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The most frequent cause of gynaecological hemoperitoneum is ruptured ectopic pregnancy. An uncommon cause of hemoperitoneum is rupture of uterine leiomoyoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to ruptured uterine leiomyoma vessels. The patient was treated with myomectomy and the postoperative course was uneventful. These case suggest that massive intra peritoneal hemorrhage associated with uterine leiomyoma should be considered in women with hypovolemic shock and pelvic mass. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum haemorrhage is the leading cause of maternal morbidity and mortality worldwide. It requires a multidisciplinary approach. Transfusion strategy is essential, playing a key role in maternal prognosis. This study aims to determine FFP/RBC ratio (plasma frais congelé/concentrés de globules rouges; fresh frozen plasma/red blood cells) during the treatment of serious postpartum haemorrhages., Methods: We conducted a retrospective study at a Maternity Referral Center (level III) in eastern Tunisia over a period of 4 years (2009-2012). All parturients admitted due to severe postpartum bleeding requiring transfusion of more than 4 Units of RBC during the first 3 hours or of more than 10 Units of RBC during the first 24 hours of treatment were included in the study., Results: 47 parturients were enrolled in our study. The diagnosis of PPH was made on the basis of vaginal bleeding in 28 cases and following cesarean section in 19 cases. Preoperative hemoglobin level was of 6.3 g/dl. Transfusion ratio (FFP/RBC) was 1/0.7., Conclusion: During tratment transfusion ratio was greater than that indicated in the existing guidelines stating an early and massive administration of FFP with a FFP/RBC ratio ranging between 1/2 and 1/1. Fibrinogen (Fbg) and tranexamic acid should be administered as early as possible. The use of recombinant activated factor VII (rFVIIa) should remain the ultimate treatment option., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts.

Sweet's syndrome has been reported in association with inflammatory diseases such as Crohn's disease. It has also been reported in association with several drugs. Here, we report a rare case of Sweet's syndrome induced by azathioprine in a patient with Crohn's disease.

Context: Pancreatitis is a very rare adverse effect of tamoxifen with only six cases of tamoxifen-associated pancreatitis reported in the English literature until now. In these cases, rechallenge with tamoxifen was not carried out., Case Report: We report a case of recurrent severe acute pancreatitis in a 44-year-old female induced by tamoxifen therapy and review the literature with regards to tamoxifen-associated pancreatitis., Conclusion: Clinicians should be aware of the risks of developing severe acute pancreatitis when using tamoxifen therapy. If tamoxifen is suspected as the probable causative agent, rechallenge with this drug should be prohibited.

Hydatid cyst of the liver is a parasitic disease caused by Echinococcus granulosus. The principal complications are infection, biliary duct fistula, and rupture into the peritoneum or chest. Diagnosis has become easier with advances in ultrasonic imaging and CT scanning. Surgery remains the most effective treatment but postoperative complications arise in 30% of cases, particularly when the surgical approach is conservative. Radical surgical approaches give better results and should be used in most cases. Biliocutaneous fistula and infection of the residual cavity are the most common postoperative complications and result in prolonged hospitalization and excess costs. New therapeutic strategies incorporate endoscopic, percutaneous, and medical therapies with surgery and have allowed an improvement in morbidity and mortality due to hydatid cysts of the liver. Until immunization becomes a possibility, preventive measures are necessary to avoid disease recurrence.

Tuberculosis abdominal lymphadenitis is rare and exceptionally revealed by digestive complications. We report one case of digestive stenosis due to duodenal external compression by tuberculosis lymph nodes. Surgical resection of periduodenal lymph nodes was performed without gastric resection or gastrointestinal anastomosis. Medical treatment of tuberculosis was successful and the patient remains asymptomatic.

The most frequent cause of gynaecological hemoperitoneum is ruptured ectopic pregnancy. An uncommon cause of hemoperitoneum is rupture of uterine leiomyoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to ruptured uterine leiomyoma vessels. The patient was treated with myomectomy and the postoperative course was uneventful. These case suggest that massive intra peritoneal hemorrhage associated with uterine leiomyoma should be considered in women with hypovolemic shock and pelvic mass.

Acute appendicitis is the most common surgical emergency occurring during pregnancy. To determine possible methods for improving diagnostic and management accuracy, a retrospective review was conducted of 23 pregnant patients who underwent laparotomy with a preoperative diagnosis of acute appendicitis. Gestational stage at presentation included the first trimester in 2 patients, the second trimester in 6 patients and the third trimester in 15 patients. Eighteen patients (78.26%) had pathologically proven acute appendicitis. Perforation occurred in 2 patients. Postoperative fetal complications included one intrauterine death (4.3%) and three premature births. There was no maternal deaths and morbidity was limited to atelectasis and wound infection in 4 patients. Gestational physiologic changes make difficult the diagnosis of acute appendicitis. Prompt surgical intervention prevent maternal complications and foetal loss.

Intestinal intussusception is a rare condition in adults. In most cases, it is caused by a benign or malignant intestinal tumor. Primitive forms are infrequent, and their occurrence following troncular vagotomoy has never been described in the literature, according to our knowledge. Two cases of post-vagotomy jejuno-jejunal intussusception are reported.

Final surgical treatment of perforated duodenal ulcer is not admitted by all authors. The aim of this study is to evaluate final treatment of perforated duodenal ulcer among 110 patients. 74.5% were aged less than 41 years. 107 patients underwent surgery. Treatment was based on: truncal vagotomy with pyloroplasty (99 cases), truncal vagotomy with closure of duodenal perforation and gastroentero-anastomosis (5 cases), truncal vagotomy with antrectomy (1 case) and simple closure of the duodenal perforation (2 cases). Mortality of truncal vagotomy with pyloroplasty was about 1%. According to the visick evaluation, clinical results were good in 95.3% cases without recurrent ulcer with a mean follow up of 4 years. According to our results truncal vagotomy with pyloroplasty seems to be a safe procedure in the management of perforated duodenal ulcer and more over gives good long-term results in control of peptic disease.

Post-operative persistent biliary fistulae due to hydatid cysts are difficult to manage. We report 3 cases of external biliary fistulae complicating surgery for hepatic hydatid cyst (2 cases) and intraperitoneal hydatid cyst (1 case). Endoscopic sphincterotomy was successful with closure of the fistulae in all patients. This procedure should be the first-line treatment for post-operative external biliary fistulae related to liver hydatid disease. Usually difficult and haemorrhagic surgery can thus be avoided.

Hydatic cysts of the liver can rupture into the thorax. The aim of this work was to demonstrate how abdominal access can be used in most cases. We report 44 cases of hydatic cysts which ruptured into the thorax among a series of 1411 hydatic cysts of the liver operated between 1974 and 1995. Abdominal ultrasound and chest x-ray provided the diagnosis preoperatively in 35/42 operated cases (one case of spontaneous elimination of a hydatic membrane via a cutaneous orifice and one case of preoperative death). Thoracophrenolaparotomy was used in 12 cases, thoracotomy with laparotomy in 6, thoracotomy alone in 5 and laparotomy alone in 19. Pulmonary resections were performed in 18 cases. No procedure could be performed in one patient who died at the beginning of surgery. A breach in the diaphragm was repaired in 41 cases. The dome of the cyst was resected in 29 cases and complete pericystectomy was performed in 12. There were 7 post-operative deaths. There were no deaths in the abdominal access patients. All emergency problems were controlled with abdominal access. Thoracic access was reserved for specific cases.