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Le lymphangiome kystique est une tumeur bégnine malformative rare des vaisseaux lymphatiques à localisations diverses. La localisation intra-abdominale du lymphangiome kystique est moins fréquente comparée à la localisation cervico-axillaire. Sa présentation clinique est polymorphe. Le diagnostic est évoqué par l'imagerie mais il nécessite une confirmation histologique. Le traitement de choix est chirurgical. Nous rapportons ici un cas rare de lymphangiome kystique intrapéritonéale acquis suite à une colectomie subtotale chez une patiente porteuse de maladie de Crohn à géni évolutif sévère et ayant nécessité l'introduction des anti TNF alpha. La patiente s'est présentée pour une masse para médiane droite douloureuse irréductible et non impulsive à la toux faisant retenir le diagnostic d'une éventration étranglée sur cicatrice de laparotomie médiane et amenant à opérer la patiente en urgence. L'exploration chirurgicale a montré une masse multi-kystique intra péritonéale extériorisée en partie à travers l'éventration paramédiane droite. L'examen anatomo-pathologique a permis de confirmer le diagnostic de lymphangiome kystique. Devant une exérèse chirurgicale incomplète, la patiente a eu deux séances de ponction évacuatrice en post-opératoire. C'est le premier cas de lymphangiome kystique rapporté chez un patient sous Anti-TNF alpha. Ceci pourrait être expliqué par la perturbation du système immunitaire et plus spécifiquement la population lymphocytaire. Cette association n'a pas été jusque-là prouvée et des études expérimentales sont nécessaires pour affirmer ou infirmer cette hypothèse.

Diffuse esophageal spasms is a primary motor disrder of the esophagus of unknown etiology characterized by intermettent peristalsis. This is rare condition which represents 3-5% if primary disorders of the esophagus. Diagnosis and treatment of this entity are difficult.To evaluate the frequency and the clinical and the manometric features of diffuse esophageal spasms.We conducted a retrospective study related to esophageal manometry performed between January 2000 and December 2011 regardless of the indication. Patients with meeting criteria for diffuse esophageal spasms (20 % simultaneous waves with greater than 30 mmHg pressure in the esophagus) were included.Out of 1188 patients, 13 (1,09 %) met the manometric criteria for diffuse esophageal spasms. It was 8 women and 5 men with a median age of 57 years. Dysphagia was the most relevant symptom and chest pain was only noted in 1 patient. The frequency of simultaneous waves was between 20 and 80 %. The pressure of the lower esophageal sphincter was normal in most cases.In this Tunisian manometric study, the diffuse esophageal spasms is rare. Dysphagia was the most relevant symptom and the pressure of the lower esophageal sphincter was normal in most cases.

Resume Osteoporose et osteopenie sont frequemment rapportees au cours des maladies inflammatoires chroniques de l’intestin, en particulier dans la maladie de Crohn (MC). Objectifs. – Determiner la prevalence de ces affections chez des patients atteints de MC et etudier les facteurs de risque associes. Methodes. – Etude prospective a propos de 56 cas de MC, 34 hommes et 22 femmes, âges, en moyenne, de 32 ± 10,4 ans (18–54 ans), n’ayant pas d’autres affections pouvant avoir des repercussions sur le metabolisme osseux. Une osteodensitometrie par absorptiometrie biphotonique aux rayons X (DEXA) est faite au col femoral et au rachis lombaire. Une analyse statistique uni puis multivariee a permis de degager les facteurs associes a une baisse de la densite minerale osseuse. Resultats. – Osteoporose et osteopenie sont constatees avec une frequence respective de 35,7 et 23,2 %. Une association statistiquement significative entre baisse de densite osseuse d’une part, index de masse corporelle (IMC), localisation colique de la maladie et corticotherapie d’autre part, est retrouvee. L’IMC est un facteur de risque independant des deux autres facteurs. Un etat de denutrition (IMC 2 ), observe chez 21 patients, etait associe a une DMO pathologique dans 76,2 % des cas, vs 48,6 % chez les patients ayant un IMC superieur a 18 ( p = 0,03, Odds ratio = 3,4). Conclusion. – Parmi les facteurs de risque impliques dans l’osteoporose au cours de la MC, l’etat nutritionnel joue un role important dont on doit tenir compte dans la prise en charge de ces malades.

La troisième table ronde, « Écrire et éditer depuis 2011 », a réuni Azza Filali et Abdelaziz Belkhodja autour de la modératrice Elisabeth Daldoul. Dans une intervention toute en poésie, l’écrivaine Azza Filali a défendu le droit de la littérature à rester en retrait, en décalage par rapport aux faits. L’écriture n’a pas pour mission d’expliquer le réel, mais de le transfigurer en captant l’essence de l’événement. C’est ce qui garantit sa liberté à l’égard des idées et des hommes. La liberté d’expression n’a donc pas véritablement modifié la façon d’écrire de l’écrivaine, l’imaginaire étant, selon elle, toujours libre. Abdelaziz Belkhodja, écrivain et éditeur (éditions Appolonia), a insisté sur le rôle croissant de l’écrit de façon plus large depuis 2011. Il a joué un rôle fédérateur par le biais d’internet ; le besoin de se réapproprier l’histoire et de réécrire les bases politiques et constitutionnelles a entrainé un retour aux textes fondamentaux. La révolution tunisienne a fait renaître la nécessité de l’écrit, sous des formes et des structures nouvelles. Les débats ont permis de poursuivre cette réflexion sur l’écrit et ses lecteurs. Selon Azza Filali, les bouleversements politiques n’ont pas provoqué un regain de la lecture et les formats et médias actuels font perdre à l’écrit sa dignité. D’autres ont soutenu qu’il fallait considérer la lecture dans ses nouvelles pratiques qui se rattachent à des textes plus courts. Enfin, la salle et les intervenants ont débattu du rôle des réseaux culturels étatiques et de l’enseignement dans le développement d’une lecture comme forme d’interaction et de socialisation.

Incidence of tuberculosis infection has considerably increased during the past 20 years due to the HIV pandemic and continues to be one of the most prevalent and deadly infections worldwide. Extrapulmonary tuberculosis lacks specific clinical manifestation and can mimic many diseases. It can invade neighbouring tissue and form a big cyst with manifesting clinical symptoms. We describe a rare case of 31-year-old immunocompetent man affected by a retroperitoneal abscess secondary to tubercular infection. Exploratory laparotomy and histopathological examinations of tissue were required for achieving diagnosis of tuberculosis. No pulmonary or spinal involvement was identified. The patient was successfully treated with standard four-drug antitubercular therapy.

The serum markers ASCA and pANCA can help the clinician in certain difficult situations of colites in IBD. The aim of this study was to determine the sensitivity and the specificity of each one of these markers and to establish the characteristics of the positive patients for each one.We included patients having a Crohn's disease (CD) or an ulcerative colitis (UC). These patients was compared to a control group.80 CD patients with an average age of 35.62 years, 25 UC cases with an average age of 34.92 years and 79 healthy subjects with an average age of 34.2 years were included. The ASCA were detected in 33.8% of CD cases , 8% of UC cases of RCH and 2.5% of contro group (p000.1). The pANCA were detected in 48% of UC cases, 27.5% of CD patients and 1.3% of controls (p000.1). The sensitivity and the specificity of the ASCA and the pANCA for the diagnosis respectively of CD and UC were 33.8%, 97.5% and of 48%, 97.8%. During the CD, the positivity of the ASCA was significantly associated with ileal location (p = 0.001), with the sténosant and/or fistulisant phenotyp of the disease (p = 0.006), the young age at the time of the diagnosis of the CD (p = 0.067) and at a greater frequency of surgical treatment (p = 00.7). The pANCA were more frequently found in colic location of CD (p = 0.09). During UC, the positivity of the pANCA was not associated with the sex, age, loca tion of the disease, medical treatment nor chiurgical treatment.The ASCA and pANCA are useful during some clinical situations such as differentiation between IBD otherss colitis and to distinguish CD from UC.

Cryolobulines are immunoglobulins that persist in the serum, precipitate with cold temperature and resolubilize when rewarmed. There are 3 types of cryoglobulinemia. Type II and III define mixed cryoglobulinemia. 40% approximately of patients with chronic hepatitis C virus (HCV) infection had cryoglobulinemia.To evaluate the frequency of cryoglobulinemia in a chronic hepatitis virus (CHV) infection group and determine the characteristics of positive cryoglobulinemia patients.76 patients were included. There were 53 women an 23 men. The mean age was 59.45 years. Mixed cryoglobulinemia was detected in 65 patients (85.5 %). Cirrhosis, old age and the long duration of CHV infection were the 3 factors associated with cryoglobulinemia positivity.Mixed cryoglobulinemia is a frequent manifestation during chronic hepatitis C infection virsus especially in patients with cirrhosis.

Osteoporosis and osteopenia have been reported frequently in patients with inflammatory bowel disease, most notably Crohn’s disease. Objectives. – To determine the prevalence and risk factors of osteoporosis in patients with Crohn’s disease. Methods. – Prospective study of 56 patients with Crohn’s disease, 34 men and 22 women with a mean age of 32 ± 10.4 years (18–54 years) and no history of disorders known to influence bone metabolism. Dual-energy X-ray absorptiometry measurements of bone mineral density (BMD) were obtained at the femoral neck and lumbar spine. A multivariate model including those factors significantly associated with low BMD in the univariate analysis was used to identify independent risk factors. Results. – Osteoporosis was found in 35.7% and osteopenia in 23.2% of patients. Low BMD was significantly associated with low body mass index (BMI), colonic involvement, and glucocorticoid therapy. Low BMI was an independent risk factor for low BMD. Malnutrition with BMI ≤18 kg/m 2 was noted in 21 patients, of whom 76.2% had low BMD values, as compared to 48.6% of the patients whose BMI was >18 kg/m 2 ( P = 0.03, odds ratio = 3.4). Conclusion. – Among risk factors for bone loss in patients with Crohn’s disease, malnutrition plays a prominent role that deserves attention when planning treatment programs.

Dear Editor: Cerebral venous thrombosis (CVT) is a rare complication of inflammatory bowel disease (IBD) with only few cases reported in the world literature. The precise mechanism involved in thrombogenesis is unclear and the treatment remains controversial. We describe herein four patients with IBD who developed CVT. Case 1 is a 30-year-old woman with an 8-year history of ulcerative colitis (UC). After a remission period of 4 years on salazopyrine treatment, she presented with abdominal pain, diarrhoea and rectal bleeding. Colonoscopy showed severe active pancolitis and she was treated with corticosteroids and azathioprine, to which she clinically responded. Two months later, she complained of subacute global headache and developed generalised tonic–clonic seizures and altered conscious state. On examination, blood pressure was 120/ 70mmHg and there was no fever. The patient was drowsy and had mixed aphasia and right hemiplegia. Brain magnetic resonance imaging (MRI) showed a left lateral sinus venous thrombosis complicated by a parieto-temporal infarction. She was also found to have a vena cava thrombosis which manifested by fever and abdominal pain few days after admission. Complete blood count showed a microcytic anaemia with a haemoglobin level of 9.3 g/dL and a thrombocytosis of 806×10/L. Erythrocyte sedimentation rate (ESR) was 75 mm in first hour and C-reactive protein (CRP) was 50 mg/dL. Anti-β2-glycoprotein I antibodies were present (IgG = 83 IU/mL, IgM = 16 IU/mL, N