed that all 23 cysts investigated (which came from 20 of the patients) were caused by E. granulosus of the G1 genotype (also known as the 'sheep' or 'sheep-dog' strain).

Summary Phytobezoars are a rare cause of acute bowel obstruction. The purpose of this work was to identify the predisposing factors and diagnostic difficulties of this rare entity. Material and methods This was a retrospective study including all cases of small-bowel obstruction secondary to phytobezoars observed between April 2001 and August 2007. The diagnosis of bezoars was established by surgical exploration or by computed tomography (CT). Results During the study period, 375 patients were hospitalized at our institution with a diagnosis of bowel obstruction that, in 15 (4%) cases, was secondary to phytobezoars. The average patient age was 55 years, with a gender ratio of 1.7, favoring men. The predisposing factors were gastroduodenal surgery for peptic ulcer in nine patients, and excessive consumption of prickly pears (cactus figs) in 12. The diagnosis was established by CT scans in three patients, who were successfully treated with gastric aspiration, thereby avoiding surgery. Laparotomy was performed in 12 patients to allow digital fragmentation of the bezoar, which was then washed into the colon. There were no postoperative deaths and morbidity was about 13%. Conclusion An abdominal CT scan should be obtained for patients with small-bowel obstruction. This examination offers a precise diagnosis of bezoars, reducing the number of unnecessary surgical procedures, and helping to guide the approach if surgery is needed.

Gastro-intestinal stromal tumors (GIST) are the most common mesenchymal gastrointestinal tumors. The Gastric location represents 60% of cases [1,2]. Complete surgical excision remains the treatment of reference for the localized forms. This surgery can be made by laparoscopy when the lesion's size doesn't exceed 5 cm. Some principles must e respected: a mono-block complete surgical resection, with healthy margins and without effraction. This technique will be reserved for trained teams and for selected cases according to the size and location. We herein try to explain the surgical laparoscopic excision of gastric stromal tumors explaining .

RésuméLa rupture vésicale spontanée (RVS), aux facteurs étiologiques variés, est rare Un homme âgé de 70ans présentait une péritonite généralisée, une rétention urinaire aigue et une hématurie. La laparotomie exploratrice avait mis en évidence une perforation du dôme vésical qui a été obturée avec des suites immédiates simples. Les berges de la perforation n'avaient pas de lésion inflammatoire ni tumorale. L'enquête étiologique avait conclu à un cancer prostatique localement avancé. Le décès du patient était survenu 2 mois après. Les auteurs ont revu les causes, le diagnostic et le traitement des RSV.AbstractSpontaneous bladder rupture (SBR) is rare. This entity occurs outside of any traumatic context. A 70 years-old man was admitted for acute peritonitis, acute urinary retention and hematuria. Laparotomy and exploration showed acute generalized peritonitis related to a centimeter hole in the bladder dome. Peritoneal lavage was done with biopsy of the perforation edges, a cystostomy and suturing of the bladder. The immediate postoperative course was uneventful. The etiological investigation revealed a locally advanced and metastatic prostate cancer. The evolution was rapidly fatal and the patient's death occurred two months later due to metastatic disease. The causes, diagnosis and treatment of SBR are reviewed by the authors.

The hydatid cyst of the diaphragm is defined as the development of a hydatid cyst in the diaphragm muscle. The purpose of this study is to identify the specific pathogenic, clinical and therapeutic aspects of this hydatid cyst. It is important to confirm the diagnosis of the location before surgery. We report the case of a patient aged 40 years, in whom the diagnosis of hydatid cyst of the diaphragm was made incidentally in the course of a gastric stromal tumour. The patient was operated by a midline laparotomy. Resection of the protruding dome of hydatid cyst of the diaphragm was carried out along with total gastrectomy. The postoperative course was uneventful. After 12 months, the results were negative. The diagnosis of hydatid cyst of the diaphragm is based on the thoraco-abdominal CT scan. The treatment is surgical based on the topographic features of the cyst.

We report a case of pneumothorax, subcutaneous emphysema and pneumoretroperitoneum after an endoscopic sphincterotomy. A 40-yr-old woman presented with dyspnea immediately after she had undergone an endoscopic retrograde cholangiopancreatogram for a residual stone in common bile duct. On arrival to our hospital, she complained about severe dyspnea and on examination subcutaneous emphysema was discovered. A CT scan was conducted and showed a right-sided pneumothorax, a pneumoretroperitoneum in the peritoneal cavity. We recommended to the patient an immediate laparotomic exploration. We discovered a duodenal perforation in which we sutured it with accompanying pyloric exclusion, double truncular vagotomy and gastroenteroanastomosis. Endoscopic retrograde cholangiopancreatogram (ERCP) is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperitoneum, mediastinum, and the soft tissues of the neck, eventually causing pneumothorax. Early recognition and appropriate management is crucial for optimal results.

In this paper, the effect of geometry and impedance on the acoustic behavior of wall and lined cylindrical ducts is investigated using a numerical model which enables one to compute the reflection and the transmission coefficients of such ducts using the multimodal scattering matrix. From this matrix, the acoustic power attenuation is deduced. By using these tools, the effect of duct diameter increase and duct diameter decrease of the wall or lined duct section is studied. The numerical results are obtained for two configurations of wall and lined ducts. Numerical coefficients of transmission and reflection as well as the acoustic power attenuation show the relative influence of each type of variation.

Hydatid disease is a considerable health problem Worldwide. Primary hydatid disease of the pancreas is very rare. We report the case of a 30-year-old woman who presented with abdominal pain and an epigastric mass. A diagnosis of hydatid cyst of the pancreas was established by ultrasonographybefore surgery. The treatment consisted of a distal pancreatectomy. The postoperative evolution was uneventful. Hydatid disease should be consideredin the differential diagnosis of all cystic masses in the pancreas, especially in the geographical regions where the disease is endemic. Surgical removal remains the main form of defi nitive treatment.

La fistule gastrojejunocolique (FGJC) est devenue une complication exceptionnelle de la maladie ulcereuse depuis la rarefaction des resections gastriques pour ulcere et le progres du traitement medical, en particulier l’eradication de l’Helicobacter pylori. Nous rapportons deux observations de FGJC postoperatoire survenue apres gastroenteroanastomose (GEA) et revelee par une diarrhee chronique, un syndrome de malabsorption et une alteration de l’etat general, imposant dans les deux cas une degastrogastrectomie avec colectomie transverse emportant la FGJC. Les suites operatoires etaient simples avec une disparition de la diarrhee et une prise de poids.