Background: Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated... more
Background: Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. Aims: Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. Methods: An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. Results: Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose (evidence level 2, grade recommendation B). Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt , a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% (level evidence 4, recommendation grade C). PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression (evidence level 2, recommendation grade B). The cecostomy is more effective and safer than conventional colostomy (level of evidence 4, recommendation grade C). The cecostomy is highly effective in colonic decompression but associated with a high mortality (level of evidence 4, recommendation grade C). Conclusion: Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression.
Research Interests:
Ovarian adrenal rest tumors (OART) are tumors that develop in females with congenital adrenal hyperplasia (CAH). In contrast to their counterpart in testicles, they are exceptional and few cases have been reported in the literature. In... more
Ovarian adrenal rest tumors (OART) are tumors that develop in females with congenital adrenal hyperplasia (CAH). In contrast to their counterpart in testicles, they are exceptional and few cases have been reported in the literature. In this report, we present clinicopathological findings of a female patient with CAH due to 21-hydroxylase deficiency who was incidentally diagnosed with OART with a review of the literature. The 14-year-old patient, who was raised as a boy, developed a virilizing syndrome with high testosterone levels that were attributed to non adherence to her replacement corticosteroid therapy. She consulted for sex reassignment surgery. Pelvic ultrasound was normal. She underwent hysterectomy and bilateral adnexectomy. No abnormalities were noticed during the operation. Grossly, both ovaries were variegated with well circumscribed and lobulated, brownish-yellow nodules. Histologically, the nodules were composed of nests of large polygonal cells with centrally located nuclei and prominent nucleoli. There was mild atypia and no crystals of Reinke. Thus, the findings of the histopathological examination were consistent with bilateral OART. Histological differential diagnosis of OART can be challenging particularly with leydig cell tumor, stromal luteoma and steroid cell tumors, not otherwise specified. OART must be considered in women with CAH and persistent virilizing symptoms despite negative imaging results.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
La peritonite biliaire lithiasique est une urgence abdominale rare et grave de diagnostic souvent difficile et son pronostic est pejoratif en raison de sa survenue chez des sujets âges et tares. Durant une periode de 21 ans, de 1983 a... more
La peritonite biliaire lithiasique est une urgence abdominale rare et grave de diagnostic souvent difficile et son pronostic est pejoratif en raison de sa survenue chez des sujets âges et tares. Durant une periode de 21 ans, de 1983 a 2003, nous avons collige 39 cas de peritonites biliaires lithiasiques. Elles representent 1,4 % des interventions biliaires colligees au cours de la meme periode d'etude. Les donnees anamnestiques, cliniques et radiologiques ont contribue au diagnostic positif de peritonite dans 24 cas soit 61,5% dont 15 cas des peritonites biliaires llthiasiques soit 38.4%. L'exploration per-operatoire a conclu a une peritonite biliaire generalisee dans 23 cas et localisee dans 16 cas. Cette peritonite etait secondaire a une perforation de l'arbre biliaire chez 22 malades (56.4 %) et par diffusion chez 17 malades (43,5 %). Une lithiase de la voie biliaire principale a ete associee dans 14 cas (35,8%). L'etude histologique a montre une cholecystite gang...
Research Interests:
Research Interests:
Research Interests: Medicine and Gynecology
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... more
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.
Research Interests:
Background Hydatid disease is endemic in Mediterranean countries and most commonly occurs in the liver followed by the lung. A primary localization in the retroperitoneum is extremely rare. Case presentation We report the case of a... more
Background Hydatid disease is endemic in Mediterranean countries and most commonly occurs in the liver followed by the lung. A primary localization in the retroperitoneum is extremely rare. Case presentation We report the case of a 29-year-old Tunisian patient presenting with progressive left flank pain and skin urticaria. On abdominal ultrasonography and computed tomography scan, a ruptured retroperitoneal hydatid cyst was diagnosed, which was confirmed by positive hydatid serology. The treatment consisted of resection of protruding dome. The evolution was favorable. No local recurrence was detected during postoperative follow-up. Conclusions Primary retroperitoneal hydatid cyst is extremely rare and has uncommon presentation, but we should learn the keys to its diagnosis. In endemic regions, high suspicion for this disease is justified regardless of localization.
Research Interests:
Les teratomes ovariens sont des tumeurs germinales considerees comme malignes lorsqu'elles sont de type immature, ils peuvent se compliquer de rupture intraperitoneale, de torsion ou de compression des organes de voisinage.... more
Les teratomes ovariens sont des tumeurs germinales considerees comme malignes lorsqu'elles sont de type immature, ils peuvent se compliquer de rupture intraperitoneale, de torsion ou de compression des organes de voisinage. L'ouverture de cette tumeur dans le tube digestif adjacent en l'occurrence le recto-sigmoide represente une complication rare, voir exceptionnelle. A travers une nouvelle observation de teratome ovarien ouvert dans le sigmoide, nous soulignons les difficultes diagnostiques que peut presenter cette complication et ses modalites therapeutiques.
Research Interests:
Research Interests:
L'insulinome est la plus frequente des tumeurs neuroendocrines pancreatiques Il peut etre a l'origine d'accidents hypoglycemiques majeurs qui peuvent engager le pronostic vital et fonctionnel Son diagnostic est biologique. La... more
L'insulinome est la plus frequente des tumeurs neuroendocrines pancreatiques Il peut etre a l'origine d'accidents hypoglycemiques majeurs qui peuvent engager le pronostic vital et fonctionnel Son diagnostic est biologique. La determination de sa topographie a grandement beneficie des progres de l'imagerie moderne. En rapportant 3 nouvelles observations, nous essayons de proposer une strategie diagnostique et therapeutique adequate de cette affection.
Research Interests:
Research Interests:
Research Interests:
BACKGROUND Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated... more
BACKGROUND Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. AIMS Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. METHODS An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. RESULTS Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first...
summaryBackground: Ogilvie’s syndrome is acute colonic dilatation withoutorganic obstacle in a previously healthy colon. Surgery is the onlytreatment of cases complicated by necrosis or perforation. Incontrast, treatment of uncomplicated... more
summaryBackground: Ogilvie’s syndrome is acute colonic dilatation withoutorganic obstacle in a previously healthy colon. Surgery is the onlytreatment of cases complicated by necrosis or perforation. Incontrast, treatment of uncomplicated forms is not unanimous, and isthe subject of this literature review. aims: Determine the results of different therapeutic methods ofuncomplicated forms of Ogilvie's syndrome in terms of efficiency ofremoval of colonic distension, recurrence, morbidity and mortality.Clarify their respective indications. methods: An electronic literature search in the "MEDLINE"database, supplemented by hand searching on the reference lists ofarticles, was conducted for the period between 1980 and 2012. results: Conservative treatment is effective in 53 to 96% of caseswith a risk of colonic perforation less than 2.5% and a mortality of 0to 14% % (level of evidence 4, recommendation grade C).Neostigmine is effective in 64 to 91% of cases after a first dose...
Research Interests:
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... more
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 colostom...
Research Interests: Adolescent, Humans, Child, Female, Male, and 6 moreAged, Middle Aged, Adult, Retrospective Studies, Colostomy, and Reoperation
Research Interests:
Research Interests: Liver diseases, Caesarean Section, Pregnancy, Humans, Hemodynamics, and 14 moreFemale, Clinical Sciences, Newborn Infant, Adult, Cesarean Section, Multidisciplinary Approach, Early Diagnosis, Pregnancy Outcome, Fetal Heart Rate, Laparotomy, splenic rupture, Fetal Distress, Uterine contraction, and Splenic Artery
ABSTRACT Les tumeurs endocrines digestives ont essentiellement une localisation gastro-intestinale et duodénopancréatique. Les métastases hépatiques y sont fréquentes. La localisation hépatique primitive demeure exceptionnelle. Nous... more
ABSTRACT Les tumeurs endocrines digestives ont essentiellement une localisation gastro-intestinale et duodénopancréatique. Les métastases hépatiques y sont fréquentes. La localisation hépatique primitive demeure exceptionnelle. Nous rapportons une nouvelle observation révélée chez une femme de 66 ans par une masse épigastrique et une altération de l’état général. L’aspect au scanner et à l’examen histologique de la biopsie percutanée était en faveur d’un carcinome hépatocellulaire. C’est l’étude immunohistochimique qui a montré la nature endocrine de la tumeur. Les différents examens endoscopiques et morphologiques, notamment l’octréoscan, ont éliminé toute localisation extra-hépatique, ce qui a permis de retenir l’origine hépatique primitive de la tumeur.
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure.It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains... more
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure.It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains controversial.Its onset is often insidious: an increase in the abdominal perimeter may be the first sign noted.Preoperative diagnosis is facilitated by modern imaging techniques.Ultrasonography and computed tomography provide complementary signs: septa and scalloping of the liver margins, respectively.Effusion in the lesser peritoneal cavity suggests this diagnosis.Magnetic resonance imaging, by showing the gelatinous ascites, their septa and the scalloping of liver and spleen, can strengthen the probability of the diagnosis.Only laparotomy can confirm it, however.Appendectomy is required in all cases.Recurrence is more frequent in the forms associated with malignant or bipolar tumors.Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the only therapy shown to be effective in cases of recurrence or malignant forms.La maladie gélatineuse du péritoine ou pseudo myxome péritonéal est une entité clinique rare, de pathogénie encore obscure.Elle est liée, dans la majorité des cas, à des tumeurs mucineuses appendiculaires. L'origine ovarienne est controversée.Souvent d'installation insidieuse, c'est l'augmentation isolée du périmètre de l'abdomen qui attire l'attention.Son diagnostic préopératoire est facilité par les moyens modernes d'imagerie.La tomodensitométrie et l'échographie apportent des signes radiologiques complémentaires : l'échographie montre mieux les images des cloisons et le scanner davantage les encoches hépatiques.La présence d'un épanchement dans la bourse omentale (arrière-cavité des épiploons) doit faire évoquer le diagnostic.L'imagerie par résonance magnétique, en montrant les masses gélatineuses, le festonnage hépatique et splénique, les septas intra-ascitiques, permettrait d'affirmer le diagnostic.Seule la laparotomie permet de confirmer le diagnostic.L'appendicectomie doit être réalisée systématiquement.Les récidives sont plus fréquentes dans les formes associées à une tumeur maligne ou à une tumeur bipolaire.La chirurgie de réduction tumorale combinée à la chimiothérapie hyperthermique intrapéritonéale est la seule thérapie démontrée efficace lorsqu'il existe une récidive tumorale ou dans les formes malignes.
Research Interests:
Research Interests:
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure. It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains controversial.... more
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure. It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains controversial. Its onset is often insidious: an increase in the abdominal perimeter may be the first sign noted. Preoperative diagnosis is facilitated by modern imaging techniques. Ultrasonography and computed tomography provide complementary signs: septa and scalloping of the liver margins, respectively. Effusion in the lesser peritoneal cavity suggests this diagnosis. Magnetic resonance imaging, by showing the gelatinous ascites, their septa and the scalloping of liver and spleen, can strengthen the probability of the diagnosis. Only laparotomy can confirm it, however. Appendectomy is required in all cases. Recurrence is more frequent in the forms associated with malignant or bipolar tumors. Cytoreductive surgery combined with hyperthermic intraperitoneal chemo...
Research Interests: Magnetic Resonance Imaging, Treatment Outcome, Rare diseases, Humans, Ultrasonography, and 13 moreFemale, Male, Differential Diagnosis, Aged, Middle Aged, Survival Rate, Appendectomy, X ray Computed Tomography, Antineoplastic Agents, Paracentesis, Pseudomyxoma peritonei, Laparotomy, and Combined Modality Therapy
Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not... more
Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence...
Research Interests:
Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption,... more
Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusceptions may warrant surgical intervention. We report a case of 47-year old woman who had suffered from intestinal obstruction for 3 days. The symptoms did not improve after conservative treatment. An exploratory laparotomy found small bowel obstruction due to proximal jejunal diverticulum with an adhesion epiploic band. Strangulation of the jejunum resulted from the internal hernia caused by the band. The band was removed and the proximal jejunum segmentally resected. The postoperative course was uneventful. Although this phenomenon is rare, we should keep in mind that intestinal diverticulosis may induce intestinal obstructions of different kinds, repeat physical examinations and X-ray films are need...
Research Interests:
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure. It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains controversial.... more
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure. It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains controversial. Its onset is often insidious: an increase in the abdominal perimeter may be the first sign noted. Preoperative diagnosis is facilitated by modern imaging techniques. Ultrasonography and computed tomography provide complementary signs: septa and scalloping of the liver margins, respectively. Effusion in the lesser peritoneal cavity suggests this diagnosis. Magnetic resonance imaging, by showing the gelatinous ascites, their septa and the scalloping of liver and spleen, can strengthen the probability of the diagnosis. Only laparotomy can confirm it, however. Appendectomy is required in all cases. Recurrence is more frequent in the forms associated with malignant or bipolar tumors. Cytoreductive surgery combined with hyperthermic intraperitoneal chemo...
Research Interests: Magnetic Resonance Imaging, Treatment Outcome, Rare diseases, Humans, Ultrasonography, and 13 moreFemale, Male, Differential Diagnosis, Aged, Middle Aged, Survival Rate, Appendectomy, X ray Computed Tomography, Antineoplastic Agents, Paracentesis, Pseudomyxoma peritonei, Laparotomy, and Combined Modality Therapy
ABSTRACT Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original... more
ABSTRACT Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in order to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. In this review of the literature of restorative proctocolectomy with ileal pouch-anal anastomosis, we discuss these technical modifications, limiting our discussion to the current points of controversy. The current “hot topics” for debate are: indications for ileal pouch-anal or ileo-rectal anastomosis, indications for pouch surgery in the elderly, indeterminate colitis and Crohn's disease, the place of the laparoscopic approach, transanal mucosectomy with hand-sewn anastomosis vs the double-stapled technique, the use of diverting ileostomy and the issue of the best route for delivery of pregnant women. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with ongoing prospective evaluation of the procedure are required to settle these issues.
Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the... more
Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in order to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. In this review of the literature of restorative proctocolectomy with ileal pouch-anal anastomosis, we discuss these technical modifications, limiting our discussion to the current points of controversy. The current "hot topics" for debate are: indications for ileal pouch-anal or ileo-rectal anastomosis, indications for pouch surgery in the elderly, indeterminate colitis and Crohn's disease, the place of the laparoscopic approach, transanal mucosectomy with hand-sewn anastomosis vs. the double-stapled technique, the use of diverting ileostomy and the issue of the best route for delivery of pregnant women. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with ongoing prospective evaluation of the procedure are required to settle these issues.
Research Interests:
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... more
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.
Duodenal diverticulum is a common occurrence but most are asymptomatic. However, in some cases, they can cause mechanical biliary compression. We report the case of a duodenal diverticulum in a 64-year-old woman revealed by severe... more
Duodenal diverticulum is a common occurrence but most are asymptomatic. However, in some cases, they can cause mechanical biliary compression. We report the case of a duodenal diverticulum in a 64-year-old woman revealed by severe cholangitis with septic shock and a liver abscess. Associated annular pancreas was found. We discuss the various investigations to diagnose these two entities as well as the therapeutic strategy in this unique combination of disease.
Research Interests:
Gastro-intestinal stromal tumors are uncommon mesenchymal tumors. There are localized preferentially in the stomach. The rectal localization is exceedingly rare. Through a new case of rectal stromal tumour as well as a review of the... more
Gastro-intestinal stromal tumors are uncommon mesenchymal tumors. There are localized preferentially in the stomach. The rectal localization is exceedingly rare. Through a new case of rectal stromal tumour as well as a review of the literature, we propose to focus on clinical, radiological and therapeutic particularities of this rare entity.