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we report the case of a 61-year-old male patient who was admitted with abdominal pain, vomiting and constipation. he had a past medical history of epidermoid lung cancer .computed tomography revealed distended stomach with mural bowel thickening. it was peroperatively two small-bowel metastasis from lung cancer that we resect.

in colon cancer surgery, anastomotic fistula (AF) is considered the most feared complication. The purpose of this study was to identify predictive factors associated with anastomotic fistula after colon cancer surgical resection and to describe the impact of this complication on mortality and postoperative length of stay.we conducted a retrospective, descriptive and analytical study in the Department of General Surgery at the Habib Bourguiba Hospital in Sfax, Tunisia from 1we collected data from the medical records of 163 patients who had undergone surgery for colon cancer. The average age of patients was 62.7 years with a sex ratio of 1.36. The postoperative course was uneventful in 64.4% of cases and complicated in 35.6% of cases. Surgical morbidity was mainly due to anastomotic fistulas (22 patients). This study demonstrated that predictors of the development of this complication were: diabetes p = 0.04, smoking p = 0.01, hypoalbuminaemia p = 0.01, preoperative haemoglobin less than 10g/dl, p0.01, anastomotic fistula located in the left colonic angle p = 0.02, perioperative transfusion p0.01, and duration of surgery longer than 180 min p = 0.04. Moreover, the occurrence of anastomotic fistula was associated with specific mortality rate (9%) and significantly prolonged postoperative length of stay.the prevention of anastomotic fistulas should be part of a multimodal approach based on the correction of nutritional deficiencies and possible pre-operative anemia.

Le dermatofibrosarcome est une tumeur cutanée rare d´aspect morphologique trompeur et inconnu pour la plupart des médecins. Le retard diagnostique peut conditionner la prise en charge et affecter le pronostic. Nous rapportons le cas d´un jeune patient qui a présenté des lésions protubérantes de la paroi abdominale pris à tort pour des kystes bénins. L´exploration radiologique a révélé une masse tissulaire du plan graisseux sous cutané suspecté d´être un fibrosarcome. Cette masse a été réséquée avec une marge de sécurité macroscopique. L´étude anatomopathologique a confirmé le diagnostic de dermatofibrosarcome. Le contrôle clinique et radiologique à distance n´a pas objectivé de récidive. Ce cas nous permet d´éviter de passer à côté d´une tumeur rare qui nécessite une prise en charge spéciale.

Un accident occlusif aigu pendant la grossesse est une complication rare mais potentiellement grave qui peut poser des difficultes diagnostiques et mettre en jeu le pronostic maternel et fœtal. Nous rapportons le cas d´une patiente âgee de 22 ans, sans antecedents, admise pour des contractions uterines au terme de 37 semaines d´amenorrhees. L´examen a l´admission etait sans anomalies. La patiente a presente 7 heures apres l´admission des vomissements repetitifs avec polypnee et fievre. Une cesarienne a ete decidee en urgence devant l´apparition d´une bradycardie fœtale a l´enregistrement du rythme cardiaque fœtal ERCF. Le diagnostic de volvulus du colon droit sur un mesentere commun complet a ete pose en per-operatoire apres l´extraction fœtale. Le colon droit etait distendu et necrose avec trois tours de spire. La decision etait de realiser une colectomie droite avec anastomose ileo-colique termino laterale. L´evolution de la patiente en post operatoire etait favorable. A travers cette observation ainsi qu´une revue de litterature nous essaierons de discuter les modalites diagnostiques et therapeutiques de cette pathologie.

Background The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens. Methods All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis. Results A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (P Conclusions The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.

But Determiner si la cure par plaque est associee ou non a un risque plus eleve d’infection au site operatoire (ISO) que les techniques par raphie simple pour les hernies inguinales etranglees chez l’adulte. Materiels et methodes Il s’agit d’une etude prospective randomisee sur une periode de 18 mois apres un consentement eclaire des patients concernant le choix de la technique (groupe a : cure par plaque vs groupe b : raphie simple) Resultats Nous avons collige dans notre etude 43 patients incluant 39 hommes et 4 femmes avec un âge moyen a 56,47. 17 patients ont ete traites par plaques versus 26 par raphie simple. L’etude analytique n’a pas montre de difference significative en terme de complication specifique type ISO (p = 0,4, une seule complication dans le groupe a) et non specifiques (p = 0,646, 2 complications reparties egalement entre les deux groupes). Conclusion Notre etude a montre que la cure par plaque est une bonne option de traitement de la hernie inguinale etranglee chez l’adulte comparee aux techniques de cure par raphie simple, donnant des resultats similaires en termes de ISO.

Abdominal pain observed in Henoch-Schönlein purpura (HSP) is usually attributed to edema and hemorrhage in the small bowel wall, secondary to a small-vessel vasculitis. Pancreatitis secondary to HSP is extremely rare. Here we report a 53-year-old man presented with acute pancreatitis that developed into characteristic rashes seen during HSP at the second day of the clinical onset, together with arthritis and glomerulonephritis. HSP is a rare and benign cause of acute pancreatitis. This complication can occur as an initial manifestation of HSP. Elevated serum amylase level can be considered as the early diagnostic tool for HSP pancreatitis. The patients with HSP who have abdominal pain as their chief complaint should be evaluated for pancreatitis, by routine serum amylase and abdominal computed tomography scan, to plan the specific treatment and avoid unnecessary surgery.

Context: Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusceptions may warrant surgical intervention. Case report: We report a case of 47-year old woman who had suffered from intestinal obstruction for 3 days. The symptoms did not improve after conservative treatment. An exploratory laparotomy found small bowel obstruction due to proximal jejunal diverticulum with an adhesion epiploic band. Strangulation of the jejunum resulted from the internal hernia caused by the band. The band was removed and the proximal jejunum segmentally resected. The postoperative course was uneventful. Conclusion: Although this phenomenon is rare, we should keep in mind that intestinal diverticulosis may induce intestinal obstructions of different kinds, repeat physical examinations and X-ray films are needed and enteroclysis studies or CT scan are helpful in diagnosis. Surgery is indicated for acute abdominal or repeated intestinal obstruction.

We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric hernia operated by laparoscopy with a 1 year mean follow-up. The purpose of our study is to investigate the contribution of laparoscopy in the treatment of in terms of results in the short and medium term. Early surgical morbidity was 14.3%. There was no mortality. At 6 months of the intervention, 28.5% of patients have kept umbilical pain. At 1 year of intervention, 2 patients have kept umbilical chronic pain. No case of recurrence was noted. In conclusion, the laparoscopic approach should be reserved for cases of large hernias and for recurrent and incisional hernias.Epigastric hernia, Laparoscopy, Mesh, Umbilical hernia.Viene riportato uno studio prospettico su 42 casi di ernia ombelicale ed epigastrica primitive e non complicate trattate per via laparoscopica e seguite in media da un follow up di un anno. Lo scopo di questo studio è quello di valutare il contributo della laparoscopia nel trattamento in termini di risultato nel breve e nel medio periodo. La morbilità chirurgica precoce è stata del 14,3%. A sei mesi dall’intervento il 28,5% dei pazienti ha lamentato dolori nell’area ombelicale. Ad un anno dall’intervento 2 pazienti hanno lamentato la cronicizzazione del dolore. Non si è avuto nessun caso di recidiva. In conclusione l’approccio laparoscopico risulta doversi riservare ai casi di ernia di maggiori dimensioni, ed in caso di recidiva o di laparocele.

The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications.reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence.A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication.Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial.Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.

Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities.We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy.We treated 44 hydatid cysts of segment I surgically in 10 men and 34 women, with a mean age of 40.6 years. Ten patients (22.7%) had a history of hydatid cysts. Symptoms or complications were noted at admission in 45% of cases. Only five cases (11.4%) required emergency surgery. Surgical examination confirmed vascular compression in 17 cases (38.6%) and a biliary fistula in 17 cases (38.6%). Surgical treatment consisted of deroofing in 37 cases (84,1%), with omentoplasty in 23 (54%), subtotal pericystectomy in 3 and simple drainage in 4. Large biliary fistulas (5 mm) were treated with bipolar drainage in 2 cases and internal transfistulary drainage in 3. Some hemorrhaging occurred during surgery in 5 cases, and one cyst ruptured in the peritoneal cavity. Albendazole was prescribed postoperatively for nine patients. There was one intraoperative death, secondary to hemorrhage resulting from erosion of the inferior vena cava. Morbidity was 25%. After a mean follow-up of 32 months, five patients had recurrences in the liver but outside segment I.Segment I of the liver is a rare site for hydatid disease, and a site where vascular and biliary complications are frequent. Its management requires a good knowledge of the vascular anatomy of the liver and wide experience of hydatid cyst surgery and especially of simple surgical procedures.