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Anorectal malformations are congenital anomalies ranging from simple perineal fistulas to complex malformations. They are usually treated inchildhood, and exceptionally in adult. We herein report the case of a 22 years aged patient and relate the diagnosis difficulties and therapeuticoptions. She consulted for anal imperforation discovered since birth. Initially, His parents refused the surgical management. It was an analimperforation with a vestibular fistula. The patient was operated by a low approach. She had a disconnection of the recto-vestibular fistula,dissection of the anal canal and a perineal posterior transposition. Postoperative course was uneventful. The evaluation of continence usingKelly's score found good Functional result.

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.

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.

Resume La fistule enterotubaire est une complication rare de la maladie de Crohn. Le diagnostic preoperatoire de cette entite est exceptionnel. Nous rapportons un nouveau cas de cette complication suspecte par la tomodensitometrie et confirme par l’hysterosalpingographie et le transit du grele. Il s’agit d’une femme âgee de 50 ans, connue porteuse d’une maladie de Crohn depuis deux ans, hospitalisee actuellement pour une stenose symptomatique de la derniere anse ileale avec decouverte fortuite lors des explorations (tomodensitometrie, transit du grele) d’une fistule enterotubaire droite. Le traitement a consiste en une resection ileocaecale associee a une salpingectomie avec des suites operatoires simples.

Resume La localisation pancreatique du kyste hydatique est exceptionnelle, meme dans les pays ou la maladie hydatique sevit a l’etat endemique. Nous rapportons trois observations de kyste hydatique du pancreas revelees par des douleurs abdominales. Le diagnostic etait porte sur les donnees de l’echographie et du scanner abdominal qui objectivaient une masse kystique a paroi propre de la queue du pancreas pour les deux premiers cas. Le troisieme kyste a ete decouvert en peroperatoire avec, a la cholangiographie peroperatoire, une large fistule wirsungokystique. La serologie hydatique (Elisa) etait positive dans tous les cas. Le traitement chirurgical a consiste en une resection du dome saillant dans deux cas et en une anastomose kystogastrique pour le troisieme cas. A travers ces trois observations et une revue de la litterature, nous discutons les difficultes diagnostiques et les modalites du traitement chirurgical de cette localisation rare du kyste hydatique.

Summary Introduction Internal hernias are a rare cause of acute intestinal obstruction. Herniation through the falciform ligament is rare and often diagnosed only during surgery. Abdominal computed tomography (CT), performed on an emergency basis, can help to diagnose this obstruction before surgery and select a therapeutic approach. Case A 60-year-old man was hospitalized on an emergency basis for symptoms that had been developing for 3 days, including tympanites and epigastric pain (torsion), associated with vomiting and the cessation of both feces and flatus. Abdominal radiography showed multiple levels of air-fluid levels in the small bowel, some projecting towards the liver area, as well as the presence of a flat intestinal loop continuous with a distended small-bowel segment. Abdominal CT suggested a diagnosis of small-bowel herniation and obstruction, very probably through the falciform ligament. The patient then underwent emergency surgery after a brief resuscitation. Intraoperative exploration confirmed the diagnosis of internal hernia through the falciform ligament. The postoperative course was without problems. Discussion Abdominal CT is the examination of choice in cases of a “new” acute intestinal obstruction. It makes it possible to diagnose the mechanism of the occlusion and especially the cause, especially for an internal hernia through the falciform ligament. It thus guides the choice of emergency surgical procedure and of appropriate approach. Once diagnosed, emergency surgery is essential to free the intestinal loop, with or without intestinal resection as a function of vitality.

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 .

Peritoneal tuberculosis and carcinomatosis are the most frequent etiologies of exsudative ascitis and require rapid diagnosis and treatment. The purpose of this study has been to evaluate the predictive value of clinical and complementary data for the etiologic diagnosis of exsudative ascites and to assess the results of laparoscopic surgery.We report a prospective long-term study conducted over 10 years, having included all cases of exsudative ascites of unidentified etiology. We excluded patients with a history of anterior laparotomy and patients having a contraindication for laparoscopic surgery. Clinical signs, results of the cytochemical and bacteriological exam of the ascetic liquid and findings from radiological exams and endoscopic investigations were noted. Open laparoscopic exploration noted the macroscopic aspect and many peritoneal biopsies were obtained as well as a liver biopsy when possible. Statistical analysis was performed with SPSS10.0 software. The degree of statistical significance was set for P0.05.We included 90 cases of isolated exsudative ascites. There were 59 cases of tuberculosis and 31 of carcinomatosis. Mean patient age was 47 years with a sex ratio of 0.5. Bowel transit disorders were significantly in favor of a carcinomatosis (P=0.04) while fever and nocturnal sweats were suggestive of tuberculosis (P=0.04) but in both instances, the positive predictive value (PPV) of these two signs was weak, respectively 29% and 43%. Relative to chemical and cytologic study of ascitic fluid, hemorrhagic fluid, low white cell count, low lymphocyte differential and presence of atypical cells were significantly linked with the carcinomatosis (P=0.01) but with a PPV85%. Radiological exams were not very contributive for the etiologic diagnosis. The laparoscopic peritoneal aspect was typical of tuberculosis in 90% of proved cases and in 29% of carcinomatosis cases, underlying the importance of peritoneal biopsies for histological study. Hepatic tuberculosis was associated with peritoneal localisation in 48% of cases. We had no surgical mortality and the morbidity was about 1%.Etiological diagnosis of exsudative ascitis remains difficult to establish. Peritoneal biopsies under videolaparoscopy are currently the "gold standard" for diagnosis.

Amyloidosis is an abnormal extracellular deposition of insoluble proteins, which is associated with an involvement of the gastrointestinal tract in 50 to 70% of cases. In primary amyloidosis (light chain amyloidosis), localized gastric involvement is a rare finding which can mimic malignancy. We report the case of a 56-year-old man, admitted with upper digestive outlet obstruction. Linitis plastica with lymph node involvement was suspected by gastroscopy, barium meal and endoscopic ultrasonography but was not confirmed by gastric biopsies. The patient was treated with total gastrectomy with lymph node dissection. Pathological examination demonstrated gastric and lymph nodes amyloidosis and no malignant tumor was found. The patient died 9 months later from cardiac failure due to amyloidosis.

Resume Le carcinome indifferencie avec cellules geantes de type osteoclastique du pancreas est une tumeur maligne rare, pouvant avoir un aspect kystique, et caracterisee par la coexistence d'une composante adenocarcinomateuse et de cellules geantes d'allure osteoclastique. Son histogenese, longtemps controversee, est maintenant bien definie. Nous rapportons l'observation d'une patiente âgee de 72 ans, hospitalisee pour un ictere cholestatique associe a des epigastralgies evoluant depuis un mois. L'echographie et la tomodensitometrie abdominales concluaient a une masse cephalique a double composante solide et kystique de 6 × 5 cm, avec une dilatation de la voie biliaire principale et du wirsung. Le geste operatoire avait consiste en une duodenopancreatectomie cephalique et l'examen anatomopathologique de la piece revelait un aspect de carcinome indifferencie avec cellules geantes de type osteoclastique. La patiente etait vivante sans signe de recidive avec un recul de 18 mois.

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.

Crohn's disease (CD) is a chronic inflammatory disease of the intestine that can cause an attack by contiguity of the urinary tract. Although the shape is common and fistulizing 35% of all patients with CD, entero-urinary fistulas are rare and only seen in 2-8% of patients. aim: To report the frequency of occurrence of this complication among the group of surgical forms of CD. Describe the different pathophysiological mechanisms of occurrence of entero-vesical fistula (EVF) during the CD. methods: We report, retrospectively, seven observations of EVF complicating MC made during the period from 01/01/1998 until 31/12/2010. results: The mean age of patients was 30 years. There were 3 men and 4 women. All patients had clinical signs and radiological EVF. In six patients, CD was ileo-caecal and the ileo-vesical fistula was between the last loop and the bladder. In one patient, the CD was located only in colon, and the fistula was between sigmoid colon and bladder. Level of the bladder, it was a false EVF in five patients and a true EVF in two patients. In these last two, the fistula of 2 mm, was on the top of the bladder. Treatment consisted in all cases by a disconnect between the digestive tract and bladder, resection with restoration of digestive continuity, and if the case of true EVF, a freshening the edges of the fistula with suture of the bladder's wall and drainage. The postoperative course was uneventful in six patients and marked by an outbreak intraperitoneal abcess in one patient who had evolved under medical treatment. After a mean of eleven months, no recurrence surgery was noted.Despite advanced treatment in the context of CD, the indication in EVF is a surgical treatment. Surgery helps fight against the consequences of septic urinary tract, but also to launder bowel disease and reduce the risk of recurrence in the short term.

La survenue d’un adenocarcinome du canal anal associe a une fistule perineale revelatrice est rare. Les auteurs rapportent une observation chez un homme de 65 ans. La pathogenie est encore obscure. Les symptomes cliniques sont non specifiques. Le diagnostic est souvent tardif a un stade evolue de la maladie. Le traitement est centre sur l’amputation abdominoperineale du rectum et la radiotherapie adjuvante n’a pas fait la preuve de son efficacite.

Gastrointestinal bleeding from a pancreatic pseudocyst is a rare condition that is diagnostically and therapeutically challenging. A 78-year-old woman with a history of acute pancreatitis due to gallstones was hospitalized for abdominal pain and gastrointestinal bleeding. Gastroscopy revealed blood extruding from the papilla of Vater. A computed tomography scan revealed hemorrhage into a pancreatic pseudocyst. The patient was successfully treated by coil embolization.

We report the diagnosis of synchronous gastrointestinal stromal tumours affecting the small bowel and intraepithelial neoplasia of the colon in a 52-year-old patient. After surgical resection of the two tumours outcome was favourable. We discuss the causality of this association, based on a literature review of the few previously published cases.

Resume Introduction La desunion anastomotique en chirurgie colorectale est une complication grave. Ainsi, la protection d’une anastomose a risque par une colostomie ouverte temporaire permet d’en reduire la gravite. La colostomie a ouverture potentielle (COP) est une alternative permettant d’eviter les inconvenients de la colostomie ouverte. Le but de ce travail etait d’etudier les resultats de cette technique et d’en preciser les indications. Materiel et methodes Nous rapportons une serie retrospective de 34 cas de COP protegeant une anastomose colorectale a risque. L’indication de cette protection etait une mauvaise preparation colique dans 59 % des cas, une denutrition dans 11,5 % des cas, une inflammation locale dans 11,5 % des cas et une anastomose tres basse dans 17 % des cas. Resultats La colostomie a ete ouverte en postoperatoire dans 6 cas (18 %) de desunion anastomotique diagnostiques sur la clinique et/ou sur une opacification par voie basse aux hydrosolubles realisee systematiquement au 6 e jour postoperatoire. Aucune reprise chirurgicale n’etait necessaire. Dans les autres cas (82 %), les suites etaient simples et une reintegration facile du colon, sous sedation legere, etait realisee sans complication per- ou post-operatoire, en moyenne au 7 e jour postoperatoire. La duree moyenne de la reintegration etait de 10 min avec une duree de sejour moyen apres reintegration de 48 heures. Conclusion La COP de protection d’une anastomose colorectale offre plusieurs avantages, notamment une morbidite et une mortalite specifiques nulles, un court sejour hospitalier et un meilleur confort psychologique. Sa principale indication est la protection d’une anastomose colorectale a risque de desunion en chirurgie elective.

Resume Nous rapportons l’observation d’une femme âgee de 23 ans suivie depuis 11 ans pour une maladie de Crohn ileo-colique et qui avait ete operee pour des stenoses etagees multiples jejuno-ileales symptomatiques. Neuf stricturoplasties de type Heineke-Mikulicz et une de type Finney avaient ete realisees. Les suites operatoires avaient ete simples. La patiente est restee asymptomatique sous Imurel ® pendant 15 mois. Elle a ete rehospitalisee pour une peritonite par perforation au niveau de la stricturoplastie de type Finney. Une exteriorisation de la perforation a ete realisee. Ce premier et unique cas rapporte de perforation sur stricturoplastie est une complication grave. Il ne doit cependant pas remettre en question l’interet de ce procede chirurgical conservateur des stenoses multiples compliquant une maladie de Crohn.

Laparoscopic cholecystectomy is the standard approach to manage symptomatic gallbladder stones. However, only twelve patients with total situs invertus have been previously reported in the literature. We report a new case of a 58-year-old patient hospitalized for acute pain of the left hypochondrium with fever. The diagnosis of acute cholecystitis with situs inversus totalis was made following clinical examination and radiological investigations. Laparoscopic cholecystectomy was subsequently performed through a modification of the technique to adapt to the mirror image anatomy.

We report a case of intraductal papillary mucinous tumor of the pancreas (IPMT) degenerated and fistulized into the stomach, the duodenum and the colon. Diagnoses of malignancy and fistulization were proven preoperatively. Pancreaticoduodenectomy extended to the body was performed. Pathological examination revealed a malignant IPMT with an invasive component. Of the 3 fistulizations tracts, both gastric and duodenal ones were malignant. To our knowledge, this is the first reported case of IPMT with colonic fistulization. Twelve months later, the patient is alive without signs of recurrence.

Curative resection with adequate lymph node dissection is the treatment of choice for gastric cancer.To determine the prognostic factors after R0 resection with DII lymph node dissection.We retrospectively assessed 126 patients who underwent R0 resection with DII lymph node dissection for gastric cancer (excluding the upper third of the stomach) in a single institution between 1991 and 2006 with median follow-up of 38.5 months (6 - 219). Prognostic factors were assessed by Cox proportional hazard model.There were 45 women and 81 men. The median age was 60 years (21 - 87). Four patients died (3.2 %). Postoperative hospital morbidity was 16.7 %. The pathologic review of the slides revealed that 50% of the tumors were stage T3 (63 cases). The median number of lymph node removed was 11 (8-40), 50% were involved. Five and 10 years survival rates were respectively 56.9 % and 40.2 %. In multivariable analysis, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were found to be independent prognosis factors.After R0 resection with DII lymphadenectomy, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were independent predictive factors for survival.

The use of an implantable room has become indispensable in the clinical practice for the cancer patients. The increasing use of these devices was associated with a greater incidence of complications.To verify the feasibility of the cephalic vein cut-down technique for placement of venous access devices.A prospective study of 58 port placements was performed at our department of general surgery. The surveillance of devices was collectively insured by the operator and by the oncologists.The indication for implantation was the infusion of intravenous chemotherapy in patients with colorectal cancer in 55.1% cases and breast cancer in 27.5%. The specific complication rate was 7%. The cephalic vein cut-down approach was used successful in 45 (77.5%) patients. When the cephalic vein could not be used, a percutaneous technique was employed using the subclavian vein in 22.4% of the patients.Cephalic vein cut-down technique should be considered a safe and feasible approach for placement of venous access devices.

Summary Objectives Hydatid cyst of liver is a parasitosis which is an endemic state in Tunisia and is a very rare cause of Budd-Chiari syndrome. The purpose of this study was to report the clinical features, radiological investigations and therapeutic management. Patients and methods A retrospective analysis of 12 patients who underwent surgery for Budd-Chiari syndrome secondary to hepatic echinococcosis between January 1990 and December 2004 was performed. Results The series included ten females and two males with a mean age of 36 years. Budd-Chiari syndrome was subacute in 75% of cases. Ultrasound showed a compression of hepatic veins by cysts with a mean diameter of 13 cm situated in at least two hepatic segments. US Doppler and CT-scan of the liver provided the diagnosis in all cases. Laparotomy was performed in all cases. Operative mortality was 8% and morbidity 66% due to biliary fistula and deep abscess formation. Hepatic vein outflow was successfully re-established in four patients. Conclusion Budd-Chiari syndrome is a rare but severe complication of hydatid cyst of the liver. Early diagnosis is necessary to improve prognosis.

Gallbladder agenesis is a rare malformation, that can lead to an unnecessary and dangerous surgery. We report a case of gallbladder agenesis in a 27-year-old woman who had a right upper abdominal pain described as intermittent without fever neither jaundice during 1 year and half. The Physical examination was normal. The abdominal ultrasound examination revealed the absence of gallbladder. The MRI-cholangiography confirmed the agenesis of gallbladder. Using this case report, we will try to remember outcome particularities of this bile duct malformation.

Internal hernias are a rare cause of acute intestinal obstruction. Herniation through the falciform ligament is rare and often diagnosed only during surgery. Abdominal computed tomography (CT), performed on an emergency basis, can help to diagnose this obstruction before surgery and select a therapeutic approach.A 60-year-old man was hospitalized on an emergency basis for symptoms that had been developing for 3 days, including tympanites and epigastric pain (torsion), associated with vomiting and the cessation of both feces and flatus. Abdominal radiography showed multiple levels of air-fluid levels in the small bowel, some projecting towards the liver area, as well as the presence of a flat intestinal loop continuous with a distended small-bowel segment. Abdominal CT suggested a diagnosis of small-bowel herniation and obstruction, very probably through the falciform ligament. The patient then underwent emergency surgery after a brief resuscitation. Intraoperative exploration confirmed the diagnosis of internal hernia through the falciform ligament. The postoperative course was without problems.Abdominal CT is the examination of choice in cases of a "new" acute intestinal obstruction. It makes it possible to diagnose the mechanism of the occlusion and especially the cause, especially for an internal hernia through the falciform ligament. It thus guides the choice of emergency surgical procedure and of appropriate approach. Once diagnosed, emergency surgery is essential to free the intestinal loop, with or without intestinal resection as a function of vitality.

To evaluate the epidemiological clinical features and herapeutic results of gastrointestinal stromal tumour (GIST).This retrospective study concerned 25 cases of gastrointestinal stromal tumour from January 1993 to December 2002. All patients have been operated and the diagnosis of GIST has been confirmed by histological and immunohistochemical study of pieces of resection or biopsies.Population include II men and 13 women with a mean age of 64 years. Symptomatology was dominated by abdominal pain (54% of cases) and the digestive haemorrhage (46% of cases). A palpable mass has been found in 29% of cases. The tumour was gastric in 17 cases, small intestinal in 6 cases, colic in 1 case and rectal in 1 case. A double gastric localization and small intestinal was found in 1 case. The mean tumour size was 8 cm (1 to 30 cm). A tumour resection has been achieved in 23 cases (96%), extended to neighbourhood organs in 2 cases. The morbidity was 12.5% and there was no operative mortality. Histologically, tumour was of low grade in 10 cases, high grade in 10 cases and unclassified in 5 cases. With a median follow up of 27 months (2 to 108), we observed 4 cases of loco-regional recurrence. Overall survival at 2 years was 74% for the whole population and 35% for the high grade. Independent prognostic factors recovered were the degree of malignancy (p = 0.01) and the local recurrence (p = 0.01).The treatment of the GIST is surgical. lymphadenectomy is superfluous. The new oral chemotherapies that inhibits Tyrosine Kinase seems to be promising.

The laparoscopic treatment of hydatic cyst of the liver is at present codified. These last years, several progresses were obtained in the laparoscopic approach of hydatic cyst by avoiding the risk of preoperative hydatic peritoneal scattering. The aim of this study is to evaluate the effect of Albendazole given before a laparoscopic management of the hydatic cyst of the liver.

Objectif En Tunisie, les etiologies des ascites exsudatives sont dominees par la tuberculose peritoneale et la carcinose. Le but de ce travail etait d’etudier la valeur predictive, respectivement des elements cliniques et paracliniques, dans le diagnostic etiologique d’une ascite exsudative, et d’evaluer les resultats de la coelioscopie diagnostique. Materiels et Methodes Nous rapportons une etude prospective s’etalant sur 10 ans, ayant inclus toutes les ascites exsudatives isolees. Nous avons exclu les patients porteurs d’une cicatrice de laparotomie et les patients inoperables ou ayant une contre indication a la chirurgie laparoscopique. Nous avons releve les signes cliniques, les donnees de l’examen cytochimique et bacteriologique du liquide d’ascite et les donnees des examens radiologiques et endoscopiques. L’exploration laparoscopique a travers une open relevait l’aspect macroscopique ; des biopsies peritoneales etaient alors realisees systematiquement ainsi qu’une biopsie hepatique dans la mesure du possible. L’etude statistique a utilise le logiciel SPSS10,0. Le degre de significativite statistique a ete fixe pour p Resultats Nous avons collige 90 cas d’ascite exsudative isolee. Il s’agissait de 59 tuberculoses et 31 carcinoses. L’âge moyen des patients etait de 47 ans avec un sex ratio de 0,5. Sur le plan clinique, les troubles du transit etaient significativement en faveur d’une carcinose (p = 0,04) tandis que la fievre et les sueurs nocturnes etaient en faveur de la tuberculose (p = 0,04) mais a chaque fois la valeur predictive positive (VPP) de ces signes etait faible respectivement de 29 % et 43 %. Concernant l’etude du liquide d’ascite, le caractere hemorragique, la faible cellularite, le faible taux de lymphocyte et la presence de cellules atypiques etaient significativement correles a la carcinose (p = 0,01) mais avec une VPP Conclusion Le diagnostic etiologique des ascites exsudatives reste difficile a etablir. Les biopsies peritoneales sous coelioscopie representent a l’heure actuelle le « Gold standard » pour le diagnostic. Remerciements, financements, autres Nous remercions les services de gastro-enterologie « A » et « B » ainsi que les services de radiologie et d’anatomo-pathologie de l’Hopital La Rabta pour la collaboration a l’elaboration de ce travail.