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Gastro-intestinal stromal tumors (GISTs) of the appendix are a rare entity. To date, only eight cases has been described in the literature, most of which have been of the benign type. We report a new case of an appendiceal GIST in a 75-year-old man. The tumor was discovered when the patient presented with acute appendiceacal peritonitis. Preoperative diagnosis of appendiceal GIST was rarely done as tumors were usually associated with appendicitis-like symptoms.Key words: Appendiceal GIST, peritonitis, surgery, CD34

The erosion of a pancreatic pseudocyst into an adjacent artery is a rare and highly lethal complication of pancreatitis with reported death rates of 12% to 40% [1]. Despite improvements in the diagnosis and management of pancreatic pseudocysts, the incidence of intracystic hemorrhage ranges from 6% to 17%. In recent reports, investigators have described the successful management of pancreatic pseudoaneurysms with endovascular techniques and have advocated percutaneous angiographic embolization as the preferred treatment modality. An operation should be reserved for actively and hemodynamically unstable patients. We report the case of a 50 year old patient having a cataclysmic upper gastrointestinal bleeding due to an erosion of the superior mesenteric artery by a pancreatic pseudocyst, and discuss contemporary methods in diagnosis and management of the condition.

The goal of this paper is to discuss how to ameliorate the management of penetrating cardiac injuries in general surgery department. An algorithm for the initial assessment of penetrating injuries in cardiac box, based on our own experience, is presented. This was a retrospective study of 19 patients undergoing thoracotomy for penetrating cardiac injuries, managed in the department of general surgery of Nabeul-Tunisia, between 1994 and 2010. The mean age of patients was 25 years old. Sex ratio was 8,5. All patients had cardiac injury resulting from stab wounds inside of the pericardium. 42% of them were critically unstable, 21% had cardiac tamponnade. All these patients were quickly transferred to the operating room without any other investigations. 37% of patients were hemodynamically stable and underwent additional investigations. The management of penetrating cardiac injuries is possible in a general surgery department, but it requires a rapid prehospital transfer, a yet thorough physical examination along with efficient surgical management, all done in minimal time.

Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all of the ligaments that hold the spleen in its normal position in the left upper quadrant of the abdomen. It is an uncommon clinical entity that mainly affects children. Among adults it most frequently affects women of reproductive age, in whom acquired laxity of the splenic ligaments is usually the cause. Patients with a wandering spleen may be asymptomatic, present with a movable mass in the abdomen, or have chronic or intermittent abdominal pain because of partial torsion and spontaneous detorsion of the spleen. A 26-year-old woman was admitted to our hospital with vomiting and abdominal pain. Abdominal examination revealed a large ovoid hypogastric mass. A CT scan showed a wandering spleen in the hypogastric region. Exploratory laparotomy revealed an ischemic spleen. A total splenectomy was performed.

Adult intussusception due to Meckel’s diverticulum is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report one case of intussusception due to Meckel’s diverticulum in an adult. A 22-year-old patient was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness. We diagnosed an acute small bowel obstruction and performed emergency surgery. The intra operative findings were distention of the small bowel and intussusception of ileus due to an inverted Meckel’s diverticulum located 70 cm from the ileocecal valve. 30 cm ischemic loop was identified. A segmental small bowel resection and hand-sewn anastomosis was performed. Histopathology distinguished Meckel’s diverticulum measuring 5 cm x 3.5 cm x 1 cm and no signs of malignancy.

Le léiomyosarcome du rein est une tumeur rare. Les auteurs ont rapporté l’observation d’un homme âgé de 45 ans, chez lequel le diagnostic d’une tumeur rétropéritoénale gauche a été posé lors de l’exploration de douleurs du flanc gauche associées à une altération de l’état général et ce par l’imagerie (Echographie et scanner abdominal). La laparotomie exploratrice avait conclu à une tumeur rénale gauche localement évoluée, une néphrectomie élargie a été réalisée et l’histologie était en faveur d’un léiomyosarcome rénal. Une récidive locale a été diagnostiquée après un recul de 6 mois. Après une nouvelle laparotomie, l’abstention était de mise devant le caractère évolué de la récidive. Le but de cette observation est double. Le premier, est la nécessité de faire un diagnostic précoce, afin d’intervenir sur une tumeur de petite taille, plus accessible à la chirurgie. Le second, est de discuter la place du traitement adjuvant, qui pourrait réduire le risque de récidive précoce.Mots clés : Léiomyosarcome, rein