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Ileal Gastrointestinal tumor are usually asymptomatic and small bowel obstruction is a rare condition.

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.

INTRODUCTION AND IMPORTANCE: Broad ligament hernia is a rare type of internal hernia caused by the protrusion of viscera through an abnormal defect on the broad ligament. The diagnosis is difficult and challenging. Usually, it requires an urgent laparotomy to avoid intestinal necrosis or even the death of the patient. CASE PRESENTATION: A 34-year-old woman, with no medical or surgical history, presented to our educational hospital with acute abdominal pain and recurrent vomiting for the last two days. After clinical and radiological investigations, the diagnosis of an internal hernia through the broad ligament was confirmed. An emergent laparoscopic repair was performed and the postoperative course was uneventful. CLINICAL DISCUSSION: We report a rare case of an internal hernia through the broad ligament and we describe the challenges associated with the preoperative diagnosis and therapeutic approach. The defect in the broad ligament may be unilateral or bilateral and congenital or acquired. There are no specific clinical and radiologic findings. Surgery remains the cornerstone of the treatment. CONCLUSION: Early diagnosis and rapid management of broad ligament hernia are necessary to prevent catastrophic sequelae. It is important to keep in mind that internal hernia like broad ligament hernia can occur in patients with no surgical history.

Spontaneous perforation of the extrahepatic bile duct (SPEBD) is an exceptional disease especially in adults. Early diagnosis and aggressive therapy are crucial to avoid the high mortality. We report a biliary peritonitis secondary to bile duct perforation in adult man and we propose a surgical management algorithm

Resume Introduction L’occlusion colique est le mode de revelation de 8 a 29 % des cancers du colon. L’objectif de notre travail est de comparer la mise en place du stent versus colostomie de decharge dans la prise en charge du cancer du colon gauche en occlusion. Materiel et methodes Nous avons realise une recherche systematique de la litterature a partir de l’interrogation de la base de donnees MEDLINE, EMBASE et Cochrane Library, pour identifier les articles relatifs a la comparaison du stent vs colostomie publies entre 2000 et 2016. Resultats La recherche electronique nous a permis d’identifier 6 etudes. Une seule etude etait prospective comparative. Trois etudes etaient dans un but curatif. Le nombre total etait 7205 malades. Dans le groupe « stent », il y avait une diminution de la duree moyenne de sejour par rapport au groupe « stomie » et une diminution du cout avec une relation statistiquement significative. Par ailleurs, il n’y avait pas de difference entre les deux groupes en termes de mortalite hospitaliere et de morbidite precoce. Conclusion Devant une occlusion neoplasique du colon gauche, le choix entre colostomie ou stent colique depend de la strategie therapeutique. En effet, en cas d’une strategie curative ou d’administration d’anti-angiogeniques il est recommande de pratiquer une colostomie. Cependant en cas de traitement palliatif, la prothese colique est le traitement de choix.

INTRODUCTION: le traitement des larges fistules kysto-biliaires ne fait pas l´unanimitA© des auteurs en l´absence de consensus ou de niveau de preuve A©levA©. Les mA©thodes chirurgicales sont controversA©es entre traitement radical permettant de suturer la fistule en zone saine et le traitement conservateur qui pose des problA¨mes de rA©paration. Le but de cette A©tude est de comparer les diffA©rentes techniques chirurgicales du traitement conservateur des larges fistules kysto-biliaires. METHODES: A©tude rA©trospective de 54 fistules larges, menA©e au service de chirurgie gA©nA©rale du CHU Habib Bourguiba A Sfax durant 9 ans (2010 - 2018). RESULTATS: il s´agit de 44 patients. L´A©chographie abdominale a permis de suspecter une ouverture dans les voies biliaires dans 18 cas (47,4%) alors que la tomodensitomA©trie (TDM), a suspectA© une ouverture chez 28 patients (68.3%). Le traitement des fistules A©tait rA©alisA© par la technique du DITFO dans 18 cas (33,3%), de PERDROMO dans 11 cas (20,4%) et le drainage bipolaire dans 25 cas. Le taux de morbiditA© chirurgicale spA©cifique A©tait de 31,5% dominA© par une fistule biliaire post opA©ratoire dans 18,5% des cas. La technique de DITFO A©tait associA©e A un sA©jour hospitalier le plus court (p=0,028) et une morbiditA© plus basse (22,2%) sans diffA©rence statistiquement significative. CONCLUSION: la technique de DITFO reprA©sente la technique de choix dans le traitement des fistules kysto-biliaires (FKB), elle a une morbiditA© moins A©levA©e et le sA©jour hospitalier le plus court.

The objective of our study was to determine the predictive factors of their occurrence during conservative surgical treatment of the hepatic hydatid cyst (HHC).We carried out a retrospective review of patients who had undergone conservative surgical treatment of the HHC during 6 years. Univariate analyzes were used to determine the predictive factors of an occult cystobiliary fistula (CBF).This current study included 105 patients. Concerning the predictive factors of an CBF regardless of its pattern of evolution, we noted that the presence of fistula was statistically correlated with the a cyst size (bigger than 8.65 cm ; p = 0.003) and with advanced age (p=0.035). Interestingly enough, the correlation to a degenerated cyst (p=0.069) were of little significance.The size of the cyst greater than 8.65 cm and the advanced age are the risk factors of CBF according to our study.Biliary Fistula, Diagnosis, Echinococcosis, Hepatic, Prevention and control.

Background: Internal fi stula with adjacent viscera during acute pancreatitis is a rare complication. Due to their anatomic localization, colon, duodenum or stomach may be involved. Pancreatico-colonic fi stula is associated with a higher septic risk and surgery is usually mandatory.

The liver is the most frequent anatomic location of hydatid disease. Imaging modality nowadays are numerous and increasingly efficient. The objective of our study is to precise the correlation between Ultrasonography, computed tomography and intraoperative findings on the different characteristics of hepatic hydatid cyst.We conducted a prospective study including all hepatic hydatid cyst operated in 2015. We evaluated statistically, by calculating the coefficient K or the intraclass correlation coefficient, the concordance between Ultrasonography, computed tomography (CT) and intraoperative findings on the different characteristics of hepatic hydatid cyst.In our study, we included 48 patients with 79 hepatic hydatid cysts. It was concluded that Ultrasonography performs better than CT in the study of type of cyst, pericyst, relationships with portal vein and main bile duct. While CT is better than echography in terms of number, localizations of cyst, relationship with the vena cava inferior, other localizations and the remaining liver, both examinations remain limited in the determination of pericyst characteristics and the identification of biliary fistula.Ultrasonography and CT cannot provide accurate data for the study of pericyst and biliary fistula, hence requiring prospective studies of the place of MRI and intraoperative echography in this domain.Diagnostic, Imaging, Echinococcosis, Hepatic, Intraoperative Care.Il fegato rappresenta la più frequente sede di localizzazione delle cisti idatidee, e le modalità diagnostiche per immagini sono attualmente numerose e sempre più efficienti. Lo scopo di questo studio è quello di precisare i rapporti tra ecografia e CT da una parte, e reperti intraoperatori delle differenti caratteristiche delle cisti idatidee dall’altra. Si tratta di uno studio prospettico che include tutte le cisti idatidee epatiche operate nel 2015, valutando statisticamente, mediante il calcolo del coefficiente K o di quello della correlazione tra classi, la concordanza tra US, CT e reperti intraoperatori riguardo alle differenti caratteristiche della cisti idatidea. Lo studio ha incluso 48 pazienti con complessive 79 cisti idatidee epatiche. Si è conlcuso che l’ultrasonografia è più efficiente della CT per quanto riguarda il tipo di cisti, del pericistio, la relazione con la vena porta e l’epatocoledoco. Mentre la CT è migliore dell’ecografia per quanto riguarda numero e localizzazione delle citi, ed i rapporti con la vena cava inferiore, le altre localizzazioni ed il restante parenchima epatico, entrambe le metodiche restano limitate nei confronti delle caratteristiche del pericistio e l’identificazione delle fistole biliari. Di qui l’esigenza di studi prospettici sul ruolo della RMN e dell’ecografia intraepatica per fornire dati accurati anche riguardo queste caratteristiche.

Colonic occlusion is the mode of discovery of 8 to 29% of colonic neoplasms. Our objective is to compare the placement of stent versus colostomy in the management of obstructing cancer of the left colon.We have carried out a systematic search of literature from MEDLINE, EMBASE and Cochrane Library database to identify articles related to the comparison of stent versus colostomy published between 2000 and 2016.We have identified 6 studies. Only one study was prospective comparative. Three studies were for curative purposes. The total number of patients was 7205. In the "stent" group, there was a decrease in the average length of hospital stay compared to the "stoma" group and there was a decrease in cost with a statistically significant relationship. There was no difference between the two groups in terms of 4 hospital mortality and early morbidity.In case of neoplastic occlusion of the left colon, the choice between colostomy or colonic stent depends on the therapeutic strategy. Indeed, for curative strategy or administration of anti-angiogenics, it is recommended to practice a colostomy. However, for palliative treatment, colonic stenting is the treatment to follow.

Colon is a very rare site of metastasis from breast cancer. Its diagnosis is challenging. We report a new case of 56-year-old woman who was previously treated for lobular breast carcinoma 11 years ago. Radiologic features on barium enema and computed tomography (CT) were concordant with primary cancer of the transverse colon. The true diagnosis was made by immunohistochemical study of hemicolectomy specimen, which showed positivity for CA 15-3, cytokeratin 7, estrogen receptor, and progesterone receptor and negativity for cytokeratin 20 and carcinoembryonic antigen (CEA). The patient received chemotherapy and hormonal therapy. After a follow-up of 17 months, she is still alive with no evidence of recurrence. Literature review revealed that diagnosis should be suspected in the presence of bowel disorders in women with history of breast cancer even several years later. Surgery is beneficial in only isolated colonic metastasis. Otherwise, the treatment is based on systemic therapy. The prognosis is usually poor.

Pure squamous cell carcinoma (SCC) of gallbladder is a very rare tumour and is responsible for only 3% of the malignant neoplasm of this organ. We report a case of SCC of gallbladder in a 58-year-old woman. Through this new observation, we propose to study the clinicopathologic features, pathogeny and treatment of this rare entity.

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.

Strangulation of an acute rectal prolapse is a rather unusual entity that represents a surgical emergency. We describe an extremely rare case of recurred, incarcerated, and strangulated acute rectal prolapse. The patient underwent emergency perineal rectosigmoidectomy (the Altemeier operation). The postoperative course was uncomplicated with an excellent final result.

Pancreatic localization of hydatid disease is atypical and extremely rare; it accounts for less than 1% of cases. Preoperative diagnosis may be difficult regarding the absence of clinical or radiological signs.We report a retrospective study of twelve cases of hydatid cyst of the pancreas over a period of 30 years (1980 to 2010). By means of our study we try to clarify clinical manifestation, radiological features and therapeutic modalities.The twelve patients consisted on eight men and four women with an average age of 25.8 years. Abdominal pain was the most frequent clinical signs. Jaundice was noted in 4 cases and abdominal mass in 2 cases. Hydatid serology, practiced in 7 cases was positive in 6 cases. Abdominal ultrasound, practiced in 11 cases, completed in 7 cases by abdominal computed tomography (CT), showed cystic lesions in 10 cases, in 7 cases the cystic lesion was dependent of the pancreas. All patients were operated by median laparotomy. Partial cystectomy was performed in six cases, cystic punture in one case, pancreaticoduodenectomy one case, distal spleno pancreatectomy in 2 cases, distal pancreatectomy in one case and trans-duodenal puncture of the cyst in 2 cases with pancreatico-duodenal anastomosis in one case.Hydatid cyst of the pancreas is extremely rare even in endemic countries, it should be considered in the differential diagnosis of cystic lesions of the pancreas. Ultrasound and CT coupled with hydatid serology could be helpful for the diagnosis. Surgery remains the treatment of choice in pancreatic hydatid cysts.

Gallbladder tuberculosis is an exceedingly rare disease. A correct preoperative diagnosis of Gallbladder tuberculosis is difficult, and it may be confused with different gallbladder diseases. We present a new case of a patient who underwent surgery with the preoperative diagnosis of cholelithiasis. Diagnosis of gallbladder tuberculosis was obtained with the histological examination of the frozen section.

Les tumeurs stromales gastro-intestinales sont des tumeurs mésenchymateuses peu fréquentes. Elles sont localisées préférentiellement eu niveau de l'estomac. La localisation rectale reste rare. A un nouveau cas de tumeur stromale du rectum ainsi qu'une bref revue de la littérature, on se propose d’étudier les particularités cliniques, radiologiques et thérapeutiques de cette entité rare.

Intussusception is a well-known cause of acute abdomen in the pediatric population. Traumatic intussusception is exceedingly rare, with only 22 cases reported in the English language literature. We report a case of jejunojejunal intussusception that happened after blunt trauma to the abdomen in a 10-year-old boy. The patient presented with clinical presentation of small-bowel obstruction. Through this case and brief review of the literature, we try to focus on the etiology of this rare condition, the clinical particularities, and treatment modalities.

Internal hernias of the abdomen are uncommun. They represent less than 1% of bowel obstruction cases. The left paraduodenal hernia is the most frequent type of internal hernias. We report a case of 77 year-old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal paraduodenal hernia by showing incarcerated jejunal loops in a paraduodenal hernia through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities. KEY WORDS: Computer tomography Internal hernia, Paraduodenal hernia, Small bowel obstruction.Le ernie addominali interne sono entità rare e rappresentano meno del 1% delle cause di occlusione. L’ernia paraduodenale sinistra è comunque il tipo più frequente di ernie interne. Si riferisce il caso di una paziente di 77 anni giunta all’osservazione per l’insorgenza di una ostruzione intestinale insorta da due giorni. La TC addominale dimostrava anse ileali a sede retroperitoneale racchiusa in un sacco peritoneale. L’esplorazione chirurgica confermò la diagnosi di ernia interna paraduodenale sinistra dimostrando anse intestinali incarcerate in un’ernia paraduodenale attraverso un ristretto passaggio posto alla sinistra dell’angolo di Treitz. All’intervento chirurgico venne effettuata la riduzione dell’ernia e la chiusura del colletto erniario ed il seguito postoperatorio fu privo di complicanze. Con l’occasione di questa osservazione ed una revision della letteratura, si cerca di ricostruire le caratteristiche cliniche e radiologiche di questa patologia e di delineare le modalità terapeutiche.