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Androgenetic alopecia (AGA) is a pathology involving the aesthetic prognosis. Hair transplantation is among best treatments. The principle of hair micro-grafts during AGA consists in taking hair from the non-androgen-dependent occipital area to transplant them with their root in the sparse androgen-dependent areas. Herein, we report 10 cases of the different types of post-transplant inflammatory complications.We included patients referred to our center by their dermatologists or hair transplant surgeons for inflammatory cicatricial alopecia or hair loss observed after the hair transplant.Ten patients (eight men and two women) were included. These patients represented 0.08% of all consultations in our center. The indication for hair transplantation was AGA in all of our patients. The technique used for the transplant was follicular unit extraction (FUE) in seven cases and follicular unit transplantation (FUT) strip in three cases. None of the patients had pathology of the scalp or an inflammatory dermatosis before the operation. The inflammatory complications found were lichen planopilaris (LPP) in seven cases, erosive pustulosis of the scalp (EPS) in two cases, and superficial folliculitis (SF) in 1 case.Our series highlight the rarity of inflammatory complications that occur after a hair transplant. We demonstrate through this work that a hair transplant can trigger inflammatory pathology a few months after the act. We show also, the importance of detecting the rough forms of lichen before an intervention, hence the interest of the systematic dermatoscopic examination during the preoperative consultation.

Sir, Eccrine spiradenoma (ES) is a rare and benign adnexal tumor originating from the eccrine glands. It is usually located in the truncal region and is most common in young adults twenty to forty years old. Herein, we report a clinical, dermoscopic, and histological description of the case of an elderly male with an atypical tumor localization. A 74-year-old male presented with a painless, nodular mass on the anterior aspect of the left forearm, growing progressively over the previous year. He had no medical history. A dermatological examination revealed a solid, skin-colored nodule with a central ulceration and a peripheral collar, measuring approx. 1 to 1.5 cm in diameter, not bleeding on contact (Fig. 1a). There were no similar nodules or palpable lymph nodes. Dermoscopy was performed with DermLite 4. It demonstrated a vascular pattern of branched vessels and a central ulceration with a reddish background and scattered blue clods. It also showed a yellowish-brown, serohematic crust surrounding the ulceration and the reddish background (Figs. 1b and 1c). Upon histopathologic examination, the excised nodule revealed a tumoral proliferation, which was well demarcated from the surrounding tissue. It consisted of sharply defined lobules and cords intertwined into a puzzle-like structure (Fig. 2a). Two cell populations were identified: small basaloid cells and larger cuboidal ones. The cells displayed high mitotic activity yet no abnormal mitotic figures and no necrotic background. The section also showed numerous amorphous eosinophilic deposits within the cell cords and a richly vascularized stroma (Fig. 2b). The excision was complete and there were no recurrences on subsequent checks.

Introduction and importance The gallbladder volvulus is a rare but life-threatening condition characterized by an axial torsion of the gallbladder along the cystic pedicle, causing gallbladder ischemia and necrosis. This paper aims to present and discuss a rare case of gallbladder volvulus. This case report has been reported in line with the SCARE criteria 2020 [1]. Case presentation We report the case of a 90-year-old female patient who presented to the emergency room with sharp right upper abdominal quadrant pain of acute onset associated with vomiting, evolving for the last 12 h. She had no fever nor jaundice. Her body mass index (BMI) was 22. She had kyphosis, and scoliosis. Physical examination found tenderness with a palpable mass in the right upper abdominal quadrant. Laboratory test results showed leukocytosis at 11600 /mL and a high C-reactive protein rate at 40 mg/L revealed acute calculous cholecystitis features. However, emergency laparotomy was performed and discovered a gallbladder volvulus. A detorsion and cholecystectomy were performed with a good outcome. Clinical discussion The preoperative diagnosis of gallbladder volvulus is difficult due to its misleading clinical presentation mimicking acute cholecystitis. The presence of the three highly suggestive triad clinical signs should encourage the radiologist to search for a gallbladder with a horizontal orientation and located outside its anatomical fossa connected to the liver by a conical structure corresponding to the twisted pedicle in ultrasonography. Unlike ordinary acute cholecystitis, which may sometimes tolerate an initial conservative medical treatment, gallbladder volvulus management is always an emergency cholecystectomy. Conclusion Despite the clinical similarities with the classical acute calculous cholecystitis, gallbladder volvulus is more likely to result in fatal outcome. Therefore, a high level of clinical suspicion is necessary to save lives., Highlights • The gallbladder volvulus is a life-threatening condition related to its pedicle strangulation. • When suspected, a complementary Doppler study should be warranted. • It requires urgent cholecystectomy.

Background Management of gastrointestinal perforation by ingested foreign bodies remains a topical subject following technological progress. This work aims to analyze, the epidemiological features, the management in a Tunisian surgical department and to access the most realistic and beneficial management of gastrointestinal perforation by ingested foreign bodies in a low-income country, where there is a paucity of information regarding this subject Methods This is a retrospective review of 24 patients with gastrointestinal perforation by ingested foreign bodies treated in the General Surgery department of Jendouba Hospital in Tunisia from January 2010 to December 2019. Results 24 patients with gastrointestinal tract perforation by an ingested foreign body were managed at our surgical ward. The mean age of patients was 56.58 years with extreme ranging 25-72 years with a male to female ratio 2/1. Three patients (12.5%) had psychiatric disorder, one had myasthenia (4.1%), two patients were alcoholics (8.33%), three patients were toothless (12.5%) and two (8.33%) patients were veiled. According to ASA classification, 6 (25%) patients were ASA I, 15 (62.5%) patients ASA II, 3 (12.5%) ASA III. The mean duration of symptoms was 2.16 days and ranges from 1 to 7 days. All patients (100%) presented to the emergency department with acute abdominal pain. Sixteen patients (66.66%) had a fever, twelve (50%) had vomiting and four (16.66%) had a sub-occlusive syndrome. All patients had performed abdominal x-ray. The foreign bodies were objectified in only six cases (25%). CT scan was performed in 16 (66.66%) patients and the location of ingested foreign bodies was obtained in 9 patients preoperatively (37.5%) and in 4 patients (16.66%) after proofreading. All the 24 patients underwent surgery and they were operated during their initial hospital stay. The most common site of perforation was the terminal ileum (62,5%) followed by the duodenum (12, 5%). Enterectomy was the procedure of choice in 20 patients (16 underwent an enterostomy and 4 patients underwent an enteroanastomosis) and four patients had a simple suture. The foreign body was found in all patients. Two patients developed postoperative complications: one case of intraabdominal abscess and one patient had a wound dehiscence . The median length of hospital stay following surgery was 4.08 days (range 2-7 days). The mortality rate was 4.16 %. All patients managed with enterostomy, had their stoma closed after 3-5 months. Conclusion Open Surgery still remains a management with satisfactory morbidity, mortality and length of hospital stay. However, we estimate that for low/middle-income countries, investing in laparoscopy, for these cases, would be more realistic and more beneficial allowing improving more the outcomes. For this fact, promoting radiologic diagnosis is highly recommended in order to increase prospective identification of the foreign body location and perforation site, allowing a safe laparoscopic approach.

BackgroundHydatid cyst is an infectious disease caused mainly by E. Granulosus, which is generally considered benign, however, the rupture of the hepatic Hydatid Cyst to the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physician, radiologists, aneasthetists and surgeons). This study aims to describe the various clinical and paraclinical features of ruptured liver hydatid cyst in the peritoneal cavity, and to detail the appropriate treatment.Materials and MethodsFifteen cases of ruptured liver hydatid cyst into the abdominal cavity that underwent urgent surgery were collected over a period of eight years. Results There were nine men and six women. The average age was 38 years. Two patients were admitted with abdominal trauma. All patients presented with acute abdominal pain. Only one patient had anaphylactic shock. Abdominal ultrasound showed discontinuous cyst wall and intraperitoneal fluid in 100% of cases. Abdominal computed tomography (CT) showed discontinuous cyst wall with intraperitoneal fluid in 100% of cases. Intraoperatively, the intraperitoneal fluid was clear in thirteen cases and purulent in two. All patients underwent unroofing procedure associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days and the mean follow-up was 19 months. No case of recurrence was reported among the patients.ConclusionRupture of a hydatid cyst in the abdominal cavity should be considered as a differential diagnosis in every case of an acute abdominal pain, especially in endemic areas and in presence of an allergic reaction or signs of anaphylactic shock. Combined medical and surgical care starting in the emergency room is the only guarantee of a good outcome.

BackgroundSigmoid volvulus is the most common type of volvulus. Its epidemiological features as well as its management differ between developed and developing countries. Tis work aims to analyze the epidemiological features and to access the surgical management of sigmoid volvulus in Tunisia, which is a developing country from North Africa and where there is a paucity of information regarding sigmoid volvulus.MethodsThis is a retrospective review of 64 patients with sigmoid volvulus treated in the General Surgery department of Jendouba Hospital in Tunisia from January 2005 to December 2019. In the absence of endoscopic management, all patients underwent surgical treatment.Results:64 patients were treated for acute sigmoid volvulus. There were 54 (84.4%) men with a male to female ratio of 5.4/1. The mean age was 62 years. The classic triad of abdominal pain, abdominal distention and constipation was reported in 56 (87.5%) patients. The mean duration of symptoms was 4.2 days. The accurate preoperative diagnosis was made in 58 (90.62%) cases. Forty patients (74%) had viable bowel obstruction and all of them had resection and primary anastomosis. Sixteen patients had gangrenous bowel obstruction of which 6 patients had resection-primary anastomosis and 10 had Hartmann’s procedure. Out of the total five deaths reported, there were only two among patients who had resection-primary anastomosis for gangrenous bowel obstruction. The commonest post-operative complication was surgical site infection in 5 cases (35.71%). The median length of hospital stay following surgery was 8 days (range 5 – 18 days). None of the patients had recurrences of volvulus after median follow up of 11 months.Conclusion Although Tunisia belongs to the volvulus belt, the epidemiologic features of sigmoid volvulus are not similar to those reported in the other African countries and tend rather to be similar to those of developed countries. Our results show that the absence of non-operative treatment can be tolerable and surgical management should be advocated as much as possible.

Introduction Le principe des micro-greffes capillaires au cours des alopecies androgenetiques (AAG) consiste a prelever des cheveux de la zone occipitale non androgeno-dependante pour les transplanter avec leur racine dans les zones clairsemees androgeno-dependantes. Nous rapportons ici les complications inflammatoires post-greffe observees au Centre Sabouraud dans les suites de correction d’AAG. Materiel et methodes Etude retrospective des patients ayant consulte entre 2015 et 2021 pour alopecie cicatricielle inflammatoire post-greffe de cheveux. Resultats Dix patients (âge moyen 53 ans) : 8 hommes et 2 femmes, tous greffes pour AAG, representant 0,08 % des consultations du centre. Aucune pathologie du cuir chevelu et aucune dermatose inflammatoire n’etait connue. Sept cas ont ete greffes par FUE et 3 cas par bandelettes FUT. Les complications inflammatoires etaient un lichen plan pilaire (LPP) dans 7 cas, une pustulose erosive du cuir chevelu (PECC) dans 2 cas et une folliculite superficielle dans 1 cas. Le delai moyen d’apparition des symptomes apres la greffe etait 12,4 mois (1 mois–4 ans). La greffe etait sur le vertex (8 cas), frontale (5 cas) ou temporale (3 cas). Les patients qui developpaient un LPP avaient tous une rarefaction des greffons et presentaient un erytheme avec des squames peripilaires au niveau des zones receveuses dans 3 cas. La dermatoscopie etait evocatrice de LPP dans ces 3 cas. La biopsie cutanee a confirme le diagnostic de LPP dans tous les cas. Les 2 patients qui avait une PECC presentaient des lesions pustulo-crouteuses au niveau de la zone receveuse. La dermatoscopie etait tres evocatrice du diagnostic dans 1cas et une histologie a confirme le diagnostic du 2e cas. La densite capillaire apres la greffe etait decevante chez tous les patients avec une estimation de repousse capillaire Discussion La greffe de cheveux est essentiellement pratiquee chez l’homme et la femme comme correction esthetique de l’AAG. Notre serie souligne la rarete des complications inflammatoires avec une nette predominance pour le LPP. Nos patients n’etaient pas porteurs d’un LPP ou d’une PECC avant la greffe. L’interet qui est montre par cette serie est de depister les formes frustes de lichen avant une intervention, d’ou l’interet de l’examen dermatoscopique systematique lors de la consultation preoperatoire afin de deceler la presence d’un eventuel LPP peu symptomatique qui contre-indiquerait la greffe, et en cas de doute de realiser une biopsie avec etude histologique en coupes verticales et horizontales, dans le but de confirmer ou non un LPP. La greffe capillaire pourrait egalement favoriser l’aggravation par effet Koebner d’un LPP fruste a ce jour non depiste. Pour la PECC, le role declenchant des traumatismes locaux est bien etabli et les micro-greffes en font partie.

Hydatid cyst is a parasitic infection caused mainly by Echinococcus granulosus, which is generally considered benign. However, the hepatic hydatid cyst rupture in the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physicians, radiologists, anesthetists, and surgeons). This study describes clinical and paraclinical liver hydatid cyst rupture in the peritoneal cavity and details the appropriate treatment.A retrospective review of clinical records of patients hospitalized in Jendouba Hospital for liver hydatid cyst was performed over 8 years, from January 1, 2012 to December 31, 2019. Fifteen cases of liver hydatid cyst complicated with acute rupture into the abdominal cavity were collected out of 625 hydatid liver cysts. All patients underwent emergency laparotomy allowing conservative unroofing procedure associated with peritoneal lavage and external drainage combined with necessary intensive care measures. Clinical features, therapeutic procedures' details as well as postoperative outcomes are reported. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 20.There were 9 men and 6 women. Patients' age ranged from 14 to 59 years, with an average of 38 years. Two patients were admitted with abdominal trauma. Acute abdominal pain was the most common complaint. Only 1 patient had an anaphylactic shock. Abdominal ultrasonography and computed tomography scan showed discontinuous cyst wall associated to intraperitoneal fluid in all cases. Intraoperatively, the intraperitoneal effusion was clear in 13 cases and purulent in 2. All patients underwent unroofing procedures associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days, and the mean follow-up was 19 months. No case of recurrence was reported among the patients.In endemic areas, rupture of a hepatic hydatid cyst in the abdominal cavity should be considered in every case of acute abdominal pain, especially if associated with anaphylaxis signs. Early management starting in the emergency room is needed to ensure good outcome.

Introduction and importance Hydatid cyst of liver is a disease usually seen in endemic regions. Fistulization into duodenum is one of the most exceptional complications of the hydatid cyst commonly discovered during surgery. This paper aims to present and discuss a rare case of cyst ruptured into the duodenum. This case report has been reported in line with the SCARE criteria 2020. Case presentation A 44-year-old female patient, previously diagnosed with hydatid cyst of liver with deferred care due to the period of COVID 19 containment, presented with the complaints of abdominal pain and fever. Abdominal CT scan showed up a 2 cm multiseptal hydatid cyst in the segment III of the liver with an exovesiculation of 20 cm, communicating with the first duodenum. The patient underwent antrectomy involving the first duodenum and removing the cystoduodenal fistula with a Roux-en-Y anastomosis. She was discharged with full recovery on the postoperative 5th day. Clinical discussion Clinical features of hydatid cyst fistulized into the duodenum are non-specific. There are two pathognomonic symptoms, hydatidemesis and hydatidenteria.Typically, cysto-duodenal fistula is intra-operatively discovered. The CT scan is the most used morphological examination. The presence of air in the cyst should alert for the gastrointestinal fistula formation. Surgical strategies to perform should be tailored to every patient and to intra operative findings. The post-operative morbidity and mortality are underestimated in the literature. Conclusion The fistulization of Hydatid cyst into the duodenum should be evoked in front of any acute abdominal pain whether or not associated with hydatidemesis or hydatidenteria., Highlights • Hepatic hydatid cyst fistulized in the duodenum is a potentially fatal condition with non-specific clinical features. • Hydatidemesis and hydatidosis are the two pathognomonic symptoms. • Fistulized hydatid cyst in the duodenum is often infected and requires urgent surgical management.

Introduction Gallbladder adenomyomatosis is a benign acquired gallbladder disease. It can mimic cancer on radiological findings, leading to a diagnostic dilemma. The management and prognosis of these two gallbladder anomalies are entirely different. Therefore, it is essential to recognize the pathognomonic features of gallbladder adenomyomatosis is in order to accurately diagnose this pathology. This paper presents two encountered cases of gallbladder adenomyomatosis is, their diagnostic modalities as well as the algorithmic approach of their management. These two-case reports have been reported in line with the SCARE Criteria 2020 [1]. Presentation of case Patient-1 was symptomatic. He was explored by an abdominal ultrasound picturing gallbladder wall thickening while the biopsy showed pleomorphic proliferation of inflammatory cells. An examination of the liver with MRI was indicated, showing diffuse parietal thickening with multiple cystic pockets. He underwent laparoscopic cholecystectomy with simple operative follow-up. Patient 2 was asymptomatic, a staging CT scan of acute pancreatitis revealed focal mural thinking of the gallbladder wall. A liver MRI showed an intramural cystic formation in the vesicular fundus. Given the inconclusive imaging results, laparoscopic cholecystectomy was performed. Histological examination confirmed the diagnosis of GA. Discussion Adenomyomatosis is usually asymptomatic. Imaging can confirm the diagnosis of gallbladder adenomyomatosis without the need for invasive procedures such as vesicular biopsy. Histologic examination can also confirm the diagnosis when cholecystectomy is done. High resolution ultra-sound is the most efficient radiological examination. Laparoscopic cholecystectomy is the gold standard for symptomatic GA or radiological suspicion of a gallbladder cancer. Conclusion The practitioner should always consider gallbladder carcinoma before confirming the GA, as they share the same features but with a far worse prognosis. The likelihood of malignancy depends on radiological characteristics. In the case of inconclusive findings, cholecystectomy is justified., Highlights • Gallbladder adenomyomatosis is a frequent but underestimated pathology as it is usually asymptomatic. • The diagnosis is most commonly made post-operatively on histological examination of a cholecystectomy specimen. • Gallbladder adenomyomatosis may mimic cancerous lesions on radiological findings, which leads to a diagnostic dilemma. • Clinical symptomatology as well as the reliability of the radiological diagnosis guide therapeutic management.