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Sarcomas are a heterogeneous group of malignant tumors that come from mesenchymal tissues. Undifferentiated sarcoma represents approximately 20% of soft tissue sarcomas. This entity represents approximately 20% of soft tissue sarcomas. These tumors are subdivided according to their appearance. Morphological in 4 subtypes: pleomorphic cells, fusiform cells, round cells, epithelioids. We report the case of a 72-year-old woman operated for a complicated adnexal tumor. But it turned out that it was Sarcoma undifferentiated (unclassified) fusiform cell type of mesentery. It is a rare and a latent tumor. Its diagnosis is histological. Its treatment consists on surgical wide excision if possible. This type of sarcoma has a poor prognosis considering the limited benefits of radio-chemotherapy. Undifferentiated sarcoma type fusiform cells of the mesentery is an exceptional entity. Its diagnosis is difficult. Its treatment is to discuss case by case, surgery is the best option if it is possible. The prognosis is bad. This entity remains to be studied.

The perforation of the gastrointestinal tract caused by fish bone is rare, with a percentage rate of 1%. Surgical intervention is necessary in less than 1% of cases. We report a case of a 55-year-old male patient who was admitted for a rectus sheath abscess caused by perforation of the small bowel by a fish bone. He was treated surgically. Diagnosing perforation secondary to fish bone ingestion poses challenges due to its presentation., Competing Interests: The authors declare no competing interests., (Copyright: Maissa Jallali et al.)

BACKGROUND Hydatid disease is a common parasitic infection in many areas of Asia, South America, and Africa. It can affect any organ, most commonly the liver. The hydatid is often asymptomatic and the diagnosis is made when complications arise. The most common complication of this disease is opening in the bile ducts, which is a life-threatening condition causing serious acute cholangitis. We report a case of acute cholangitis caused by hydatid cyst rupture into the right bile duct. CASE REPORT A 33-year-old woman, with no medical or surgical history, presented to our Emergency Department with abdominal pain, jaundice, and fever for 3 days prior to admission. The patient was hemodynamically stable. In the examination, we noticed right upper-quadrant tenderness with guarding, icterus sclera, and negative Murphy sign. A CT scan showed a liver hydatid cyst of the 4th and 8th of segments, with intrahepatic and extrahepatic biliary duct dilation. The cyst communicated with the right hepatic bile duct via a large fistula. A diagnosis of acute cholangitis was made and she underwent conservative treatment with external drainage of the pericystic cavity through the biliary duct. The postoperative course was uncomplicated and she was discharged 15 days later. CONCLUSIONS The surgical approach to hepatic hydatid must be customized based on the specific characteristics of the cyst and associated complications. Acute hydatid cholangitis is a rare but serious complication of a hydatid cyst, which requires early diagnosis and adequate surgical management.

Acute chylous peritonitis is an uncommon medical condition that can occur suddenly, resulting in the buildup of chylous fluid in the peritoneal cavity. It is considered idiopathic because the exact cause is often unknown. The symptoms of acute chylous idiopathic peritonitis can mimic other abdominal emergencies, making it challenging to diagnose and manage, requiring a multidisciplinary approach. We present a case report of acute idiopathic chylous peritonitis miming acute abdomen, how was successfully treated with surgery, and provide a comprehensive review of the available literature on this topic. Chylous peritonitis is a rare condition whose clinical presentation mimics an acute abdomen. It is necessary to undertake careful exploration. An emergent laparotomy is indicated to treat the peritonitis and search for and treat the underlying cause., Competing Interests: The authors declare no competing interests., (Copyright: Hanen Zenati et al.)

Colorectal injuries caused by high-pressure air compressors are rare and reported especially among industrial workers. They may appear because of intended or accidental injury. In the present paper, we report a case of colorectal injuries due to air insufflation from a distance towards the anus with the clothes on, as a means of a practical joke. The patient presented one day after the trauma to the Emergency Department with complaints of severe abdominal pain and vomiting. On examination, he had signs of peritonitis. A computed tomography (CT) scan did not show any perforation. Emergency laparotomy was performed with the suspicion of pneumatic pressure-induced lesions. A total resection of the colon was made with enterostomy. The pathologic examination of the resected piece revealed multiple gangrenous areas without perforation associated to signs of peritonitis. Follow up was uneventful. A reversal of the enterostomy was scheduled., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Fournier's gangrene (FG) is a rapidly progressive necrotizing bacterial dermo-hypodermitis of the perineum and external genitalia. It represents a real medical and surgical emergency requiring multidisciplinary care. Our study was based on the retrospective analysis of 18 cases of FG, collected in the Department of General and Visceral Surgery of Fattouma Bourguiba University Hospital in Monastir over an 18-year period extending from January 2000 to December 2018. Our series included 18 cases of FG collected over an 18-year period, an annual incidence of one case per year. The average age of our patients was 58 years (36 to 77). The male prevalence was clear. Diabetes and old age were found to be the major risk factors. The treatment was based on an aggressive surgical debridement remains to be the cornerstone of therapy and is commonly preceded by patient preparation for the surgical act by perioperative resuscitation and broad-spectrum antibiotic therapy, possibly accompanied by hyperbaric oxygen therapy (HBOT). The vaccum assisted closure (VAC) therapy is also used, which is a non-invasive system that promotes open wound healing. Healing techniques can be once the septic risk is controlled. Dressings topical treatments, such as fatty substances or calcium alginate, in addition to skin grafts, musculo-neurotic or musculo-cutaneous cover flaps can be used. During the follow-up period, no reccurrence occurred in 14 out of the 18 cases (2 patients were lost to follow-up and 2 patients died). A colostomy was closed in 10 out of 11 cases with simple follow-ups. Restorative surgery (partial thickness skin graft) at the perineal level was performed in only one case. Despite the better understanding of its etiopathogenesis, the advent of targeted antibiotic therapy, the establishment of a better codification of surgical procedures, the contribution of hyperbaric oxygenation and reconstruction techniques, mortality rates are still high and FG remains a real health threat, thus constituting a real medical and surgical emergency., Competing Interests: The authors declare no competing interests., (Copyright: Faiez Boughanmi et al.)

Introduction: Intrauterine devices (IUDs) are commonly used as a contraceptive method. However, they may cause rare but potentially serious complications such as migration through the uterine wall and gastrointestinal perforation., Presentation of Case: We report a case of a 26-year woman, carrying an IUD for 2 years, who presented to the emergency with pelvic pain with breakthrough bleeding. Abdominal imaging revealed the presence of two devices the first of which was located in the uterine cavity and the other in the wall of the sigmoid colon associated with a 5-centimeter pelvic collection. Intraoperatively, the IUD was found to be embedded in the wall of the sigmoid colon which was removed by wedge resection of the involved segment followed by a closure of the puncture with drainage., Discussion: The Intrauterine Device (IUD) is an effective method of contraception, relatively well tolerated, reversible, inexpensive and widely used. However, it is not without risk. Indeed, serious complications can occur such as uterine perforation and migration to adjacent abdomino-pelvic structures. Our observation illustrates its rarity given the fact that this complication has been observed the first time in our department over the last ten years., Conclusion: The migration of IUD must be treated even in asymptomatic patients due to the risk of severe complications., (Published by Elsevier Ltd.)

Introduction: Congenital bile duct cysts (CBDC) is a rare congenital malformation. It results from an anomaly of the biliopancreatic junction (AJBP). This condition is often diagnosed at a young age. Although, it can be asymptomatic and discovered only at an advanced age. The aim of our work was to describe the diagnosis, therapeutic and evolutionary aspects of BVCD through a series of 11 cases diagnosed in adult cases., Methods: This is a descriptive, retrospective and monocentric study. It collects patients operated for CBDC between 01/08/1999 and 30/06/2009., Results: The mean age was 45.3 years. Two men and nine women. The right hypochondria pain has been reported by all patients. On physical examination, jaundice was noted in five cases and the rest of the examination was normal. Biology showed cholestasis in six cases and cytolysis in four cases. Only one patient had hyperamylasaemia (five times normal). The preoperative diagnosis of a VBCD was reported in eight cases. Peroperative cholangiography (OCP) allowed to make the diagnosis and classify the CBDC according to the classification of Todani. Microscopic examination demonstrated three cases of associated gallbladder adenocarcinoma. The operative follow-up was simple for ten cases. A case of surgical recovery was necessary due to infection of necrotic pancreatitis. The mean follow-up was 40.6 months with extremes from one month to seven years. Only one case of death has been reported. No patient has presented a later biliary tract degeneration. Only one case of secondary biliary cirrhosis due to repeated attacks of angiocholitis has been reported., Conclusion: CBDC is rare. It must be suspected at any age. It is characterized by the increased risk of degeneration. Radiological examinations can suspect the diagnosis in younger and asymptomatic patients to ensure a well-conducted and timely surgical treatment.

Introduction: Gastroblastoma is a rare gastric biphasic tumor with both epithelial and mesenchymal components. To the best of our knowledge only eight cases have been reported in the English literature till date., Presentation of Case: We report a case of a 29-year-old female, hospitalized for epigastric pain with poor general condition. An upper gastrointestinal endoscopy showed a polypoid mass in the stomach near the gastric cardia suspicious of gastrointestinal stromal tumor. The patient underwent atypical proximal gastrectomy with splenectomy. Detailed histopathological examination of the resected specimen revealed the diagnosis of gastroblastoma. After six months, the patient developed loco-regional recurrence for which surgical debulking was performed., Discussion: Gastroblastoma is predominantly seen in young adults with non-specific complaints. They appear as submucosal lesion in the stomach mimicking gastrointestinal stromal tumor. Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment. On histology, they consist of mesenchymal component which stain positively for vimentin and CD10 and epithelial component which is positive for cytokeratin on immunohistochemistry., Conclusion: Gastroblastoma is a malignant tumor with risk of local recurrence after curative resection., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)